Is sublobar resection a valid option for radiologically pure-solid clinical stage IA non-small cell lung cancer?: insights from real-world data and current status.

[OBJECTIVES] We aimed to evaluate the oncologic outcomes of sublobar resection (SLR) compared with lobectomy in patients with radiologically pure-solid stage IA non-small cell lung cancer (NSCLC).

[METHODS] We retrospectively reviewed 363 patients with clinical stage IA pure-solid NSCLC who underwent curative-intent resection between 2018 and 2020. Patients were divided into SLR (n = 60) and lobectomy (n = 303) groups. Kaplan-Meier analysis was used to estimate overall survival (OS) and recurrence-free survival (RFS), and Cox regression identified prognostic factors. Subgroup analyses were performed for stage IA2 and IA3 patients.

[RESULTS] In the overall cohort, the SLR group had significantly worse 5-year OS (75.5 % vs. 93.3 %, p < 0.01) and RFS (58.3 % vs. 77.4 %, p < 0.01) compared with lobectomy. In stage IA2, OS was comparable (87.2 % vs. 91.7 %, p = 0.1), but RFS was inferior after SLR (65.9 % vs. 81.2 %, p = 0.02). In stage IA3, both OS (54.3 % vs. 94.4 %, p < 0.01) and RFS (40.6 % vs. 74.9 %, p < 0.01) were markedly worse after SLR. Segmentectomy showed outcomes similar to lobectomy in IA2 but was inferior in IA3, whereas wedge resection was consistently associated with poor survival.

[CONCLUSIONS] Lobectomy remains the standard surgical procedure for pure-solid stage IA NSCLC, particularly IA3 disease. Segmentectomy may be considered in carefully selected IA2 patients, while it is advisable to avoid wedge resection. These findings emphasize the importance of selecting the most appropriate patients for SLR and support the need for prospective validation.