Lung cancer surgery is shifting toward less invasive procedures, particularly for younger and healthier patients, according to a new study led by Duke University School of Medicine analyzing two decades of data.
Traditionally, removing an entire lobe of the lung – lobectomy—was the gold standard for early-stage lung cancer. But the study in the March issue of JTO Clinical and Research Reports shows a shift to more patients opting for less invasive procedures like segmentectomy and wedge resection.
These techniques remove only the part of the lung affected by cancer, allowing patients to keep more of their healthy lung tissue and breathing ability, while helping them live longer.
“This is a very encouraging finding for the entire community of professionals caring for lung cancer patients,” said study corresponding author Xiaofei Wang, PhD, professor in the Department Biostatics and Bioinformatics at Duke medical school.
The study was based on patient data from 76,466 lung cancer cases in the National Cancer Database between 2004 and 2020.
But researchers warn that clinical trials tracking patients throughout their treatment are needed to prove if these surgical trends lead to better patient outcomes.
According to the study, lobectomy procedures declined from 75.2% to 67.6% of lung cancer surgeries. Meanwhile segmentectomy – a procedure that removes a smaller portion of the lung – more than doubled, rising from 4.3% to 9.7%. Wedge resections remained steady, increasing slightly from 20.5% to 22.8%
“Looking at the surgical care of early-stage non-small cell lung cancer over the past two decades we’re seeing remarkable improvements in survival outcomes and surgical quality, thanks to advancements in surgical techniques, tumor detection and classification, and peri-operative care,” said Wang, a member of the Duke Cancer Institute and expert in cancer survival analysis.
Lung cancer causes 1 in 5 cancer deaths, with smoking as the leading risk. While most lung cancer cases are diagnosed around age 70, cases are rising among younger adults who have never smoked.
The problem is that early-stage lung cancer is hard to catch. Symptoms—like back pain, a chronic cough, chest pain, and shortness of breath—can be vague or mistaken for other health conditions.
The study found that younger patients, age 18-69, with fewer underlying health conditions, and smaller cancer tumors measured at 2 cm or less, about the width of the top edge of a pencil, were increasingly opting for the less extensive surgeries.
“This is a notable shift from past trends, when these procedures were mainly for older and sicker patients who may not tolerate a larger procedure like lobectomy,” said Eden Z. Deng, the study's first author and a graduate of Duke University who worked on the study with the Department of Statistical Science. “Since 2004, segmentectomy has maintained overall survival rates comparable to lobectomy, and wedge resection appears to be quickly catching up in the most recent five years we studied.”
Wedge resections initially had worse survival outcomes but have improved with five-year survival reaching 79.9% in lung cancer cases treated between 2016 and 2019. Segmentectomy showed comparable five-year survival rates to lobectomy – 80.6% versus 83.6% over the study period.
Early detection through screening and improved tumor staging has allowed doctors to identify patients who may recover well with one of the less aggressive surgeries instead of a full lobectomy. Advances in robotic and video-assisted techniques have also made these smaller lung surgeries easier to perform.
The study was supported in part by the National Institutes of Health and the National Institute of Aging (R01 AG066883).
In addition to Deng, Wang and Altorki, study authors include senior study author Nasser Altorki, MD, Weill Cornell Medicine; Jianrong Zhang, MD, MPH, University of Melbourne, Victoria Australia; Thomas E. Stinchcombe, MD, Duke Cancer Institute; and Chi-Fu (Jeffrey) Yang, MD, Department of Surgery Massachusetts General Hospital and Harvard Medical School.