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The trial that showed taking out one segment of a lung, rather than a whole lobe, is enough for a small peripheral lung cancer, and that the smaller operation leaves people alive longer.
JCOG0802/WJOG4607L randomised 1,106 patients in Japan with a peripheral non-small-cell lung cancer of 2 cm or less to segmentectomy or lobectomy, with overall survival as the primary endpoint and a non-inferiority design. Segmentectomy not only met non-inferiority but was superior for overall survival, which was the surprise: the smaller operation preserves lung function, and the deaths it prevents are from second primary cancers and other causes rather than from the index tumour.
The 2024 supplemental analysis in Lancet Respiratory Medicine looked at the 553 patients (50 percent) whose tumours were radiologically pure-solid, the group thought most likely to need the larger operation. After a median 7.3 years, five-year overall survival was 92.4 percent after segmentectomy against 86.1 percent after lobectomy (hazard ratio 0.64, 95 percent confidence interval 0.41 to 0.97, log-rank p=0.033), with 38 deaths against 55.
Read with CALGB 140503, which randomised 697 patients in North America to sublobar resection or lobectomy and found disease-free survival non-inferior, the two trials moved sublobar resection from a compromise for the unfit to a standard option for small peripheral tumours. What they do not answer is which sublobar operation, segmentectomy or wedge, and how wide a margin.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival at 5 years (radiologically pure-solid subgroup) | Segmentectomy | 279 | 92.4% | 0.64 (0.41 to 0.97) | 0.033 | link |
| Lobectomy | 274 | 86.1% |
Shares Segmentectomy (sublobar resection), Minimally invasive surgery (laparoscopic, robotic, VATS), Lobectomy, Adenocarcinoma of the lung.
Shares Lobectomy, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares Curative intent vs palliative intent, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares STARS and ROSEL pooled analysis, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares Lobectomy, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares Lobectomy, Adenocarcinoma of the lung, Resectable stage I to III non-small-cell lung cancer.
Shares Lobectomy, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares Lobectomy, Adenocarcinoma of the lung.