Comparative effectiveness of lobectomy and sublobar resections in early-stage non-small cell lung cancer: A systematic review and meta-analysis

Abstract

Relevance: Non-small cell lung cancer (NSCLC) remains one of the leading causes of cancer-related mortality despite significant advances in diagnostic and therapeutic approaches. Anatomical lobectomy is traditionally considered the “gold standard” for stage I NSCLC, but the increasing detection of small-sized tumors through screening programs has renewed interest in sublobar resections.
The study aimed to compare the efficacy and safety of lobectomy versus sublobar resections (segmentectomy and wedge resection) in patients with early-stage non-small cell lung cancer.
Methods: The meta-analysis was conducted following the PRISMA and AMSTAR guidelines. Literature was searched across PubMed, Embase, Cochrane Library, Scopus, Web of Science, and other databases for studies published between 2010 and 2024. Eligible studies included adult patients with stage I NSCLC undergoing either lobectomy or sublobar resection, with reported oncological or perioperative outcomes. Statistical analysis was performed using RevMan 5.4. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated; heterogeneity was assessed using the I² statistic.
Results: Twelve studies comprising 17,454 patients were included; 13,692 underwent lobectomy, and 3,762 received sublobar resection. No statistically significant difference in recurrence rates was found (RR=0.92; 95% CI: 0.65-1.31; p=0.66), although heterogeneity was substantial (I²=87%). The risk of postoperative complications was significantly higher after lobectomy (RR=1.22; 95% CI: 1.08-1.37; p<0.01; I²=0%). Five-year overall survival favored lobectomy (RR=1.08; 95% CI: 1.00-1.17; p=0.05), with high
heterogeneity (I²=91%).
Conclusion: Sublobar resections demonstrate comparable oncological outcomes to lobectomy in selected patients with tumors ≤2 cm, no signs of invasion, and reduced physiological reserve. These findings support the importance of an individualized surgical approach. Further multicenter randomized trials are warranted to confirm oncological equivalence and define clinical indications.