Lobectomy remains the standard of care for patients who have early-stage lung cancer (stages Ia and Ib). The role of less extensive surgery has yet to be defined.

Some surgeons have advocated use of wedge resection or segmental resection for early-stage lung cancer. Less extensive surgery confers less morbidity and lower mortality risk. With modern surgical technique, wedge resection would likely result in operative mortality much less than 1% in selected patients.

Several studies, however, have demonstrated that lobectomy substantially lowers the risk of local or regional recurrence compared to less extensive surgery. Long term survival is also improved. Thus at this time, lobectomy maintains superiority over wedge or segmental resection even for patients who have early-stage NSCLC (T1 N0).

Limited resection followed by local radiation therapy represents a potentially more effective alternative to wedge resection or segmental resection alone. Several retrospective studies have suggested that local radiation therapy does reduce the risk of recurrence after less extensive surgery. The efficacy of combined treatment has yet to be evaluated in prospective, controlled clinical trials.

The role of lymph node dissection in early-stage lung cancer also remains unresolved at this time. Patients who have hilar nodal disease should undergo total lymph node dissection. The potential for limited lymph node sampling in the absence of hilar node metastasis has yet to be determined.

To this end the American College of Surgeons Oncology Group has initiated a large multicenter clinical trial to address the role of lymph node sampling at the time of surgery. Patients who do not have hilar nodal disease are randomized to complete lymph node dissection or lymph node sampling. The trial should answer the question of whether lymph node dissection improves overall survival by elimination of occult metastatic disease.

Lung cancer screening by spiral computed tomography (CT) has raised the possibility of a role for limited resection. Some surgeons question the appropriateness of lobectomy for a lesion of less than 1 cm detected by screening CT. The emergence of spiral CT in the diagnoses of early stage lung cancer raises reconsideration of the role of wedge and segmental resection for patients who have very small early-stage lesions.

A possible role for limited resection also may exist for treatment of bronchoalveolar hyperplasia. Japanese investigators have begun several prospective studies to evaluate the role of wedge resection for confirmed hyperplasia that has no solid component.

Until data from appropriately controlled clinical trial dictate otherwise, primary surgery will remain the gold standard for treatment of early-stage lung cancer.