Sublobar Resection Or Lobectomy for Stage 1a Non-Small Cell Lung Cancer: a Meta-Analysis

Abstract

Background For patients with stage 1a non-small cell lung cancer (NSCLC), an increasing number of studies have evaluated how the outcomes of sublobar resections (segmentectomy and wedge resections) compare with lobectomy, the traditional surgical approach. This systematic review and metaanalysis combines estimates from both randomised and observational cohort studies to determine whether lobectomy or sublobar resection results in improved outcomes for patients with stage 1a NSCLC. Methods A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search using PubMed, Cochrane library and Web of Science was performed. Studies comparing lobectomy against sublobar resection for clinically diagnosed NSCLC stage 1a, with tumour diameter <2cm, were included. Quality of included studies was assessed by the ROB2 or ROBINS1 tools. PROSPERO registration number: CRD42023443965. Results After reviewing results against the eligibility criteria, 19 studies were included for analysis, including four RCTs. Overall survival at 5 years following lobectomy and sub-lobar resection for stage 1a NSCLC are equivocal (HR=0.99, 95% CI=0.87, 1.12], p=0.85). Disease-free survival at five years is also similar between the two surgical approaches (HR=1.06, 95% CI=0.91, 1.23], p=0.48). However sublobar resection is associated with higher rates of local disease recurrence (OR=1.86, 95% CI=1.07, 3.25], p=0.03). No difference was found for 10-year survival (OR=0.99, 95% CI=0.27, 3.59], p=0.99) or post-operative reduction in forced expiratory volume in one second (Mean Difference = -4.70, 95% CI=- 11.15, 1.76], p=0.15). Conclusion This study has shown that survival at five and 10 years following lobectomy and sub-lobar resection for stage 1a NSCLC are equivocal. Disease-free survival at five years is also similar between the two surgical approaches, however sublobar resection is associated with higher rates of local disease recurrence. Longer follow-up and patient reported outcomes should the priorities for future research.