Surgery for early lung cancer

Patients

What patients need to know about choosing between removing part or all of a lung lobe

The Bottom Line First

If your surgeon is recommending removing an entire lobe of your lung (called a "lobectomy"), you should ask: "Could a smaller operation remove just the cancerous section and save more of my healthy lung?"

Recent confusion about two major studies is causing some surgeons to remove more lung tissue than necessary.

What's Happening?

Two important studies (called JCOG and CALGB)[1,2] compared two types of lung cancer surgery:

  1. Lobectomy - removing an entire section (lobe) of lung

  2. Sub-lobar - removing just the tumor and surrounding tissue (segmentectomy or wedge resection)

The confusion: Many surgeons think "the studies show lobectomy is better" - but they may be misreading what the studies actually found.

What the Studies Actually Showed

Both studies found that smaller operations resulted in:

  • ✓ Same survival rates as removing the whole lobe

  • ✗ Slightly higher chance of cancer coming back (about 1-1.2% higher over 5-10 years)

  • ✗ No difference in lung function loss on average

The critical problem: The studies only measured average lung function loss across all patients. They didn't measure what really matters for YOU as an individual - how much healthy lung tissue could be saved with a smaller amount of lung removed.

A Real Example

Imagine you have a 2cm tumor at the tip of one lung section:

  • Smaller operation (wedge): Removes about 5% of your lung

  • Removing entire lobe: Removes about 25% of your lung

That's a 20% difference in preserved lung tissue - yet the studies never measured this!

The Trade-Off You Should Understand

Smaller operation:

  • ✓ Saves more healthy lung tissue

  • ✗ About 1-1.2% higher risk of death or recurrence over 5-10 years

Removing entire lobe:

  • ✓ About 1-1.2% lower risk of death or recurrence

  • ✗ Removes more healthy lung tissue

Since survival rates are the similar [1 - 4% difference at 5-10 years respectively for CALBG and JCOG], the choice depends on what matters more to YOU.

Questions to Ask Your Surgeon

  1. "How much of my lung would be removed with each option?"

  2. "For my specific tumor location and size, could a smaller operation save healthy lung tissue?"

  3. "What's the trade-off between preserving my lung function and the small difference in recurrence risk?"

  4. "Are you recommending the bigger operation based on my individual situation or based on average study results?"

Why This Matters Now

Surgeons worldwide are currently debating these studies, and some are changing their practice based on misunderstandings. Don't let averaged research data override what's best for your individual situation.

You deserve a personalized discussion about how much lung could be saved versus the small increased recurrence risk - not a one-size-fits-all approach.

This is a decision that should be made together with your surgeon based on your specific tumor, your lung function, and your priorities - not on misinterpreted average results from clinical trials.

Why choose Professor Eric Lim?

I have extensive experience with single incision keyhole surgery (since 2010) with excellent clinical outcomes, leading on how surgery for lung cancer can be optimally conducted. Much of the advice in global guidelines have been based on my work, that can be tailored to you personally.

Have you or a loved one been diagnosed with early-stage lung cancer? Book a consultation with Professor Eric Lim to explore your surgical options.

References

1. Saji H, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. The Lancet, Volume 399, Issue 10335, 1607 - 1617

2. Altorki et al. Lobar or Sublobar Resection for Peripheral Stage IA Non–Small-Cell Lung Cancer. N Engl J Med 2023;388:489-498