J.Jpn. Surg. Soc.. 125(4): 325-332, 2024

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Feature topic

SUBLOBAR RESECTIONS FOR SMALL-SIZED LUNG CANCER

Results from large prospective trials, including Japan Clinical Oncology Group (JCOG) 0802/West Japan Oncology Group (WJOG) 4607L, have demonstrated the significant role of sublobar resection as an intensive indication for small-sized peripheral non-small cell lung cancer. The indications for sublobar resection in these cases are increasing. Since the concept of wedge resection and segmentectomy is distinctly different, it is crucial to fully understand each surgical technique to select the appropriate procedure. The key factors include surgical margins, lymph node dissection, and patient background. For radiologically solid-dominant tumors on high-resolution computed tomography, anatomical segmentectomy with hilar and mediastinal lymph node dissection should be selected. Conversely, for ground glass opacity-dominant tumors, wedge resection or segmentectomy (where lymph node dissection may not be necessary) should be chosen to ensure an appropriate surgical margins. Given the proven contribution of parenchymal preservation to survival, general thoracic surgeons should strive to minimize lung parenchymal resection by improving assessment methods, surgical techniques, and developing new modalities, thereby allowing more patients to benefit from sublobar resection.

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