Locoregional recurrence after pulmonary sublobar resection of non-small cell lung cancer: can it be reduced by considering cancer cells at the surgical margin?

The standard surgical procedure for resectable non-small cell lung cancer (NSCLC) is a pulmonary lobectomy, while a sublobar resection is done with an expected curative power equivalent to a pulmonary lobectomy or as a limited operation. The incidence of locoregional recurrence is lower after a pulmonary lobectomy than a pulmonary segmentectomy, followed by a pulmonary wedge resection of NSCLC. One of the causes of locoregional recurrence following pulmonary sublobar resection is speculated to be the cancer cells remaining around the surgical margin, thus irradiation of that area may reduce the rate of such recurrence. However, it may also be prevented using an adequate surgical technique that provides a distance from the surgical margin to the tumor that is greater than the size of the tumor, as the possibility of cancer cells in the surgical margin is very low when the margin-tumor distance is sufficient.