Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer

Nasser Altorki, Xiaofei Wang, David Kozono, Colleen Watt, Rodney Landrenau, Dennis Wigle, Jeffrey Port, David R. Jones, Massimo Conti, Ahmad S. Ashrafi, Moishe Liberman, Kazuhiro Yasufuku, Stephen Yang, John D. Mitchell, Harvey Pass, Robert Keenan, Thomas Bauer, Daniel Miller, Leslie J. Kohman, Thomas E. StinchcombeEverett Vokes

Research output: Contribution to journalArticlepeer-review


Background: The increased detection of small-sized peripheral non-small-cell lung cancer (NSCLC) has renewed interest in sublobar resection in lieu of lobectomy. Methods: We conducted a multicenter, noninferiority, phase 3 trial in which patients with NSCLC clinically staged as T1aN0 (tumor size, ≤2 cm) were randomly assigned to undergo sublobar resection or lobar resection after intraoperative confirmation of node-negative disease. The primary end point was disease-free survival, defined as the time between randomization and disease recurrence or death from any cause. Secondary end points were overall survival, locoregional and systemic recurrence, and pulmonary functions. Results: From June 2007 through March 2017, a total of 697 patients were assigned to undergo sublobar resection (340 patients) or lobar resection (357 patients). After a median follow-up of 7 years, sublobar resection was noninferior to lobar resection for disease-free survival (hazard ratio for disease recurrence or death, 1.01; 90% confidence interval [CI], 0.83 to 1.24). In addition, overall survival after sublobar resection was similar to that after lobar resection (hazard ratio for death, 0.95; 95% CI, 0.72 to 1.26). The 5-year disease-free survival was 63.6% (95% CI, 57.9 to 68.8) after sublobar resection and 64.1% (95% CI, 58.5 to 69.0) after lobar resection. The 5-year overall survival was 80.3% (95% CI, 75.5 to 84.3) after sublobar resection and 78.9% (95% CI, 74.1 to 82.9) after lobar resection. No substantial difference was seen between the two groups in the incidence of locoregional or distant recurrence. At 6 months postoperatively, a between-group difference of 2 percentage points was measured in the median percentage of predicted forced expiratory volume in 1 second, favoring the sublobar-resection group. Conclusions: In patients with peripheral NSCLC with a tumor size of 2 cm or less and pathologically confirmed node-negative disease in the hilar and mediastinal lymph nodes, sublobar resection was not inferior to lobectomy with respect to disease-free survival. Overall survival was similar with the two procedures.

Original languageEnglish (US)
Pages (from-to)489-498
Number of pages10
JournalNew England Journal of Medicine
Issue number6
StatePublished - 2023


  • Hematology/Oncology
  • Lung Cancer
  • Pulmonary/Critical Care
  • Pulmonary/Critical Care General
  • Surgery
  • Surgery General
  • Treatments in Oncology

ASJC Scopus subject areas

  • General Medicine


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