Background Recent data have suggested possible oncologic equivalence of sublobar resection with lobectomy for early-stage non–small-cell lung cancer (NSCLC). Our aim was to evaluate and compare short-term and long-term survival for these surgical approaches. Methods This retrospective cohort study utilized the National Cancer Data Base. Patients undergoing lobectomy, segmentectomy, or wedge resection for preoperative clinical T1A N0 NSCLC from 2003 to 2011 were identified. Overall survival (OS) and 30-day mortality were analyzed using multivariable Cox proportional hazards models, logistic regression models, and propensity score matching. Further analysis of survival stratified by tumor size, facility type, number of lymph nodes (LNs) examined, and surgical margins was performed. Results A total of 13,606 patients were identified. After propensity score matching, 987 patients remained in each group. Both segmentectomy and wedge resection were associated with significantly worse OS when compared with lobectomy (hazard ratio: 1.70 and 1.45, respectively, both p < 0.001), with no difference in 30-day mortality. Median OS for lobectomy, segmentectomy, and wedge resection were 100, 74, and 68 months, respectively (p < 0.001). Finally, sublobar resection was associated with increased likelihood of positive surgical margins, lower likelihood of having more than three LNs examined, and significantly lower rates of nodal upstaging. Conclusion In this large national-level, clinically diverse sample of clinical T1A NSCLC patients, wedge and segmental resections were shown to have significantly worse OS compared with lobectomy. Further patients undergoing sublobar resection were more likely to have inadequate lymphadenectomy and positive margins. Ongoing prospective study taking into account LN upstaging and margin status is still needed.

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Thoracic radiation with protons is associated with better survival in this retrospective analysis; further validation in the randomized setting is needed to account for any imbalances in patient characteristics, including positron emission tomography-computed tomography staging.

The baseline performance of NI-RADS was good, demonstrating significant discrimination among the categories 1-3 for predicting disease.

Introduction Questions remain regarding nodal evaluation and upstaging between thoracotomy (open) and Video Assisted Thoracic Surgery (VATS) approaches to lobectomy for early stage lung cancer. Potential differences in nodal staging based on operative approach remains as the final significant barrier to widespread adoption of VATS lobectomy. The current study examines differences in nodal staging between open and VATS lobectomy. Methods The National Cancer Data Base was queried for lung cancer patients with clinical stage ≤T2N0M0 who underwent lobectomy in 2010-2011. Propensity score matching was performed to compare rate of nodal upstaging in VATS vs. open approaches. Additional sub-group analysis was performed to assess whether or not rates of upstaging differed by specific clinical settings. Results A total of 16,983lobectomies were analyzed; 4935 (29.1%) were performed via VATS. Nodal upstaging was more frequent in the open group (12.8 vs. 10.3%; p<0.001). In 4,437 matched pairs, nodal upstaging remained more common for open approaches. For a sub-group of patients whose number of lymph nodes examined was ≥7, propensity matching revealed that nodal upstaging remained more common following open vs. VATS (14.0 vs. 12.1%; p=0.03). However, for patients who were treated in an Academic/Research Facility, the difference in nodal upstaging was no longer significant between an open vs. VATS approach (12.2 vs. 10.5%, p=0.08). Conclusions Nodal upstaging was more frequently observed with thoracotomy compared to VATS for early stage lung cancer. However, nodal upstaging appears to be impacted by facility type, which may represent a surrogate for minimally invasive expertise.