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Removing part of a lobe of the lung rather than the whole lobe. For small peripheral tumours with lymph nodes shown to be clear, two randomised trials found it as good as taking the whole lobe, and it leaves more lung behind.
Lobectomy has been the standard operation for lung cancer since a randomised trial in 1995 found limited resection worse, and two modern trials overturned that for the smallest tumours. JCOG0802/WJOG4607L randomised 1,106 Japanese patients with clinical stage IA non-small-cell lung cancer 2 cm or smaller with a consolidation-to-tumour ratio above 0.5 to lobectomy or anatomical segmentectomy; at a median 7.3 years the 5-year overall survival was 94.3 percent after segmentectomy against 91.1 percent after lobectomy (hazard ratio 0.663, 95 percent confidence interval 0.474 to 0.927), which met both non-inferiority and superiority. CALGB 140503 randomised 697 American patients with clinically T1aN0 tumours of 2 cm or less, after the hilar and mediastinal nodes were confirmed negative during the operation, to sublobar or lobar resection; at a median 7 years disease-free survival was non-inferior (hazard ratio 1.01, 90 percent confidence interval 0.83 to 1.24), 5-year disease-free survival was 63.6 against 64.1 percent, 5-year overall survival 80.3 against 78.9 percent, and 2 percentage points more predicted forced expiratory volume was preserved at 6 months. The two conditions that make the result apply are the same in both trials: a small peripheral tumour, and lymph nodes shown to be clear, which is why systematic nodal staging is part of the operation rather than an optional extra. Spread through air spaces, which cannot be assessed before the specimen is examined, argues the other way.
Showing the technology this term belongs to: SBRT / SABR (stereotactic radiotherapy).
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Shares Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung, Spread through air spaces (STAS), Adenocarcinoma of the lung, Lung cancer (all types) and the tag lung.
Shares Spread through air spaces (STAS), Adenocarcinoma of the lung, Lung cancer (all types), Non-small-cell lung cancer and the tag lung.
Shares Mediastinal lymph node stations, Lung cancer (all types), Non-small-cell lung cancer and the tag lung.
Shares TNM 9: what changed in lung cancer staging, Lung cancer (all types), Non-small-cell lung cancer and the tag lung.
Shares Adenocarcinoma of the lung, Lung cancer (all types), Non-small-cell lung cancer and the tag lung.
Shares Lung cancer (all types), Non-small-cell lung cancer and the tag lung.