Sublobar resection is equivalent to lobectomy for T1a non–small cell lung cancer in the elderly: a Surveillance, Epidemiology, and End Results database analysis

Background: Anatomic lobectomy with mediastinal lymph node dissection is considered the optimal management for early stage non–small cell lung cancer (NSCLC). Limited lung resection may be preferable in the elderly population, who are more likely to have poor pulmonary reserve and multiple comorbidities. Our primary objective was to compare the survival of patients aged ≥75 y who underwent sublobar resection or lobectomy for stage IA NSCLC. Materials and methods: We queried the Surveillance, Epidemiology, and End Results database for patients aged ≥75 y who were diagnosed with stage IA NSCLC from 1998–2007. Patients were divided into three groups based on the type of surgery performed (wedge resection, segmentectomy, and lobectomy). Kaplan–Meier analysis and Cox proportional hazard model were used for survival analysis. Results: A total of 1640 patients were analyzed. Lobectomy was performed in 1051 patients, 119 underwent segmentectomy, and 470 patients had wedge resection. Overall and cancer-specific survival were significantly lower in the wedge resection group as compared with those in lobectomy (P < 0.05). However, for T1a tumors, no significant difference was found in risk adjusted 5-y cancer-specific survival for patients who underwent wedge resection, segmentectomy (hazard ratio, 1.009; 95% confidence interval 0.624–1.631; P = 0.972), or lobectomy (hazard ratio, 0.98; 95% confidence interval, 0.691–1.388; P = 0.908). Conclusions: Sublobar resection is not inferior to lobectomy for T1a N0 M0 NSCLC in the elderly and should be considered a viable alternative in this high-risk population.