Surgical therapy for stage I lung cancer - lobar versus sublobar resection

Lung cancer is a leading cause of cancer-related mortality, but advances in screening and early detection have improved opportunities for curative treatment. Therapeutic intent surgical resection remains a cornerstone for managing clinical stage IA disease. However, the optimal extent of surgical resection in this population has been a subject of ongoing debate. This review, guided by an introductory case-based vignette, provides a primer on the technical aspects of resection, pretreatment patient-level factors underlying decision-making, and other determinants of outcomes that may influence decisions to pursue lobar versus sublobar resection. We then offer a critique of the evidence base, focusing on the results of four randomized controlled trials: the Lung Cancer Study Group, DRKS00004897, JCOG0802/WJOG4607L, and CALGB140503. Following an interpretation of the available evidence, the review highlights contemporary practice patterns and the challenges of preference-based decisions. Finally, evidence gaps are highlighted as opportunities for future study to improve patient outcomes and experiences.