Spread through air spaces-positive T1 lung adenocarcinoma: is lobectomy associated with better outcomes than sublobar resection?

The gold standard for operative management of early-stage, non-small cell lung cancer (NSCLC) is resection by anatomic lobectomy (1). There exists persistent debate, however, regarding the potential for oncologic equivalence of sublobar resections (wedge or segmentectomy) versus lobectomy for small, peripheral, early-stage NSCLC (2). A parenchymal-sparing resection strategy is appealing, particularly for patients with significant comorbidities, or prohibitively poor lung function that would otherwise preclude resection by lobectomy. Attempts to identify the appropriate cohorts of patients for sublobar resection have included risk stratification by a multitude of factors; including tumor size, histologic subtype, and radiographic characterization (e.g., solid versus ground-glass appearance on cross-sectional imaging), among others (3). The pursuit of parenchymal-sparing options remains at the forefront of investigators’ aims to codify oncologic outcomes with extent of surgical resection, yet there persists a lack of certainty regarding which clinicopathologic features contribute to outcome and therefore should be utilized to dictate that operative decision.