{"schema_version":"bookimed.page-context.v1","id":"organ-lung","url":"https://hub.bookimed.com/oncologic-surgery/organ-lung/","json_url":"https://hub.bookimed.com/oncologic-surgery/organ-lung/#page-context","content_revision":"prepared-registry-v2","date_modified":"2026-10-21","language":"en","kind":"guide","title":"Lung cancer surgery","summary":"Two different choices matter in lung cancer surgery: how much lung tissue to remove and how to reach it. A lobectomy removes a lobe of the lung; a sublobar resection removes less than a whole lobe. These are not interchangeable choices for every tumour. The approach is a separate decision: a lobectomy can be performed through open surgery or video-assisted thoracoscopic surgery, called VATS. Uniportal VATS uses one access incision rather than several. A 2019 expert consensus considered it an alternative to standard VATS, while calling for longer follow-up and randomised comparisons before drawing firm conclusions about its wider use.","research_credit":{"name":"Yevhenii Kozlov","role":"Co-Founder of Bookimed","url":"https://us-uk.bookimed.com/ceo/kozlov/","contribution":"Research project led","assistance":"For me, helping patients find the best medical care is a personal responsibility. This guide is built by a process we designed to do the hard part — reading the research, comparing surgeons and clinics, checking real offers — and to make the result simple and clear for every patient. AI tools do much of the work; every fact links to its source."},"editorial_scope":"Source-linked research and public provider information. Individual treatment requires clinical assessment.","research_method":"How this guide is researched and compared Research project led by Yevhenii Kozlov .","sections":[{"id":"narrative-mechanism_and_choices","title":"How surgery works and how approaches differ","text":"How surgery works and how approaches differ Two different choices matter in lung cancer surgery: how much lung tissue to remove and how to reach it. A lobectomy removes a lobe of the lung; a sublobar resection removes less than a whole lobe. These are not interchangeable choices for every tumour. The approach is a separate decision: a lobectomy can be performed through open surgery or video-assisted thoracoscopic surgery, called VATS. Uniportal VATS uses one access incision rather than several. A 2019 expert consensus considered it an alternative to standard VATS, while calling for longer follow-up and randomised comparisons before drawing firm conclusions about its wider use. Sources (3) Could less be enough: sublobar resection vs lobectomy for clinical stage IA non-small cell lung cancer patients with visceral pleural invasion or spread through air spaces. Survival outcome of VATS compared with open lobectomy for lung cancer: an individual patient data meta-analysis of randomised trials. Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS).","links":[{"label":"Could less be enough: sublobar resection vs lobectomy for clinical stage IA non-small cell lung cancer patients with visceral pleural invasion or spread through air spaces.","url":"https://pubmed.ncbi.nlm.nih.gov/39878072/"},{"label":"Survival outcome of VATS compared with open lobectomy for lung cancer: an individual patient data meta-analysis of randomised trials.","url":"https://pubmed.ncbi.nlm.nih.gov/41864749/"},{"label":"Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS).","url":"https://pubmed.ncbi.nlm.nih.gov/31056711/"}]},{"id":"methods-evidence","title":"Methods and what the numbers show","text":"Methods and what the numbers show Other methods with evidence","links":[],"tables":[[["Method","What it is","What the numbers show"],["Freezing tumour tissue (cryoablation)","Freezing tumour tissue (cryoablation).","Local recurrence-free response (local tumor efficacy) of the treated tumor was 172 of 202 (85.1%) at 12 months and 139 of 180 (77.2%) at 24 months after the initial treatment. 12 months; 24 months; The patients were enrolled on the basis of the outlined key inclusion criteria, which include one to six metastases from extrapulmonary cancers with a maximal diameter of 3.5 cm. [2] After a second cryoablation treatment for recurrent tumor, secondary local recurrence-free response (local tumor efficacy) was 184 of 202 (91.1%) at 12 months and 152 of 180 (84.4%) at 24 months. 12 months; 24 months; The patients were enrolled on the basis of the outlined key inclusion criteria, which include one to six metastases from extrapulmonary cancers with a maximal diameter of 3.5 cm. [2] Kaplan-Meier estimates of 12- and 24-month overall survival rates were 97.6% (95% confidence interval: 92.6-99.2) and 86.6% (95% confidence interval: 78.7-91.7), respectively. 24-month; The patients were enrolled on the basis of the outlined key inclusion criteria, which include one to six metastases from extrapulmonary cancers with a maximal diameter of 3.5 cm. [2]"],["Removal of a lung lobe","Removal of a lung lobe.","The meta-analysis revealed that SLR was associated with impaired 5-year OS (HR: 1.25; 95% CI: 1.10-1.41) and slightly inferior RFS (HR: 1.25; 95% CI: 0.99-1.58) compared to lobectomy for pT2a (VPI) NSCLC patients with tumor ≤3 cm. 5-year; The final analysis included 14 retrospective studies and 1 randomized controlled trial, encompassing a total of 8054 patients with NSCLC (tumors ≤3 cm) exhibiting VPI or STAS. [3] Similarly, SLR was associated with significantly worse 5-year OS (HR: 2.58; 95% CI: 1.92-3.45) and 5-year RFS (HR: 2.42; 95% CI: 1.69-3.46) compared to lobectomy for stage IA NSCLC patients with STAS. 5-year; The final analysis included 14 retrospective studies and 1 randomized controlled trial, encompassing a total of 8054 patients with NSCLC (tumors ≤3 cm) exhibiting VPI or STAS. [3] Subgroup analysis revealed that statistically significant differences in 5-year OS (HR: 1.13; 95% CI: 0.92-1.38) and 5-year RFS (HR: 0.87; 95% CI: 0.56-1.36) were not observed between the SLR and lobectomy groups for pT2a (VPI) NSCLC patients with tumor ≤2 cm. 5-year; The final analysis included 14 retrospective studies and 1 randomized controlled trial, encompassing a total of 8054 patients with NSCLC (tumors ≤3 cm) exhibiting VPI or STAS. [3]"],["Removal of lymph nodes","Removal of lymph nodes.","In multivariable Cox analysis, DLN count less than or equal to 16 is associated with an improved PFS in all cohorts [primary cohort: HR=0.26 (95% CI: 0.07-0.89), P =0.03]; [validation cohort: HR=0.46 (95% CI: 0.22-0.96), P =0.04]; [entire cohort: HR=0.53 (95% CI: 0.32-0.89), P =0.02]. Study follow-up: With a median follow-up time of 14.3 months (95% CI: 11.0-17.6), the overall median progression-free survival (PFS) was 7.9 (95% CI: 4.1-11.7) months, 11.7 (95% CI: 7.9-15.6) months in the combination therapy subgroup, and 4.8 (95% CI: 3.1-6.4) months in the immunotherapy alone subgroup, respectively.; However, murine studies have indicated that excising tumor-draining LNs diminished immunotherapy effectiveness, though its applicability to clinical patients remains uncertain. [4] A higher level of CD8+ central memory T cell (Tcm) within LNs was associated with improved PFS (HR: 0.235, 95% CI: 0.065-0.845, P =0.027). Study follow-up: With a median follow-up time of 14.3 months (95% CI: 11.0-17.6), the overall median progression-free survival (PFS) was 7.9 (95% CI: 4.1-11.7) months, 11.7 (95% CI: 7.9-15.6) months in the combination therapy subgroup, and 4.8 (95% CI: 3.1-6.4) months in the immunotherapy alone subgroup, respectively.; However, murine studies have indicated that excising tumor-draining LNs diminished immunotherapy effectiveness, though its applicability to clinical patients remains uncertain. [4] Upstaged patients showed significantly worse 3- (upstaged: 60.6% vs. pN0: 83.2%; p = 0.01) and 5-year (upstages: 38% vs. pN0 71.5%; p = 0.02) survival rates. 16.5% of patients with ≤2 cm NSCLC were nodal upstaged postoperatively. 5-year; Sublobar resection is frequently performed for Non-Small Cell Lung Cancer (NSCLC) patients with ≤2 cm nodules. [5]"],["Destroying tumour tissue with microwave energy","Destroying tumour tissue with microwave energy.","According to our study, the incidence of patients with stage I NSCLC who were older than 60 years old was 98 % (95 % CI [94-100 %]); the lesions were mostly located in RUL (Right Upper Lobe) and LUL (Left Upper Lobe), and the incidence of the two sites was 29 % (95 % CI [23-35 %]) and 27 % (95 % CI [21-33 %]), respectively; the types of lung cancers mainly included adenocarcinoma, squamous carcinoma, and large-cell lung cancer, of which adenocarcinoma accounted for the largest proportion of 63 % (95 % CI [56-70 %]); the causes of death were mainly categorized into cancer-related (57 %, 95 %CI[40-74 %]) and noncancer-related (40 %, 95 %CI [23-58 %]); the common complications in the postoperative period were pneumothorax and pain, with the incidence of 33 % (95 %CI[24-44 %]) and 33 % (95 %CI[19-50 %]), and the rate of the postoperative complications in MWA was slightly higher than those in RFA; the local recurrence rate was 23 % (95 %CI[17-29 %]) and the distant recurrence rate was 18 % (95 %CI[7-32 %]); the pooling result showed the rate of 1-, 2-, 3-, and 5-year survival rate were 96 %, 81 %, 68 %, and 42 %, the Cancer-specific survival (CSS) rates at 1, 2, 3, and 5 years were 98 %, 88 %, 75 %, and 58 %, Disease-free survival (DFS) rates at 1, 2, 3, and 5 years were 87 %, 63 %, 57 %, and 42 %, there were no significant differences existed between the RFA group and MWA group in survival rate, CSS and DFS. 60 years; 5-year; 5 years; The objective of this study was to measure the safety and efficacy of thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), for patients with stage I non-small cell lung cancer (NSCLC). [6] Subgroup analysis demonstrated no significant OS difference between lobectomy and MWA, but there were significantly better 1- and 2-year OS with sublobar resection (wedge resection or segmentectomy) versus RFA (OR 2.85, 95% CI 1.33-6.10; OR 4.54, 95% CI 2.51-8.21, respectively). 2-year; Multiple cohort studies have compared surgical resection with CT-guided percutaneous ablation for patients with stage 1 non-small cell lung cancer (NSCLC); however, the results have been heterogeneous. [7] Median PFS was 10.3 months (95% CI 8.0-13.0) in the MWA plus chemotherapy group and 4.9 months (95% CI 4.2-5.7) in the chemotherapy group (HR = 0.44, 95% CI 0.28-0.53; p < 0.0001). 10.3 months; 4.9 months; From March 1, 2015, to June 20, 2017, treatment-naïve patients with pathologically verified advanced or recurrent non-small cell lung cancer (NSCLC) were randomly assigned to MWA plus chemotherapy group or chemotherapy group. [8]"],["Minimally invasive removal of a lung lobe","Minimally invasive removal of a lung lobe.","After MIL and SABR, unadjusted 5-year PFS was 63% and 30%, OS was 72% and 38% and LCSS was 81% and 76%, respectively. 5-year; A minimally invasive lobectomy (MIL) is the standard treatment for stage I non-small cell lung cancer (NSCLC) in medically operable patients. [9]"],["Open removal of a lung lobe","Open removal of a lung lobe.","Compared with open lobectomy, video-assisted thoracic surgery, lobectomy and robotic lobectomy had significantly reduced 30-day mortality (risk ratio = 0.53; 95% credible intervals, 0.40-0.66 and risk ratio = 0.51; 95% credible intervals, 0.36-0.71), pulmonary complications (risk ratio = 0.70; 95% credible intervals, 0.51-0.92 and risk ratio = 0.69; 95% credible intervals, 0.51-0.88), and overall complications (risk ratio = 0.77; 95% credible intervals, 0.68-0.85 and risk ratio = 0.79; 95% credible intervals, 0.67-0.91). 30-day; Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach. — Thirty-four studies (183,426 patients) were included; 88,865 (48.4%) underwent open lobectomy, 79,171 (43.2%) video-assisted thoracic surgery lobectomy, and 15,390 (8.4%) robotic lobectomy. [10] At 52 weeks, there were no differences in cancer progression-free survival (hazard ratio, 0.74 [0.43 to 1.27]) or overall survival (hazard ratio, 0.67 [0.32 to 1.40]). 52 weeks; METHODS: We conducted a parallel-group multicenter randomized trial that recruited participants with known or suspected early-stage lung cancer and randomly assigned them to open or VATS resection of their lesions. [11] The patients with surgical site infection had significantly higher mortality (3.19% vs. 0.41%, p < 0.001), higher median medical cost (90774.95 yuan vs. 63079.38 yuan, p < 0.001), and longer postoperative length of stay (15 days vs. 9 days, p < 0.001). 15 days; 9 days; A prospective nested case-control study was performed on patients with lung cancer who underwent open lobectomy in the lung cancer center of West China Hospital from January 2017 to December 2019. [12]"],["Open removal of a lung segment","Open removal of a lung segment.","The overall 5-year survival rates for patients with stage Ia1 and Ia2 NSCLC after open segmentectomy and lobectomy were 79.7% and 83.5% (p=0.951), 5-year disease-free survival rates - 74.5% and 76.9%, respectively (p=0.457). 5-year; A retrospective study included patients with primary malignant lung tumors who underwent anatomical lung resection, including segmentectomy (335 patients) and lobectomy (1.238 patients) via thoracoscopic and open approaches between January 01, 2009 and December 31, 2022. [13] Minimally invasive surgery had less 30-day morbidity compared with open segmentectomy (video-assisted thoracoscopic surgery odds ratio, 0.71; 95% CI, 0.55-0.94; P = .013; robotic-assisted thoracoscopic surgery odds ratio, 0.59; CI, 0.43-0.81; P = .001). 30-day; Trends and comparative outcomes between operative approaches for segmentectomy in lung cancer. — RESULTS: Of 9927 patients who underwent segmentectomy, 84.8% underwent minimally invasive surgery, with robotic-assisted thoracoscopic surgery becoming the most common approach in 2019. [14]"],["Removal of a lung","Removal of a lung.","Pooled estimates for 3-year and 5-year OS were 50.6% (95% confidence interval [CI], 34.7%-66.5%) and 38.9% (95% CI, 32.2%-46.1%) in SPLC patients. 3-year; 5-year; Studies were included if they indicated outcomes of patients with lung cancer undergoing CP. [15] When the SPLC was a stage I tumor, pooled 5-year OS was favorable with 60.7% (95% CI, 43.2%-75.9%). 5-year; Studies were included if they indicated outcomes of patients with lung cancer undergoing CP. [15] In LRLC, pooled 3-year and 5-year OS were 47.6% (95% CI, 36.1%-59.4%) and 33.8% (95% CI, 26.8%-41.5%), respectively. 3-year; 5-year; Studies were included if they indicated outcomes of patients with lung cancer undergoing CP. [15]"],["Destroying tumour tissue with radiofrequency energy","Destroying tumour tissue with radiofrequency energy.","According to our study, the incidence of patients with stage I NSCLC who were older than 60 years old was 98 % (95 % CI [94-100 %]); the lesions were mostly located in RUL (Right Upper Lobe) and LUL (Left Upper Lobe), and the incidence of the two sites was 29 % (95 % CI [23-35 %]) and 27 % (95 % CI [21-33 %]), respectively; the types of lung cancers mainly included adenocarcinoma, squamous carcinoma, and large-cell lung cancer, of which adenocarcinoma accounted for the largest proportion of 63 % (95 % CI [56-70 %]); the causes of death were mainly categorized into cancer-related (57 %, 95 %CI[40-74 %]) and noncancer-related (40 %, 95 %CI [23-58 %]); the common complications in the postoperative period were pneumothorax and pain, with the incidence of 33 % (95 %CI[24-44 %]) and 33 % (95 %CI[19-50 %]), and the rate of the postoperative complications in MWA was slightly higher than those in RFA; the local recurrence rate was 23 % (95 %CI[17-29 %]) and the distant recurrence rate was 18 % (95 %CI[7-32 %]); the pooling result showed the rate of 1-, 2-, 3-, and 5-year survival rate were 96 %, 81 %, 68 %, and 42 %, the Cancer-specific survival (CSS) rates at 1, 2, 3, and 5 years were 98 %, 88 %, 75 %, and 58 %, Disease-free survival (DFS) rates at 1, 2, 3, and 5 years were 87 %, 63 %, 57 %, and 42 %, there were no significant differences existed between the RFA group and MWA group in survival rate, CSS and DFS. 60 years; 5-year; 5 years; The objective of this study was to measure the safety and efficacy of thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), for patients with stage I non-small cell lung cancer (NSCLC). [6] Patients treated with RFA combined with chemotherapy significantly improved OS compared with those treated with chemotherapy alone [HR 0.50, 95% confidence interval (CI) 0.41-0.61; p < 0.00001], with an absolute difference at 12 months of 29.6% (95% CI 23.7-35.5), at 24 months of 19.2% (95% CI 10.1-28.2), and at 36 months of 22.9% (95% CI 12.0-33.7). 12 months; 24 months; 36 months; The present study aimed to assess the OS of RFA and/or chemotherapy in patients with lung cancer or pulmonary metastases who were not candidates for surgical resection. [16] RFA alone was 0.53 (95% CI 0.41-0.70; p < 0.00001), corresponding to a 27.1% (95% CI 18.3-35.8), 31.0% (95% CI 19.9-41.9), and 24.9% (95% CI 15.0-34.7) absolute difference in survival at 12 months, 24 months, and 36 months, respectively. 12 months; 24 months; 36 months; The present study aimed to assess the OS of RFA and/or chemotherapy in patients with lung cancer or pulmonary metastases who were not candidates for surgical resection. [16]"],["Robot-assisted removal of a lung lobe","Robot-assisted removal of a lung lobe.","Compared with open lobectomy, video-assisted thoracic surgery, lobectomy and robotic lobectomy had significantly reduced 30-day mortality (risk ratio = 0.53; 95% credible intervals, 0.40-0.66 and risk ratio = 0.51; 95% credible intervals, 0.36-0.71), pulmonary complications (risk ratio = 0.70; 95% credible intervals, 0.51-0.92 and risk ratio = 0.69; 95% credible intervals, 0.51-0.88), and overall complications (risk ratio = 0.77; 95% credible intervals, 0.68-0.85 and risk ratio = 0.79; 95% credible intervals, 0.67-0.91). 30-day; Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach. — Thirty-four studies (183,426 patients) were included; 88,865 (48.4%) underwent open lobectomy, 79,171 (43.2%) video-assisted thoracic surgery lobectomy, and 15,390 (8.4%) robotic lobectomy. [10] After a median follow-up of 58.0 months, the 3-year overall survival was 94.6% (95% confidence interval [CI], 91.0-98.3) in the RAL group and 91.5% (95% CI, 87.2-96.0) in the VAL group (hazard ratio [HR] for death, 0.65; 95% CI, 0.33-1.28; P = 0.21); noninferiority of RAL was confirmed according to the predefined margin of -5% (absolute difference, 2.96%; a one-sided 90% CI, -1.39% to ∞; P = 0.0029 for noninferiority). 58.0 months; 3-year; Robotic-assisted versus video-assisted lobectomy for resectable non-small-cell lung cancer: the RVlob randomized controlled trial. — A total of 320 patients were randomized to receive RAL (n = 157) or VAL (n = 163). [17] The 3-year disease-free survival was 88.7% (95% CI, 83.6-94.1) in the RAL group and 85.4% (95% CI, 80.0-91.2) in the VAL group (HR for disease recurrence or death, 0.87; 95% CI, 0.50-1.52; P = 0.62). 3-year; Robotic-assisted versus video-assisted lobectomy for resectable non-small-cell lung cancer: the RVlob randomized controlled trial. — A total of 320 patients were randomized to receive RAL (n = 157) or VAL (n = 163). [17]"],["Removal of a lung segment","Removal of a lung segment.","Additionally, no statistically significant survival difference was observed between the segmentectomy and lobectomy groups for NSCLC patients (≤3 cm) with VPI (5-year OS: HR: 1.16; 95% CI: 0.89-1.52; 5-year RFS: HR: 1.07; 95% CI: 0.88-1.30) or STAS (5-year OS: HR: 3.88; 95% CI: 0.82-18.31; 5-year RFS: HR: 1.64; 95% CI: 0.70-3.80). 5-year; The final analysis included 14 retrospective studies and 1 randomized controlled trial, encompassing a total of 8054 patients with NSCLC (tumors ≤3 cm) exhibiting VPI or STAS. [3] At 24 and 60 months, OS rates were RR = 0.95 (95% CI 0.92-0.97, p = 0.0001) and RR = 0.81 (95% CI 0.67-0.98, p = 0.03), respectively. 60 months; Assessing Outcomes in Clinical Stage I Non-small Cell Lung Tumors up to Two Centimeters in Diameter in Segmentectomy vs. Lobectomy: Systematic Review and Meta-analysis. — Twelve studies involving 6049 patients revealed that segmentectomy and lobectomy demonstrated comparable overall survival (OS), with an HR of 0.99 (95% CI 0.81-1.21, p = 0.90). [18] Subgroup analysis demonstrated no significant OS difference between lobectomy and MWA, but there were significantly better 1- and 2-year OS with sublobar resection (wedge resection or segmentectomy) versus RFA (OR 2.85, 95% CI 1.33-6.10; OR 4.54, 95% CI 2.51-8.21, respectively). 2-year; Multiple cohort studies have compared surgical resection with CT-guided percutaneous ablation for patients with stage 1 non-small cell lung cancer (NSCLC); however, the results have been heterogeneous. [7]"],["Removal of a wedge-shaped piece of lung","Removal of a wedge-shaped piece of lung.","Subgroup analysis demonstrated no significant OS difference between lobectomy and MWA, but there were significantly better 1- and 2-year OS with sublobar resection (wedge resection or segmentectomy) versus RFA (OR 2.85, 95% CI 1.33-6.10; OR 4.54, 95% CI 2.51-8.21, respectively). 2-year; Multiple cohort studies have compared surgical resection with CT-guided percutaneous ablation for patients with stage 1 non-small cell lung cancer (NSCLC); however, the results have been heterogeneous. [7] Survival results favored lobectomy in stage IA NSCLC ≤2 cm (combined HR: 1.530, 95% CI: 1.402-1.671, P < 0.001) or patient's ≥65 years old (combined HR: 1.227, 95% CI: 1.003-1.502, P = 0.047). 65 years; Meta-analysis of lobectomy, segmentectomy, and wedge resection for stage I non-small cell lung cancer. — RESULTS: A total of 42 studies published from 1980 to 2014 enrolling 21,926 patients were included in this meta-analysis. [19] Five-year DFS was 64.7% after LR (95% confidence interval [CI], 59.6%-70.1%), 63.8% after SR (95% CI, 55.6%-73.2%), and 62.5% after WR (95% CI, 55.8%-69.9%) (P = .888, log-rank test). Five-year; METHODS: Between June 2007 and March 2017, a total of 697 patients were randomized to LR (n = 357) or SLR (n = 340) stratified by clinical tumor size, histology, and smoking history. [20]"]]]},{"id":"narrative-indications_and_alternatives","title":"When surgery may help and what alternatives to discuss","text":"When surgery may help and what alternatives to discuss Lobectomy is a standard treatment for stage I non-small cell lung cancer, but suitability depends on more than age. Important considerations include needing oxygen because of severe lung disease, reduced ability of the lungs to transfer gas into the blood, frailty, and how well you manage everyday activities. A smaller resection is an alternative to discuss in selected early-stage disease, but tumour features matter. In particular, invasion of the lung's outer lining or spread of cancer cells through air spaces can change the balance between a smaller operation and lobectomy. Evidence about these features should not be applied to all small lung tumours. Sources (2) Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. Could less be enough: sublobar resection vs lobectomy for clinical stage IA non-small cell lung cancer patients with visceral pleural invasion or spread through air spaces.","links":[{"label":"Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document.","url":"https://pubmed.ncbi.nlm.nih.gov/34716030/"},{"label":"Could less be enough: sublobar resection vs lobectomy for clinical stage IA non-small cell lung cancer patients with visceral pleural invasion or spread through air spaces.","url":"https://pubmed.ncbi.nlm.nih.gov/39878072/"}]},{"id":"narrative-outcomes_and_limits","title":"Expected outcomes and limits of the evidence","text":"Expected outcomes and limits of the evidence A 2025 review examined five-year survival in 8,054 patients across 15 studies of non-small cell lung cancers measuring 3 cm or less with invasion of the lung's outer lining or spread through air spaces. Overall, smaller resections were associated with worse survival than lobectomy in these groups. However, comparisons limited to segmentectomy, a particular type of smaller resection, did not find statistically significant survival differences. Fourteen of the studies were retrospective, meaning they looked back at earlier treatment rather than randomly assigning it; the findings show associations and do not prove that one operation caused better survival. The total of 8,054 covers the whole review, not each comparison, and a lack of statistical difference does not establish that treatments are equivalent. A separate 2026 review of stage I cancers with spread through air spaces found worse recurrence-free survival after smaller resections but similar overall survival, so the reviews do not give a uniform answer about survival. Sources (2) Could less be enough: sublobar resection vs lobectomy for clinical stage IA non-small cell lung cancer patients with visceral pleural invasion or spread through air spaces. Analysis of Individual Patient Data Demonstrates that Sublobar Resection Followed by Adjuvant Chemotherapy has Equivalent Prognosis to Lobectomy in Patients with Stage I NSCLC with Spread through Air Spaces.","links":[{"label":"Could less be enough: sublobar resection vs lobectomy for clinical stage IA non-small cell lung cancer patients with visceral pleural invasion or spread through air spaces.","url":"https://pubmed.ncbi.nlm.nih.gov/39878072/"},{"label":"Analysis of Individual Patient Data Demonstrates that Sublobar Resection Followed by Adjuvant Chemotherapy has Equivalent Prognosis to Lobectomy in Patients with Stage I NSCLC with Spread through Air Spaces.","url":"https://pubmed.ncbi.nlm.nih.gov/40781382/"}]},{"id":"narrative-risks","title":"Risks to discuss with your surgeon","text":"Risks to discuss with your surgeon Lobectomy carries a risk of complications, including death, and some people have a high enough risk that it may not be suitable. Severe underlying lung disease, frailty and reduced day-to-day function are important parts of that assessment. Cardiopulmonary exercise testing measures how the heart and lungs respond during exercise. A 2026 review linked lower peak oxygen uptake and less efficient breathing during exercise with a greater risk of complications around surgery. These findings can inform an individual risk discussion; they are not a personal prediction of the chance of a complication or death. Sources (2) Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. Grading the evidence for CPET variables in predicting perioperative morbidity and long-term mortality in lung cancer surgery: a systematic review and meta-analysis.","links":[{"label":"Definition and assessment of high risk in patients considered for lobectomy for stage I non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document.","url":"https://pubmed.ncbi.nlm.nih.gov/34716030/"},{"label":"Grading the evidence for CPET variables in predicting perioperative morbidity and long-term mortality in lung cancer surgery: a systematic review and meta-analysis.","url":"https://pubmed.ncbi.nlm.nih.gov/42432773/"}]},{"id":"narrative-recovery_and_followup","title":"Recovery and follow-up care","text":"Recovery and follow-up care Breathing-muscle training is one topic to discuss when preparing for surgery. A 2026 review of 13 studies involving 761 patients undergoing lung cancer surgery examined threshold inspiratory muscle training, which trains the muscles used to breathe in against resistance. Compared with conventional breathing training, it found fewer postoperative lung complications, shorter hospital stays and improvements in breathing strength and walking performance. Its timing analysis supported starting one week before surgery and continuing from the first day after surgery. Discuss whether this approach fits your care plan rather than starting a programme on your own. Chest-drain management is another part of early recovery: a separate 2026 review of 17 studies involving 2,929 patients after anatomical lung resection suggested that digital drainage may shorten drainage time and hospital stay, but differences between studies limited firm conclusions. Sources (2) Optimal timing of threshold inspiratory muscle training for functional outcomes in patients undergoing lung cancer surgery: a systematic review and meta-analysis. A Network Meta-Analysis of Drainage Systems and Suction Strategies After Lung Cancer Surgery.","links":[{"label":"Optimal timing of threshold inspiratory muscle training for functional outcomes in patients undergoing lung cancer surgery: a systematic review and meta-analysis.","url":"https://pubmed.ncbi.nlm.nih.gov/40719350/"},{"label":"A Network Meta-Analysis of Drainage Systems and Suction Strategies After Lung Cancer Surgery.","url":"https://pubmed.ncbi.nlm.nih.gov/41832991/"}]},{"id":"explore","title":"Explore surgery and care teams","text":"Explore surgery and care teams Lung cancer surgery Lung surgery surgeons Lung cancer surgery surgeons Lung surgery clinics Lung cancer surgery clinics","links":[{"label":"Lung cancer surgery","url":"https://hub.bookimed.com/oncologic-surgery/method-oncosurgery-op374/"},{"label":"Lung surgery surgeons","url":"https://hub.bookimed.com/oncologic-surgery/surgeons-organ-lung/"},{"label":"Lung cancer surgery surgeons","url":"https://hub.bookimed.com/oncologic-surgery/surgeons-method-oncosurgery-op374/"},{"label":"Lung surgery clinics","url":"https://hub.bookimed.com/oncologic-surgery/clinics-organ-lung/"},{"label":"Lung cancer surgery clinics","url":"https://hub.bookimed.com/oncologic-surgery/clinics-method-oncosurgery-op374/"}]},{"id":"specialists","title":"Specialists and their operations","text":"Specialists and their operations Turkey · 12 entries Germany · 3 entries Austria · 1 entries Italy · 1 entries Romania · 1 entries Egypt · 1 entries Sources (19) Mustafa Solak Viola Fox Onder Surgit Bulent Karagoz Halil Alis Peter Schenker Assoc Prof Dr Guner Cakmak Selin Kapan Mustafa Ozdogan Wolfgang Schröder Altan Kir Walter Klepetko Giampiero Negri Serkan Keskin Alper Toker Irfan Eser Yildiray Bekar Felix Dobritoiu Amr Mahmoud Al Demery","links":[{"label":"","url":"https://hub.bookimed.com/oncologic-surgery/surgeon-bookimed-2922/"},{"label":"Mustafa 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prostatectomy; Transurethral resection of the prostate (TURP); Breast cancer surgery; Hysterectomy (uterus removal); Lumpectomy; Hyperthermic Intraperitoneal Chemotherapy (HIPEC); Whipple surgery; Orchiectomy; Mohs microsurgery; Hysterectomy with DaVinci robot; Lung cancer surgery; Bladder removal; Colectomy (large bowel resection); Liver resection; Removal of meningioma; Rectal resection; Removal of testicle tumor; Throat cancer operation; Tongue cancer surgery; Gastroectomy; Pancreatic cancer surgery; Bladder removal with reconstruction; Laparoscopic Hysterectomy In practice since 2006","Ask about treatment"],["Onder Surgit","Optimed International Hospital Tekirdag, Turkey","Prostatectomy; Breast cancer surgery; Whipple surgery; Lung cancer surgery; Gastroectomy In practice since 1995","Ask about treatment"],["Bulent Karagoz","Anadolu Medical Center Istanbul, Turkey","Mastectomy; Melanoma surgery; Stomach cancer surgery; Breast cancer surgery; Whipple surgery; Lung cancer surgery; Colectomy (large bowel resection); Rectal resection; Throat cancer operation In practice since 1993","Ask about treatment"],["Halil Alis","Valued Med Hub Hospitals Istanbul, Turkey","Small intestine resection; Hysterectomy (uterus removal); Lumpectomy; Whipple surgery; Lung cancer surgery; Colectomy (large bowel resection); Liver resection; Gastroectomy In practice since 1992","Ask about treatment"],["Assoc Prof Dr Guner Cakmak","Bookimed Batman, Turkey","Breast cancer surgery; Lumpectomy; Whipple surgery; Lung cancer surgery; Gastroectomy In practice since 1997","Ask about treatment"],["Selin Kapan","İstinye University Liv Hospital Topkapı Istanbul, Turkey","Esophagectomy; Small intestine resection; Breast cancer surgery; Lumpectomy; Whipple surgery; Orchiectomy; Lung cancer surgery; Colectomy (large bowel resection); Liver resection; Rectal resection; Throat cancer operation; Gastroectomy; Pancreatic cancer surgery In practice since 1995","Ask about treatment"],["Mustafa Ozdogan","Memorial Göztepe Hospital Istanbul, Turkey","Mastectomy; Breast cancer surgery; Hyperthermic Intraperitoneal Chemotherapy (HIPEC); Lung cancer surgery In practice since 2012","Ask about treatment"],["Altan Kir","Anadolu Medical Center Istanbul, Turkey","Da Vinci Robotic System; Lung cancer surgery In practice since 1984","Ask about treatment"],["Serkan Keskin","Memorial Şişli Hospital Istanbul, Turkey","Lung cancer surgery In practice since 2001","Ask about treatment"],["Alper Toker","Istanbul Florence Nightingale Hospital Istanbul, Turkey","Lung cancer surgery In practice since 1997","Ask about treatment"],["Irfan Eser","Medical Park Antalya Hospital Complex Antalya, Turkey","Lung cancer surgery In practice since 2011","Ask about treatment"],["Yildiray Bekar","Medical Park Bahcelievler Hospital Istanbul, Turkey","Lung cancer surgery In practice since 2005","Ask about treatment"]],[["Specialist","Clinic","Operations and experience","Ask about treatment"],["Viola Fox","Medical Center in Solingen Solingen, Germany","Mastectomy; Thyroid resection; Removal of liver cancer; Removal of colon cancer; Prostatectomy; Melanoma surgery; Stomach cancer surgery; Da Vinci Robotic System; Esophagectomy; Small intestine resection; Robotic da Vinci prostatectomy; Breast cancer surgery; Hysterectomy (uterus removal); Hyperthermic Intraperitoneal Chemotherapy (HIPEC); Whipple surgery; Hysterectomy with DaVinci robot; Lung cancer surgery; Colectomy (large bowel resection); Liver resection; Removal of meningioma; Rectal resection; Removal of testicle tumor; Throat cancer operation; Tongue cancer surgery; Gastroectomy; Pancreatic cancer surgery; Bladder removal with reconstruction; Laparoscopic Hysterectomy In practice since 2012","Ask about treatment"],["Peter Schenker","Medical Center in Solingen Solingen, Germany","Esophagectomy; Small intestine resection; Lumpectomy; Whipple surgery; Mohs microsurgery; Lung cancer surgery; Colectomy (large bowel resection); Liver resection; Rectal resection; Gastroectomy; Pancreatic cancer surgery In practice since 2007","Ask about treatment"],["Wolfgang Schröder","Helios Gesundheit Wuppertal, Germany","Removal of liver cancer; Removal of colon cancer; Nephrectomy; Stomach cancer surgery; Da Vinci Robotic System; Esophagectomy; Small intestine resection; Breast cancer surgery; Lumpectomy; Hyperthermic Intraperitoneal Chemotherapy (HIPEC); Whipple surgery; Mohs microsurgery; Lung cancer surgery; Colectomy (large bowel resection); Liver resection; Rectal resection; Throat cancer operation; Gastroectomy; Pancreatic cancer surgery In practice since 2001","Ask about treatment"]],[["Specialist","Clinic","Operations and experience","Ask about treatment"],["Walter Klepetko","Wiener Privatklinik (WPK) Vienna, Austria","Lung cancer surgery In practice since 1978","Ask about treatment"]],[["Specialist","Clinic","Operations and experience","Ask about treatment"],["Giampiero Negri","San Raffaele Milan, Italy","Lung cancer surgery","Ask about treatment"]],[["Specialist","Clinic","Operations and experience","Ask about treatment"],["Felix Dobritoiu","Ponderas Academic Hospital Bucharest, Romania","Da Vinci Robotic System; Lung cancer surgery In practice since 2015","Ask about treatment"]],[["Specialist","Clinic","Operations and experience","Ask about treatment"],["Amr Mahmoud Al Demery Portrait unavailable.","Shefaa Al Orman international oncology hospitals Cairo, Egypt","Lung cancer surgery In practice since 2009","Ask about treatment"]]]},{"id":"programmes","title":"Programmes and prices","text":"Programmes and prices Sources (2) Lung cancer Lung Cancer Comprehensive Diagnosis and Treatment Program","links":[{"label":"VM Medical Park Florya Hospital","url":"https://hub.bookimed.com/oncologic-surgery/clinic-5613/"},{"label":"Bookimed offer","url":"https://us-uk.bookimed.com/offer-procedure/680f4c3b82844e686405cf53/"},{"label":"Read the public programme 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activities not included Excluded: Accommodation is not included Excluded: Transfer is not included Read the public programme source","Ask about treatment"],["Lung Cancer Comprehensive Diagnosis and Treatment Program","Shanghai Tongji Hospital, International Department","USD 55715 Bookimed offer , Oct 2026","What the programme includes Lung Cancer Comprehensive Diagnosis and Treatment Program Included: Complex diagnostics of lung cancer Included: Lung cancer surgery Included: Chemotherapy for lung cancer Included: Immunotherapy for lung cancer Included: Consultation with an oncologist Included: Consultation with a thoracic surgeon Included: CT Scan Included: PET/CT Included: Biopsy Included: Histopathology revision Included: Follow-up examination Excluded: Airfare Excluded: Hotel Excluded: Additional activities not included Excluded: Accommodation is not included Excluded: Transfer is not included Stay: 7 days in the hospital Read the public programme source","Ask about treatment"]]]},{"id":"research","title":"References and further reading","text":"References and further reading Lung surgery surgeons Multicenter Study of Metastatic Lung Tumors Targeted by Interventional Cryoablation Evaluation (SOLSTICE). Could less be enough: sublobar resection vs lobectomy for clinical stage IA non-small cell lung cancer patients with visceral pleural invasion or spread through air spaces. Impact of lymphadenectomy extent on immunotherapy efficacy in postresectional recurred non-small cell lung cancer: a multi-institutional retrospective cohort study. Sublobar resection without staging and lymphadenectomy for ≤2 cm Non-Small Cell Lung Cancer is no adequate therapy. Efficacy and Safety of Thermal Ablation for Patients With Stage I Non-small Cell Lung Cancer. Survival outcomes for surgical resection versus CT-guided percutaneous ablation for stage I non-small cell lung cancer (NSCLC): a systematic review and meta-analysis. Microwave ablation plus chemotherapy versus chemotherapy in advanced non-small cell lung cancer: a multicenter, randomized, controlled, phase III clinical trial. Minimally invasive lobectomy versus stereotactic ablative radiotherapy for stage I non-small cell lung cancer. Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach. Video-Assisted Thoracoscopic or Open Lobectomy in Early-Stage Lung Cancer. Surgical site infection following open lobectomy in patients with lung cancer: A prospective study. [Segmentectomies in patients with primary malignant lung tumors]. Trends and comparative outcomes between operative approaches for segmentectomy in lung cancer. Completion Pneumonectomy for Second Primary/Primary Lung Cancer and Local Recurrence Lung Cancer. Survival after radiofrequency ablation and/or chemotherapy for lung cancer and pulmonary metastases: a systematic review and meta-analysis. Robotic-assisted versus video-assisted lobectomy for resectable non-small-cell lung cancer: the RVlob randomized controlled trial. Assessing Outcomes in Clinical Stage I Non-small Cell Lung Tumors up to Two Centimeters in Diameter in Segmentectomy vs. Lobectomy: Systematic Review and Meta-analysis. Meta-analysis of lobectomy, segmentectomy, and wedge resection for stage I non-small cell lung cancer. Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance).","links":[{"label":"Lung surgery surgeons","url":"https://hub.bookimed.com/oncologic-surgery/surgeons-organ-lung/"},{"label":"Multicenter Study of Metastatic Lung Tumors Targeted by Interventional Cryoablation Evaluation (SOLSTICE).","url":"https://pubmed.ncbi.nlm.nih.gov/32151777/"},{"label":"Could less be enough: sublobar resection vs lobectomy for clinical stage IA non-small cell lung cancer patients with visceral pleural invasion or spread through air spaces.","url":"https://pubmed.ncbi.nlm.nih.gov/39878072/"},{"label":"Impact of lymphadenectomy extent on immunotherapy efficacy in postresectional recurred non-small cell lung cancer: a multi-institutional retrospective cohort study.","url":"https://pubmed.ncbi.nlm.nih.gov/37755384/"},{"label":"Sublobar resection without staging and lymphadenectomy for ≤2 cm Non-Small Cell Lung Cancer is no adequate therapy.","url":"https://pubmed.ncbi.nlm.nih.gov/36096011/"},{"label":"Efficacy and Safety of Thermal Ablation for Patients With Stage I Non-small Cell Lung Cancer.","url":"https://pubmed.ncbi.nlm.nih.gov/38942645/"},{"label":"Survival outcomes for surgical resection versus CT-guided percutaneous ablation for stage I non-small cell lung cancer (NSCLC): a systematic review and meta-analysis.","url":"https://pubmed.ncbi.nlm.nih.gov/33449192/"},{"label":"Microwave ablation plus chemotherapy versus chemotherapy in advanced non-small cell lung cancer: a multicenter, randomized, controlled, phase III clinical trial.","url":"https://pubmed.ncbi.nlm.nih.gov/32020400/"},{"label":"Minimally invasive lobectomy versus stereotactic ablative radiotherapy for stage I non-small cell lung cancer.","url":"https://pubmed.ncbi.nlm.nih.gov/35348664/"},{"label":"Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach.","url":"https://pubmed.ncbi.nlm.nih.gov/33097244/"},{"label":"Video-Assisted Thoracoscopic or Open Lobectomy in Early-Stage Lung Cancer.","url":"https://pubmed.ncbi.nlm.nih.gov/38319202/"},{"label":"Surgical site infection following open lobectomy in patients with lung cancer: A prospective study.","url":"https://pubmed.ncbi.nlm.nih.gov/37399047/"},{"label":"[Segmentectomies in patients with primary malignant lung tumors].","url":"https://pubmed.ncbi.nlm.nih.gov/42296313/"},{"label":"Trends and comparative outcomes between operative approaches for segmentectomy in lung cancer.","url":"https://pubmed.ncbi.nlm.nih.gov/39002852/"},{"label":"Completion Pneumonectomy for Second Primary/Primary Lung Cancer and Local Recurrence Lung Cancer.","url":"https://pubmed.ncbi.nlm.nih.gov/33964258/"},{"label":"Survival after radiofrequency ablation and/or chemotherapy for lung cancer and pulmonary metastases: a systematic review and meta-analysis.","url":"https://pubmed.ncbi.nlm.nih.gov/37869011/"},{"label":"Robotic-assisted versus video-assisted lobectomy for resectable non-small-cell lung cancer: the RVlob randomized controlled trial.","url":"https://pubmed.ncbi.nlm.nih.gov/39105193/"},{"label":"Assessing Outcomes in Clinical Stage I Non-small Cell Lung Tumors up to Two Centimeters in Diameter in Segmentectomy vs. Lobectomy: Systematic Review and Meta-analysis.","url":"https://pubmed.ncbi.nlm.nih.gov/40114910/"},{"label":"Meta-analysis of lobectomy, segmentectomy, and wedge resection for stage I non-small cell lung cancer.","url":"https://pubmed.ncbi.nlm.nih.gov/25322915/"},{"label":"Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance).","url":"https://pubmed.ncbi.nlm.nih.gov/37473998/"}]},{"id":"request","title":"Request a treatment proposal","text":"Request a treatment proposal Share your diagnosis and reports through the Bookimed request form.","links":[]},{"id":"request-form","title":"Ask about treatment","text":"Ask about treatment What would you like help with? Answer a few questions on Bookimed, then add your contact details to request help. Privacy policy Open the Bookimed request form","links":[{"label":"Privacy policy","url":"https://us-uk.bookimed.com/page/privacy-policy/"}]}],"introduction":"Oncologic surgery guide / Lung cancer surgery Decision guide Lung cancer surgery Two different choices matter in lung cancer surgery: how much lung tissue to remove and how to reach it. Research project led by Yevhenii Kozlov · Co-Founder of Bookimed Updated 21 October 2026 Sources linked throughout","related_documents":[{"id":"oncologic-surgery","title":"Oncologic surgery: explore care by organ","kind":"home","url":"https://hub.bookimed.com/oncologic-surgery/","json_url":"https://hub.bookimed.com/oncologic-surgery/page-contexts/oncologic-surgery.json"},{"id":"clinic-7176","title":"Memorial Göztepe Hospital","kind":"clinic-profile","url":"https://hub.bookimed.com/oncologic-surgery/clinic-7176/","json_url":"https://hub.bookimed.com/oncologic-surgery/clinic-7176/#page-context"},{"id":"clinic-5615","title":"Medical Park Antalya Hospital Complex","kind":"clinic-profile","url":"https://hub.bookimed.com/oncologic-surgery/clinic-5615/","json_url":"https://hub.bookimed.com/oncologic-surgery/clinic-5615/#page-context"},{"id":"surgeon-bookimed-2922","title":"Mustafa 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