Limited Resection for Lung Cancer: Current Role

Sublobar resection for lung cancer-whether non-anatomic wedge resection or anatomic segmentectomy has been performed for many decades. That it has never become a mainstream strategy for treating primary lung cancer is mainly due to evidence from the late 20th Century demonstrating that it offers inferior results compared to conventional lobectomy in terms of survival and loco-regional recurrence rates. In recent years, however, emerging clinical evidence has begun to suggest otherwise. In selected patients with small tumors up to 2 cm diameter located in the periphery of the lung, it has been shown that survival after sublobar resection may approach that of postlobectomy. More importantly, the latest revisions to the adenocarcinoma classification system has further helped to identify candidates for sublobar resection with tumors showing radiological features of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) being associated with potentially good outcomes after this type of surgery. The refinement of criteria to select patients that may benefit from sublobar resection has helped fuel the current resurgence of interest. Recent evidence has been less successful at demonstrating that sublobar resection delivers less morbidity than lobectomy. However, such comparison with lobectomy may not be the point. Current evidence simply does not support sublobar resection as a competitor to lobectomy as routine management for lung cancer. Instead, sublobar resection has been proven to be safe and feasible in patients who may not be candidates at all for lobectomy. In that sense, the role of sublobar resection may be to offer the hope of resectional therapy to selected patients who would otherwise have been denied surgery.