Lobectomy has been and remains the standard surgical treatment for peripheral cT1aN0M0
lung cancer because of the conclusion of the randomized controlled trial performed by the
Lung Cancer Study Group in 1995, and limited resection (
segmentectomy and wedge resection) is still not the standard treatment for patients who are candidates for lobectomy; limited resection compared with lobectomy was statistically associated with a significantly greater incidence of local recurrence, although no statistically significant difference was identified in overall survival. In 2002, a Japanese prospective single-arm study of peripheral cT1aN0M0
lung cancer revealed no significantly different outcomes between
segmentectomy and lobectomy with aggressive lymph node examination using frozen sections and wide
surgical margins; the 5-year survival rate was 81.8% and local recurrence rate was 1.8%. Recently, two clinical trials conducted by the Japan Clinical Oncology Group (JCOG) have completed patient enrollment: JCOG0802, a phase III randomized trial of lobectomy versus
segmentectomy for small peripheral
non-small cell lung cancer; and JCOG0804, a nonrandomized confirmatory study of limited surgical resection for peripheral early
lung cancer as defined based on thoracic thin-section computed tomography. The results will be published in the near future, and the standard treatment for peripheral cT1aN0M0
lung cancer may change.