Sublobar resection in high-risk patients for lobectomy: current and future strategy

Scott J Swanson,Daniel P Dolan

doi:10.20517/2574-1225.2020.101

Abstract

Surgical resection by lobectomy is the gold standard of therapy for early stage non-small cell lung cancer. However, not all patients are medically fit to undergo surgery. In patients considered high-risk for lobectomy, alternative strategies have been developed including radiofrequency ablation, cryoablation, microwave ablation, stereotactic radiation therapy, wedge resection, and segmentectomy. This work reviews the definition of high-risk, and the outcomes that have been associated with each treatment technique. Some technical points regarding wedge resection versus segmentectomy are noted. Future directions are discussed in the context of treatment for patients considered at high-risk for lobectomy.

Highlights

This work is intended to review the current literature surrounding the definition of a patient with lungcancer who is considered high-risk for lobectomy, discuss different treatment modalities and their outcomes for these patients, and note some potential future directions and their benefits to high-risk patients
Technical aspects of wedge resection and segmentectomy are discussed for high-risk patients, and future directions of lung cancer treatment that could benefit high-risk patients are noted
One of the most used definitions for high-risk patients come from the American College of Surgeons Oncology Group (ACOSOG) Z4032 trial of stage I non-small cell lung cancer (NSCLC), with tumors ≤ 3 cm, that focused on clinical details to define high risk[1]

Summary

Introduction

This work is intended to review the current literature surrounding the definition of a patient with lungcancer who is considered high-risk for lobectomy, discuss different treatment modalities and their outcomes for these patients, and note some potential future directions and their benefits to high-risk patients. Technical aspects of wedge resection and segmentectomy are discussed for high-risk patients, and future directions of lung cancer treatment that could benefit high-risk patients are noted. The study focused on Stage I NSCLC and, in their sub-analysis of patients who underwent sublobar resection, reported shorter operative time in the high-risk group vs standard risk group, median 89.0 min (range 64.0-110.0) vs 112.5 min (74.0-145.5), P = 0.04; but longer length of stay, median 4 days (3-7) in the high risk group vs median 3 days (2-5) in the standard risk group, P = 0.003.

Results

Conclusion