Encouraging early outcomes in cancer and leukemia group B (CALGB)/Alliance 140503: patient selection, not extent of resection, is the key to perioperative success

After the Lung Cancer Study Group published its seminal trial in 1995, anatomic lobectomy was established as the gold standard surgical therapy for patients with resectable non-small cell lung cancer (NSCLC) (1). However, the increasing utilization of low-dose helical computed tomography (CT) as a screening strategy in high-risk patients and the resultant increase in the frequency of diagnosis of smaller, more peripheral lesions has reinvigorated interest in the oncologic merits of sublobar resection (2). A host of retrospective studies have suggested that sublobar resection provides equivalent locoregional disease control while sparing lung parenchyma (3-5). Consequently, sublobar resection is frequently offered to patients with marginal pulmonary function or to those whose comorbidities render them to be otherwise borderline surgical candidates. A critical determinant in the preoperative decision-making process is the postoperative morbidity profile associated with each operation. In fact, this lack of clarity with regard to oncologic outcomes and postoperative morbidity has in part spurred the expansion of less-invasive local therapeutic techniques to some operable patients with peripheral, node-negative tumors. As a consequence, it is clear that greater elucidation of the therapeutic benefits, as well as the associated perioperative morbidity profile, associated with each extent of resection is in desperate need