New Research on Limited Resection vs. Lobectomy Advances Standard of Care for Early-Stage Lung Cancers

Hackensack University Medical Center expert discusses key publications on early-stage lung cancer surgery approaches

For 30 years, thoracic surgeons haven’t had much data on limited resection compared to lobectomy for small, peripheral non-small-cell lung cancers (NSCLC). A paper published by Ginsberg, et al., in 1995, suggested that lobectomy was the “procedure of choice” for early-stage NSCLC due to higher death and recurrence rates associated with limited lung resections — effectively establishing lobectomy as the standard of care for many years.

However, a recent groundbreaking paper titled “Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer,” published in The New England Journal of Medicine by Altorki, et al., in February 2023, shed new light on the subject, showing that segment or wedge resections in selected patients have similar outcomes to lobectomy.

“At the time when the Ginsberg study was conducted in the ‘90s, PET scans were not available, CT scans were not readily available, and minimally invasive and robotic surgical technology had not yet been developed,” said Nabil P. Rizk, M.D., chief of Thoracic Surgery and Co-Director of Thoracic Oncology at Hackensack University Medical Center’s John Theurer Cancer Center. “Now, with access to these technologies, our anecdotal data has shown that we can safely recommend less-extensive procedures for select patients whose cancers are less aggressive based on imaging correlates, biopsy findings and likelihood of lymph involvement — and now we have new research that builds on the Ginsberg study and backs up our data.”

The Altorki paper reported the results of a prospective, randomized study conducted from 2007 to 2017. The study randomized 697 patients with early-stage tumors in the outer third of the lung to either a lobectomy or a limited (segment or wedge) resection and measured the five-year disease-free and overall survival rates, as well as other outcomes.

Dr. Rizk said the Altorki study plays a critical role in advancing the standard of care for early-stage lung cancers — particularly as lung cancer screening becomes more widely adopted and the number of cancers identified early is expected to increase.

However, Dr. Rizk said more research is needed to answer additional questions — such as how segmentectomy and wedge resection stack up in terms of overall and disease-free survival, recovery time and pulmonary function, and which type of limited resection is better for deeper lesions.

“Wedge resection is appropriate for several cancer types, and half of our wedge resection patients go home the same day,” said Dr. Rizk. “Compared to a wedge, a segmentectomy is also a more challenging procedure for the surgeon — maybe even more challenging than a lobectomy, even with robotic technology — which might make a surgeon more reluctant to perform that procedure if outcomes are similar. By looking at subsets of groups, thoracic surgeons may be able to understand the reasons why a surgeon is choosing to perform a segmentectomy versus a wedge.”

But perhaps most importantly, Dr. Rizk said this study underscores the importance of lung cancer screening.

“When we catch lung cancer early through screening, we can safely perform less-extensive resections with outstanding outcomes — but if a patient already has a large tumor and is showing symptoms, a more extensive resection is their only option,” said Dr. Rizk.

Learn more about innovative pulmonary and thoracic surgery care at Hackensack University Medical Center.