Sublobar Resection Without Staging and Diagnostic for Tumors <2 cm is no Adequate Therapy for Non-Small Cell Lung Cancer Patients

Abstract Purpose: Sublobar resection is a frequently performed surgical approach for Non-Small Cell Lung Cancer (NSCLC) patients with <2cm nodules. Retrospective studies are claiming that survival rates after sublobar resection are comparable to that after anatomical resection although studies dealing with sublobar resection do not perform guideline-based staging and little to no lymphadenectomy. Methods: 747 patients underwent surgery for NSCLC at our institution between 2012 and 2020. We retrospectively reviewed data of NSCLC patients with <2cm tumors (n=236). Nodal upstaging and lymphangiosis- (L1) and hemangiosis carcinomatosa (V1) were analyzed. pN0 patients were compared to patients with nodal upstaging. One-, three and five-year survival rates were measured. Survival was assessed by Kaplan-Meier curves.Results: Mean tumor size was 1.4cm±0.39 in our cohort. Of our patients, 14% showed a cT1a tumor and 86% of patients cT1b. 24.0±12.3 lymph nodes were dissected and analyzed per patient, and 0.7±2.0 of those were affected. Of our patients, 16.1% showed an L1 affection and 7.6% a V1 affection. Lymph node involvement was diagnosed in 11(4.7%) patients preoperatively. 39(16.5%) patients were upstaged due to lymph node involvement postoperatively (p<0.001). Upstaged patients showed significantly worse 3- (upstaged: 60.6% vs. pN0: 83.2%; p=0.01) and 5-year (upstages: 38% vs. pN0 71.5%; p=0.02) survival rates.Conclusion: Of our patients with <2cm NSCLC 16.5% were nodal upstaged postoperatively. These results underline that lymphadenectomy during surgery is crucial for NSCLC patients irrespective of the tumor size and the surgical approach.