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Editorials: POINT/COUNTERPOINT EDITORIALS |

Point: Are Limited Resections Appropriate in Non-small Cell Lung Cancer? YesLimited Resections for NSCLC? Yes

Jessica S. Donington, MD
Author and Funding Information

From the Department of Cardiothoracic Surgery, NYU School of Medicine.

Correspondence to: Jessica S. Donington, MD, Department of Cardiothoracic Surgery, NYU School of Medicine, 530 First Ave, Ste 9V, New York, NY 10016; e-mail: Jessica.Donington@nyumc.org


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(3):588-590. doi:10.1378/chest.11-3108
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Extract

Sublobar resection has always been a surgical option for the medically high-risk patients who lack the pulmonary reserve for formal lobectomy. The more controversial issue is the role of sublobar resection for medically fit patients who could tolerate lobectomy. The 1995 publication of the Lung Cancer Study Group’s (LCSG’s) prospective randomized trial of lobectomy vs limited resection for stage IA non-small cell lung cancer (NSCLC)1,2 solidified lobectomy as the standard of care for resection in patients with early-stage disease for the past 15 years. It was a well-conceived and well-executed trial. The stated conclusions were an increased risk for local/regional recurrence and associated reduced 5-year mortality, without evidence for pulmonary function preservation in patients undergoing sublobar resection.1 It disproved earlier speculation that sublobar resection had comparable outcome to lobectomy. In the 2 decades since the trial, there has been an explosion in radiographic technology and significant advances in our understanding of the biology of NSCLC. Refinement of spiral CT imaging has dramatically improved the diagnosis and staging of NSCLC. Enhanced spatial resolution has increased the detection of subcentimeter nodules and ground-glass opacities (GGOs). CT screening initiatives have also helped to create a growing cohort of patients with smaller and more indolent tumors than what was assessed by the LCSG. This coincided with a growing population of older patients with significant medical comorbidities that preclude larger operations. These serve as primary reasons for the resurgence of interest in sublobar resections for the treatment of NSCLC.

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