Lobectomy offers higher incidence of up-staging in patients with T1a-c non-small cell lung carcinomas: Is completion lobectomy necessary?

Gizem Özçıbık Işık; Burcu Kılıç; Ezel Erşen; Mehmet K Kaynak; Hasan V Kara; Akif Turna

doi:10.5114/kitp.2025.158036

Lobectomy offers higher incidence of up-staging in patients with T1a-c non-small cell lung carcinomas: Is completion lobectomy necessary?

Kardiochir Torakochirurgia Pol. 2025 Dec 17;22(4):241-248. doi: 10.5114/kitp.2025.158036. eCollection 2025 Dec.

Authors

Gizem Özçıbık Işık¹, Burcu Kılıç², Ezel Erşen², Mehmet K Kaynak², Hasan V Kara², Akif Turna²

Affiliations

¹ Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey.
² Department of Thoracic Surgery, School of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey.

Abstract

Introduction: Completion lobectomy is defined as the excision of the remaining lobe following a previous sublobar resection. While it is considered a salvage option in selected cases, its impact on nodal staging and overall survival remains unclear in patients with early-stage non-small cell lung cancer (NSCLC).

Aim: This study aimed to evaluate the effect of completion lobectomy on nodal upstaging and overall survival in patients with T1a-c NSCLC.

Material and methods: A retrospective analysis was conducted on 477 patients with pathologically confirmed NSCLC and tumor size ≤ 3 cm, who underwent sublobar resection (n = 45), lobectomy (n = 270), or completion lobectomy (n = 117) between 2001 and 2023. Patients were stratified into subgroups based on tumor size: 0-2 cm (T1a,b) and 2-3 cm (T1c). Clinical, surgical, and pathological parameters, as well as survival data, were compared among groups.

Results: The lobectomy group demonstrated significantly higher rates of N1 nodal involvement compared to the sublobar group (p < 0.001). The VATS approach and N0 status were more common in the sublobar resection group (p < 0.001). Perineural, lymphatic, and vascular invasion were significantly less frequent in the sublobar group (p = 0.001, p = 0.032, and p = 0.004, respectively). No significant difference in overall survival was observed among surgical groups (p = 0.164); however, lobectomy yielded better survival in T1a,b tumors (p = 0.037). Nodal status, perineural invasion, and stage were independent predictors of survival (p = 0.002 and p = 0.02).

Conclusions: Lobectomy results in higher pathological upstaging in cT1N0M0 NSCLC. Completion lobectomy is feasible and safe when nodal upstaging occurs following segmentectomy, though it may not confer a survival advantage in cT1aN0 cases.

Keywords: completion lobectomy; non-small cell lung cancer; sublobar resection; up-staging.

Copyright: © 2025 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).