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Semin Respir Crit Care Med
DOI: 10.1055/a-2649-9277
Review Article

Surgical Therapy for Stage I Lung Cancer—Lobar Versus Sublobar Resection

Sarah Rudasill
1   Department of Surgery, University of Washington, Seattle, Washington
,
Farhood Farjah
1   Department of Surgery, University of Washington, Seattle, Washington
› Author Affiliations
Funding U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute (grant no.: F32CA290759 [PI: S.R.])
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Abstract

Lung cancer is a leading cause of cancer-related mortality, but advances in screening and early detection have improved opportunities for curative treatment. Therapeutic intent surgical resection remains a cornerstone for managing clinical stage IA disease. However, the optimal extent of surgical resection in this population has been a subject of ongoing debate. This review, guided by an introductory case-based vignette, provides a primer on the technical aspects of resection, pretreatment patient-level factors underlying decision-making, and other determinants of outcomes that may influence decisions to pursue lobar versus sublobar resection. We then offer a critique of the evidence base, focusing on the results of four randomized controlled trials: the Lung Cancer Study Group, DRKS00004897, JCOG0802/WJOG4607L, and CALGB140503. Following an interpretation of the available evidence, the review highlights contemporary practice patterns and the challenges of preference-based decisions. Finally, evidence gaps are highlighted as opportunities for future study to improve patient outcomes and experiences.

Keywords

non-small-cell lung cancer - surgical resection - lobectomy - sublobar resection - randomized controlled trials

Note

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.




Publication History

Accepted Manuscript online:
07 July 2025

Article published online:
30 July 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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