Sublobar resection versus lobectomy for stage IA non-small-cell lung cancer: A systematic review and meta-analysis of randomized controlled trials

Surgical resection is the first-line treatment for early-stage lung cancer, with lobectomy being the standard choice since the 1960s. Nevertheless, recent studies have shown controversies about whether sublobar resection or lobectomy is the optimal surgical approach today. In this sense, this meta-analysis aims to compare these techniques. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing sublobar resection with lobectomy for stage IA non-small-cell lung cancer (NSCLC) and reporting any of the following outcomes: (1) Overall survival (OS); (2) disease-free survival (DFS); and (3) total disease recurrences. Sublobar resection encompassed wedge resection and segmentectomy techniques. A total of 1975 patients from four studies were included, of whom 978 (49.5%) underwent sublobar resection and 973 (49.3%) were male. All tumors were smaller than 2 cm. Follow-up ranged from 5 to 7.3 years. Mean age was 62.8 +/- 37.0 years, and 1353 (68.5%) patients had a known smoking history. OS (HR 0.79; 95% CI 0.60-1.05; p = 0.11) and DFS (HR 1.02; 95% CI 0.86-1.22; p = 0.80) did not significantly differ between the sublobar resection and lobectomy groups. Similarly, no significant statistical difference was observed in total disease recurrences (RR 1.17; 95% CI 0.93-1.46; p = 0.17). Subgroup and isolated sublobar resection techniques analyses were not possible due to the lack of data. Sublobar resection and lobectomy have similar OS, DFS, and disease recurrence rates for stage IA NSCLC. These findings underline the need for new RCTs investigating these outcomes in specific patient subgroups and isolated sublobar resection techniques.