To compare the outcomes between sublobar resection and lobectomy for T1 non-small cell lung cancer(NSCLC)(tumor diameter ≤3 cm).

The clinical data of 278 patients with T1 NSCLC undergoing surgery in Department of Thoracic Surgery in China-Japan Friendship Hospital between January 2007 and December 2014 were collected. The mean age of these patients was (60.7±10.4) years. Sixty-one patients received sublobar resection(wedge resection, n=35; segmentectomy, n=26), and the other 217 underwent lobectomy. There was 81.7% of adenocarcinoma, 12.9% of squamous cell carcinoma, and 5.4% of cancer of other types. High differentiated, moderate differentiated and poor differentiated cancer accounted for 8.6%, 27.0% and 20.5%, respectively, and there were 43.9% cases with undermined differentiation status. In cases of adenocarcinoma, there were 4.0% preinvasive lesions, 7.5% minimally-invasive lesions and 88.5% invasive adenocarcinoma. There were 86.7% cases with T1N0M0, 1.1% cases with T1N1M0 and 12.2% cases with T1N2M0.

Compared with lobectomy group, patients were much elder, the duration of operation was much shorter, and the percentage of lesion≤2 cm was significantly larger in sublobar resection group(t=0.496, P=0.009; t=8.082, P=0.029; χ²=2.105, P=0.002). There was no significant difference in forced expiratory volume in one second(FEV₁), FEV₁%, surgical procedure and incidence of postoperative complications between two groups(t=0.065, P=0.713; t=2.12, P=0.085; χ²=0.399, P=0.274; χ²=0.438, P=0.490). For NSCLC patients with T1N0M0, the 5-year survival of sublobar resection group and lobectomy group were 73.9% and 83.5%, respectively, with no significant difference(P=0.883). In sublobar resection group, the 5-year survival of patients undergoing wedge resection and segmentectomy were 79.4% and 70.6%, respectively, with no significant difference(P=0.979). Multivariate analysis indicated that only age and mediastinal lymph node metastasis N2 were risk factors for poor prognosis(HR=1.07, P=0.048; HR=5.56, P=0.011). There was no significant difference in 5-year survival between sublobar resection group and lobectomy group(HR=1.38, P=0.552).

For NSCLC patients with T1N0M0, though sublobar resection can not totally substitute lobectomy, it may become a main surgical procedure for senior patients with poor pulmonary reserve.