{
  "abstract": "Background This systematic review and meta-analysis synthesises evidence from both randomised trials and observational studies to determine whether lobectomy or sublobar resection offers improved outcomes for patients with stage Ia non-small cell lung cancer (NSCLC).Methods Studies (up to June 2025) comparing lobectomy and sublobar resection (segmentectomy or wedge) for clinical stage Ia NSCLC (<2 cm) were included in the random-effects meta-analyses. Risk of bias was assessed using Risk of Bias 2 for randomised trials or Risk of Bias in Non-randomised Studies of Interventions-I for observational studies.Results 19 studies, including four randomised trials, were included. Overall survival at 5 years was comparable between lobectomy and sublobar resection (HR=1.00; 95% CI 0.84 to 1.19; I²=26%), as was disease-free survival (HR=1.05; 95% CI 0.90 to 1.23; I²=0%). Sublobar resection was associated with significantly higher local recurrence (OR=1.86; 95% CI 1.07 to 3.25; I²=73%). No differences were observed in 10-year survival (OR=0.99; 95% CI 0.27 to 3.59; I²=86%) or postoperative change in forced expiratory volume in 1 s (mean difference=–4.70; 95% CI –11.15 to 1.76; I²=99%). In 10 studies that mandated systematic hilar and mediastinal lymph node sampling, sublobar resection was associated with improved overall survival compared with lobectomy (HR=0.81; 95% CI 0.69 to 0.965; I²=0%).Conclusion Lobectomy and sublobar resection offer comparable long-term survival for patients with stage Ia NSCLC. While sublobar resection is associated with higher local recurrence rates, subgroup analysis suggests that when intraoperative systematic hilar and mediastinal lymph node sampling is performed, sublobar resection may offer a survival advantage.",
  "authors": [
    {
      "affiliations": [
        "Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK",
        "Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England, UK"
      ],
      "name": "Lauren Kari Dixon"
    },
    {
      "affiliations": [
        "Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK"
      ],
      "name": "Ella Barber"
    },
    {
      "affiliations": [
        "Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK"
      ],
      "name": "Adrian Cook"
    },
    {
      "affiliations": [
        "Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK"
      ],
      "name": "Joanne Boudour"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, UK"
      ],
      "name": "John Conibear"
    },
    {
      "affiliations": [
        "University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England, UK"
      ],
      "name": "Douglas West"
    },
    {
      "affiliations": [
        "University College London, London, UK",
        "Lungs for Living Research Centre, University College London Respiratory, London, England, UK"
      ],
      "name": "Neal Navani"
    },
    {
      "affiliations": [
        "Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK",
        "Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England, UK"
      ],
      "name": "David A Cromwell"
    }
  ],
  "title": "Sublobar resection or lobectomy for stage Ia non-small cell lung cancer: a systematic review and meta-analysis",
  "uid": "24ebbe01-48d0-5afc-b974-18389f972ba5"
}