Sublobar Resection With Adequate Margin is Comparable to Lobectomy in Locoregional Recurrence

OBJECTIVES: Although sublobar resection is a standard treatment for small peripheral non-small-cell lung cancer (NSCLC), the optimal margin distance remains under investigation. This study aimed to determine the adequacy of commonly used margin distances by comparing locoregional recurrence (LRR) with lobectomy. METHODS: We retrospectively reviewed data from patients with completely resected ≤3 cm adenocarcinoma, squamous cell carcinoma, or adenosquamous cell carcinoma treated between April 2018 and March 2024. We compared sufficient and insufficient margin sublobar resection and lobectomy in terms of freedom from LRR (FLRR) rate and the cumulative risk of LRR. RESULTS: Of the 528 included patients, 200 underwent sublobar resection and 328 underwent lobectomy. After excluding 23 patients with pure ground-glass nodules, 505 patients with 19 LRR events were included in the prognostic analysis. In the overall cohort, LRR risk was worse in the insufficient margin group than in the sufficient margin and lobectomy groups, whereas the risk in the sufficient margin group was similar to the lobectomy groups (5-year FLRR: 75.1% vs 95.9% vs 95.8%, respectively). Conversely, in the pure-solid cohort, the risk of LRR was worse in the insufficient margin group and even in the sufficient margin group, compared to the lobectomy group. CONCLUSIONS: Among patients with completely resected ≤3 cm NSCLC, our study indicated that those who underwent sublobar resection with a sufficient margin achieved better local control than those with an insufficient margin, and sublobar resection with a sufficient margin was comparable to lobectomy. However, for pure-solid nodules, conventional margin distance might be insufficient. CLINICAL REGISTRATION NUMBER: UMIN Clinical Trials Registry: Registration number: UMIN000058449. https://center6.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000066821.