Surgery that removes only a portion of one of the five lobes that comprise a lung is as effective as the traditional surgery that removes an entire lobe for certain patients with early-stage lung cancer, according to results of a phase 3 multicenter clinical trial sponsored by the Alliance for Clinical Trials in Oncology, an NCI-supported clinical trials network. The trial team was led by Dr. Nasser Altorki, chief of the Division of Thoracic Surgery at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center, and co-investigators from Duke University as well as investigators from 83 hospitals across the United States, Canada and Australia.
In the trial, reported Feb. 8 in the New England Journal of Medicine, the investigators compared outcomes for nearly 700 patients with early-stage lung cancer, about half of whom were randomly assigned to “lobectomy” surgery, which removes the whole lobe, while the other half had “sublobar resection” surgery, which removes part of the affected lobe. Over a median follow-up period of seven years after surgery, the two groups did not differ significantly in terms of disease-free or overall survival, and the sublobar group had modestly better lung function.
Lobectomy has been the standard approach for early-stage lung cancer surgery for almost 30 years, but the study’s results indicate that a subset of early-stage lung cancer patients would be better off, or at least no worse, with the more tissue-conserving sublobar surgery.
“This is a practice-changing study,” said study chair and lead author Dr. Altorki, who is also the David B. Skinner, M.D. Professor of Thoracic Surgery at Weill Cornell Medicine and a cardiothoracic surgeon at NewYork-Presbyterian/Weill Cornell Medical Center.
Worldwide, lung cancers are diagnosed in more than two million people, and nearly as many die of the disease, each year. The vast majority of cases fall into the category known as non-small cell lung cancer (NSCLC), which in its earliest stage—small and localized—is often treated with surgery alone.
An influential 1995 clinical study compared lobectomy to sublobar surgery in patients with early-stage lung cancer and found much worse outcomes in the sublobar group—triple the rate of tumor recurrence and 50 percent higher mortality. That established lobectomy as the standard surgical approach for the disease.
However, since the 1990s, major improvements in imaging and determining the stage of the cancer have led to increased detection of smaller, early-stage lung tumors, prompting some clinicians to question whether lobectomy is best for such cases. A trial in early-stage lung cancer patients in Japan, published last year, found that a sublobar technique called segmentectomy had comparable outcomes to standard lobectomy, and even brought a modestly better chance of overall survival.