Optimal resection strategies for small-size lung cancer: Is a wedge enough? Is lobectomy too much?

Recently published large multi-center prospective clinical trials have demonstrated that sublobar resection is non-inferior to the traditional treatment of choice, lobectomy, for peripherally-located early stage lung cancer. Most clinical trials and several retrospective studies to date have used the consolidation to tumor ratio to define the indication for sublobar resection, as it is well known that the size of the solid portion seen on high resolution computed tomography is highly correlated with pathologic invasiveness. However, it is difficult to accurately predict pathologic features that may increase the risk of locoregional recurrence, such as specific adenocarcinoma subtypes or spread through air spaces, based on imaging characteristics alone, and the location of the nodule should also be considered as one of the important factors to obtain an adequate parenchymal resection margin. In this article, we summarized the results of the most recently published clinical trials related to sublobar resection and discuss various factors that should be considered for optimal candidate selection for sublobar resection.