{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T15:28:16Z","timestamp":1793633296155,"version":"4.5.1"},"reference-count":91,"publisher":"Oxford University Press (OUP)","issue":"11-12","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Randomized trials have established anatomical segmentectomy as an acceptable alternative to lobectomy for selected patients with peripheral, node-negative Non Small Cell Lung Cancer (NSCLC) \u22642 cm. However, trial populations were highly selected, and tumour diameter alone does not capture the biological heterogeneity of early-stage disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To critically review the importance of tumour biology on outcomes following lobectomy or segmentectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A structured search of Undermind and PubMed identified comparative studies, randomized trials, meta-analyses, and consensus evidence available through August 10, 2026. Evidence was critically appraised and synthesized narratively, with emphasis on recurrence, survival, staging, and technical quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Segmentectomy provides excellent outcomes when adequate margins, anatomical completeness, and rigorous nodal assessment are achieved. Ground-glass opacity (GGO)-dominant tumours, particularly those with low consolidation-to-tumour ratio (CTR), represent the strongest candidates for parenchymal preservation. Increasing CTR, pure-solid morphology, larger size, high Fluorodeoxyglucose (FDG) uptake, micropapillary or solid histology, spread through air spaces (STAS), visceral pleural invasion, and lymphovascular invasion identify progressively higher-risk phenotypes, but none alone consistently proves that lobectomy improves survival. Micropapillary components exceeding approximately 5%, STAS, inadequate margins, incomplete staging, and multiple coexisting adverse features strengthen the rationale for lobectomy. Segmentectomy is generally preferable to wedge resection for solid, deeper, or biologically aggressive lesions, whereas wedge resection remains reasonable for carefully selected small, peripheral, GGO-dominant tumours. The favourable results of randomized trials depend on accurate preoperative and intraoperative staging and should not be generalized to unselected cT1c or biologically aggressive tumours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Sublobar resection should be viewed as refined selection rather than replacement of lobectomy. Tumour size defines eligibility, but biology increasingly determines suitability. Precision surgery will require prospective validation of integrated models combining morphology, metabolism, pathology, molecular biomarkers, patient physiology, and technical quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezag228","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:23:11Z","timestamp":1790310191000},"source":"Crossref","is-referenced-by-count":0,"title":["Beyond Tumour Size: Integrating Tumour Biology and Technical Quality to Select the Extent of Resection in Early-Stage NSCLC"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6505-1656","authenticated-orcid":false,"given":"Alessandro","family":"Brunelli","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Leeds Teaching Hospitals NHS Trust , Leeds, LS9 7TF,","place":["United Kingdom"]},{"name":"School of Medicine, University of Leeds , Leeds,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"2026110209465989200_ezag228-B1","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1016\/S0140-6736(21)02333-3","article-title":"Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802\/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial","volume":"399","author":"Saji","year":"2022","journal-title":"Lancet"},{"key":"2026110209465989200_ezag228-B2","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1056\/NEJMoa2212083","article-title":"Lobar or sublobar resection for peripheral stage IA non-small-cell lung cancer","volume":"388","author":"Altorki","year":"2023","journal-title":"N Engl J Med"},{"key":"2026110209465989200_ezag228-B3","doi-asserted-by":"publisher","first-page":"2449","DOI":"10.1200\/JCO.2013.50.8762","article-title":"Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis","volume":"32","author":"Landreneau","year":"2014","journal-title":"J Clin Oncol"},{"key":"2026110209465989200_ezag228-B4","doi-asserted-by":"publisher","first-page":"1882","DOI":"10.1016\/j.athoracsur.2020.01.020","article-title":"Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer","volume":"110","author":"Onaitis","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2026110209465989200_ezag228-B5","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1093\/icvts\/ivab212","article-title":"Lobectomy versus segmentectomy: a propensity score-matched comparison of postoperative complications, pulmonary function and prognosis","volume":"34","author":"Nomori","year":"2022","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2026110209465989200_ezag228-B6","doi-asserted-by":"publisher","first-page":"ivad204","DOI":"10.1093\/icvts\/ivad204","article-title":"Minimally invasive segmentectomy and lobectomy for peripheral stage IA1-2 non-small-cell lung cancer: a case-matched cohort study from a UK Centre","volume":"37","author":"Brunelli","year":"2023","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"2026110209465989200_ezag228-B7","doi-asserted-by":"publisher","first-page":"ezae388","DOI":"10.1093\/ejcts\/ezae388","article-title":"European multicentre study evaluating the prognosis of peripheral early-stage lung adenocarcinoma patients operated on by segmentectomy or lobectomy","volume":"66","author":"Lula","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026110209465989200_ezag228-B8","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1093\/ejcts\/ezz339","article-title":"Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: a systematic review and meta-analysis","volume":"57","author":"Winckelmans","year":"2020","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026110209465989200_ezag228-B9","doi-asserted-by":"publisher","first-page":"107990","DOI":"10.1016\/j.lungcan.2024.107990","article-title":"Segmentectomy vs. lobectomy in stage IA non-small cell lung cancer: a systematic review and meta-analysis of perioperative and survival outcomes","volume":"197","author":"Bertolaccini","year":"2024","journal-title":"Lung Cancer"},{"key":"2026110209465989200_ezag228-B10","doi-asserted-by":"publisher","first-page":"4187","DOI":"10.21037\/tlcr-2025-816","article-title":"Survival after wedge resection, segmentectomy and lobectomy for clinical stage IA non-small cell lung cancer: a systematic review and network meta-analysis","volume":"14","author":"Sun","year":"2025","journal-title":"Transl Lung Cancer Res"},{"key":"2026110209465989200_ezag228-B11","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.jtcvs.2020.09.146","article-title":"A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer","volume":"163","author":"Suzuki","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B12","doi-asserted-by":"publisher","first-page":"ezad222","DOI":"10.1093\/ejcts\/ezad222","article-title":"European guidelines for the surgical management of pure ground-glass opacities and part-solid nodules: task force of the European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons","volume":"64","author":"Cardillo","year":"2023","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026110209465989200_ezag228-B13","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.21037\/tlcr-24-191","article-title":"Segmentectomy versus lobectomy for ground-glass opacity dominant cT1N0 invasive lung adenocarcinoma","volume":"13","author":"Ma","year":"2024","journal-title":"Transl Lung Cancer Res"},{"key":"2026110209465989200_ezag228-B14","doi-asserted-by":"publisher","first-page":"e233244","DOI":"10.1148\/radiol.233244","article-title":"Predicting recurrence after sublobar resection in patients with lung adenocarcinoma using preoperative chest CT scans","volume":"313","author":"Yun","year":"2024","journal-title":"Radiology"},{"key":"2026110209465989200_ezag228-B15","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/S2213-2600(23)00382-X","article-title":"Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer with radiologically pure-solid appearance in Japan (JCOG0802\/WJOG4607L): a post-hoc supplemental analysis of a multicentre, open-label, phase 3 trial","volume":"12","author":"Hattori","year":"2024","journal-title":"Lancet Respir Med"},{"key":"2026110209465989200_ezag228-B16","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1016\/j.jtho.2024.03.015","article-title":"The International Association for the Study of Lung Cancer (IASLC) staging project for lung cancer: recommendation to introduce spread through air spaces as a histologic descriptor in the ninth edition of the TNM classification of lung cancer. Analysis of 4061 pathologic stage I NSCLC","volume":"19","author":"Travis","year":"2024","journal-title":"J Thorac Oncol"},{"key":"2026110209465989200_ezag228-B17","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1016\/j.jtho.2020.01.008","article-title":"Tumor spread through air spaces is a predictor of occult lymph node metastasis in clinical stage IA lung adenocarcinoma","volume":"15","author":"Vaghjiani","year":"2020","journal-title":"J Thorac Oncol"},{"key":"2026110209465989200_ezag228-B18","doi-asserted-by":"publisher","first-page":"3382","DOI":"10.3390\/cancers17203382","article-title":"Visceral pleural invasion as a determinant of surgical strategy in non-small cell lung cancer: a multicenter study","volume":"17","author":"Nagase","year":"2025","journal-title":"Cancers (Basel)"},{"key":"2026110209465989200_ezag228-B19","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1016\/j.athoracsur.2013.11.002","article-title":"Lymphovascular invasion as a prognostic indicator in stage I non-small cell lung cancer: a systematic review and meta-analysis","volume":"97","author":"Mollberg","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2026110209465989200_ezag228-B20","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1148\/radiol.211582","article-title":"CT-based radiogenomic analysis of clinical stage I lung adenocarcinoma with histopathologic features and oncologic outcomes","volume":"303","author":"Perez-Johnston","year":"2022","journal-title":"Radiology"},{"key":"2026110209465989200_ezag228-B21","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1093\/jnci\/djt166","article-title":"Impact of micropapillary histologic subtype in selecting limited resection vs lobectomy for lung adenocarcinoma of 2 cm or smaller","volume":"105","author":"Nitadori","year":"2013","journal-title":"J Natl Cancer Inst"},{"key":"2026110209465989200_ezag228-B22","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1016\/S2213-2600(23)00041-3","article-title":"Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): a multicentre, single-arm, confirmatory, phase 3 trial","volume":"11","author":"Aokage","year":"2023","journal-title":"Lancet Respir Med"},{"key":"2026110209465989200_ezag228-B23","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.xjon.2024.05.002","article-title":"Oncologic outcomes after minimally invasive segmentectomy or lobectomy in patients with hypermetabolic clinical stage IA1-2 non-small cell lung cancer","volume":"20","author":"Brunelli","year":"2024","journal-title":"JTCVS Open"},{"key":"2026110209465989200_ezag228-B24","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.athoracsur.2018.07.042","article-title":"Segmentectomy is equivalent to lobectomy in hypermetabolic clinical stage IA lung adenocarcinomas","volume":"107","author":"Kamel","year":"2019","journal-title":"Ann Thorac Surg"},{"key":"2026110209465989200_ezag228-B25","doi-asserted-by":"publisher","first-page":"100861","DOI":"10.1016\/j.jtocrr.2025.100861","article-title":"Occult node detection with lobectomy versus segmentectomy for stage IA NSCLC","volume":"6","author":"Suzuki","year":"2025","journal-title":"JTO Clin Res Rep"},{"key":"2026110209465989200_ezag228-B26","doi-asserted-by":"publisher","first-page":"2099","DOI":"10.1245\/s10434-015-5043-9","article-title":"Minor components of micropapillary and solid subtypes in lung adenocarcinoma are predictors of lymph node metastasis and poor prognosis","volume":"23","author":"Zhao","year":"2016","journal-title":"Ann Surg Oncol"},{"key":"2026110209465989200_ezag228-B27","doi-asserted-by":"publisher","first-page":"1758835920937893","DOI":"10.1177\/1758835920937893","article-title":"Procedure-specific prognostic impact of micropapillary subtype may guide resection strategy in small-sized lung adenocarcinomas: a multicenter study","volume":"12","author":"Su","year":"2020","journal-title":"Ther Adv Med Oncol"},{"key":"2026110209465989200_ezag228-B28","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.jtho.2018.09.005","article-title":"Lobectomy is associated with better outcomes than sublobar resection in spread through air spaces (STAS)-positive T1 lung adenocarcinoma: a propensity score-matched analysis","volume":"14","author":"Eguchi","year":"2019","journal-title":"J Thorac Oncol"},{"key":"2026110209465989200_ezag228-B29","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1097\/JTO.0000000000000486","article-title":"Tumor spread through air spaces is an important pattern of invasion and impacts the frequency and location of recurrences after limited resection for small stage I lung adenocarcinomas","volume":"10","author":"Kadota","year":"2015","journal-title":"J Thorac Oncol"},{"key":"2026110209465989200_ezag228-B30","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1053\/j.semtcvs.2022.02.001","article-title":"Segmentectomy provides comparable outcomes to lobectomy for stage IA non-small cell lung cancer with spread through air spaces","volume":"35","author":"Ikeda","year":"2023","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B31","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.1016\/j.jtcvs.2025.12.018","article-title":"Extent of resection for spread-through air spaces-positive stage IA1-2 non-small cell lung cancer","volume":"171","author":"Yang","year":"2026","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B32","doi-asserted-by":"publisher","first-page":"108838","DOI":"10.1016\/j.lungcan.2025.108838","article-title":"Threshold of adequate resection margin for sub-lobar resection in peripheral clinical stage IA1-2 non-small cell lung cancer with tumor spread through air spaces","volume":"210","author":"Pan","year":"2025","journal-title":"Lung Cancer"},{"key":"2026110209465989200_ezag228-B33","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1378\/chest.13-0394","article-title":"Visceral pleural invasion does not affect recurrence or overall survival among patients with lung adenocarcinoma \u2264 2 cm: a proposal to reclassify T1 lung adenocarcinoma","volume":"144","author":"Nitadori","year":"2013","journal-title":"Chest"},{"key":"2026110209465989200_ezag228-B34","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1001\/jamaoncol.2024.2491","article-title":"Recurrence of non-small cell lung cancer with visceral pleural invasion: a secondary analysis of a randomized clinical trial","volume":"10","author":"Altorki","year":"2024","journal-title":"JAMA Oncol"},{"key":"2026110209465989200_ezag228-B35","doi-asserted-by":"publisher","first-page":"830470","DOI":"10.3389\/fonc.2022.830470","article-title":"Treatment modality for stage IB peripheral non-small cell lung cancer with visceral pleural invasion and \u22643 cm in size","volume":"12","author":"Huang","year":"2022","journal-title":"Front Oncol"},{"key":"2026110209465989200_ezag228-B36","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1016\/j.athoracsur.2023.06.020","article-title":"Segmentectomy vs lobectomy for early non-small cell lung cancer with visceral pleural invasion","volume":"117","author":"Mathey-Andrews","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"2026110209465989200_ezag228-B37","doi-asserted-by":"publisher","first-page":"e99","DOI":"10.1016\/j.cllc.2024.11.007","article-title":"Lobectomy is not associated with improved survival as compared to segmentectomy in early-stage lung cancer patients with visceral pleural invasion","volume":"26","author":"Whitehorn","year":"2025","journal-title":"Clin Lung Cancer"},{"key":"2026110209465989200_ezag228-B38","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.lungcan.2020.04.033","article-title":"Comparison of prognostic impact of lymphovascular invasion in stage IA non-small cell lung cancer after lobectomy versus sublobar resection: a propensity score-matched analysis","volume":"146","author":"Yun","year":"2020","journal-title":"Lung Cancer"},{"key":"2026110209465989200_ezag228-B39","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.atssr.2025.11.003","article-title":"Sublobar resection in stage I non-small cell lung cancer with lymphovascular invasion","volume":"4","author":"Brady","year":"2026","journal-title":"Ann Thorac Surg Short Rep"},{"key":"2026110209465989200_ezag228-B40","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.atssr.2024.12.011","article-title":"Lobectomy vs segmentectomy in stage I non-small cell lung cancer with lymphatic vascular invasion","volume":"3","author":"Stanley","year":"2025","journal-title":"Ann Thorac Surg Short Rep"},{"key":"2026110209465989200_ezag228-B41","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/j.xjon.2023.11.003","article-title":"Vascular invasion predicts the subgroup of lung adenocarcinomas \u22642.0 cm at risk of poor outcome treated by wedge resection compared to lobectomy","volume":"16","author":"Ma","year":"2023","journal-title":"JTCVS Open"},{"key":"2026110209465989200_ezag228-B42","doi-asserted-by":"publisher","first-page":"S0022","DOI":"10.1016\/j.jtcvs.2026.06.023","article-title":"Resection outcomes according to pathologic risk in \u22642 cm invasive lung adenocarcinoma","volume":"9","author":"Yang","year":"2026","journal-title":"J Thorac Cardiovasc Surg."},{"key":"2026110209465989200_ezag228-B43","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1016\/j.jtcvs.2024.05.009","article-title":"High-risk features associated with recurrence in stage I lung adenocarcinoma","volume":"169","author":"Fick","year":"2025","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B44","doi-asserted-by":"publisher","first-page":"108541","DOI":"10.1016\/j.ejso.2024.108541","article-title":"Sublobar resection for small-sized non-small cell lung cancer: a comprehensive comparison between subsegmentectomy, segmentectomy and wedge resection","volume":"50","author":"Li","year":"2024","journal-title":"Eur J Surg Oncol"},{"key":"2026110209465989200_ezag228-B45","doi-asserted-by":"publisher","first-page":"ezaf281","DOI":"10.1093\/ejcts\/ezaf281","article-title":"Wedge resection versus segmentectomy in early-stage lung cancer considering resection margin and lymph node evaluation: a retrospective study","volume":"67","author":"Kim","year":"2025","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026110209465989200_ezag228-B46","doi-asserted-by":"publisher","first-page":"ezad224","DOI":"10.1093\/ejcts\/ezad224","article-title":"European society of thoracic surgeons expert consensus recommendations on technical standards of segmentectomy for primary lung cancer","volume":"63","author":"Brunelli","year":"2023","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026110209465989200_ezag228-B47","doi-asserted-by":"crossref","first-page":"ezae351","DOI":"10.1093\/ejcts\/ezae351","article-title":"Optimal planning and management strategies for minimally invasive lung segmentectomies: an international Delphi consensus report","volume":"66","author":"Bertolaccini","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026110209465989200_ezag228-B48","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.xjon.2023.03.013","article-title":"Asia expert consensus on segmentectomy in non-small cell lung cancer: a modified Delphi study","volume":"14","author":"Liu","year":"2023","journal-title":"JTCVS Open"},{"key":"2026110209465989200_ezag228-B49","doi-asserted-by":"publisher","first-page":"1919","DOI":"10.1016\/j.jtcvs.2022.08.042","article-title":"When a segmentectomy is not a segmentectomy: quality assurance audit and evaluation of required elements for an anatomic segmentectomy","volume":"165","author":"Weiss","year":"2023","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B50","doi-asserted-by":"crossref","first-page":"ezae089","DOI":"10.1093\/ejcts\/ezae089","article-title":"Complete anatomic segmentectomy shows improved oncologic outcomes compared to incomplete anatomic segmentectomy","volume":"65","author":"McAllister","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026110209465989200_ezag228-B51","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.jtcvs.2022.05.050","article-title":"National trends in the quality of segmentectomy for lung cancer","volume":"165","author":"Logan","year":"2023","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B52","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1111\/1759-7714.14840","article-title":"Segmentectomy versus lobectomy for small-sized pure solid non-small cell lung cancer","volume":"14","author":"Li","year":"2023","journal-title":"Thorac Cancer"},{"key":"2026110209465989200_ezag228-B53","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1097\/JS9.0000000000000896","article-title":"Differential efficacy of segmentectomy and wedge resection in sublobar resection compared to lobectomy for solid-dominant stage IA lung cancer: a systematic review and meta-analysis","volume":"110","author":"Lin","year":"2024","journal-title":"Int J Surg"},{"key":"2026110209465989200_ezag228-B54","doi-asserted-by":"publisher","first-page":"1500","DOI":"10.1016\/j.athoracsur.2018.11.046","article-title":"Long-term prognosis after segmentectomy for cT1 N0 M0 non-small cell lung cancer","volume":"107","author":"Nomori","year":"2019","journal-title":"Ann Thorac Surg"},{"key":"2026110209465989200_ezag228-B55","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1016\/j.jtcvs.2014.03.019","article-title":"Clinical outcomes and changes in lung function after segmentectomy versus lobectomy for lung cancer cases","volume":"148","author":"Deng","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B56","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1378\/chest.13-1094","article-title":"Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy","volume":"145","author":"Tsutani","year":"2014","journal-title":"Chest"},{"key":"2026110209465989200_ezag228-B57","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1093\/ejcts\/ezu429","article-title":"Outcomes of segmentectomy for cT1bN0M0 lung adenocarcinoma and squamous cell carcinoma: a possible association with pathological invasion","volume":"48","author":"Ogawa","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026110209465989200_ezag228-B58","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/j.chest.2020.06.066","article-title":"The effect of tumor size and histologic findings on outcomes after segmentectomy vs lobectomy for clinically node-negative non-small cell lung cancer","volume":"159","author":"Raman","year":"2021","journal-title":"Chest"},{"key":"2026110209465989200_ezag228-B59","doi-asserted-by":"publisher","first-page":"3175","DOI":"10.1200\/JCO.2015.64.6729","article-title":"Choice of surgical procedure for patients with non-small-cell lung cancer \u2264 1 cm or &gt; 1 to 2 cm among lobectomy, segmentectomy, and wedge resection: a population-based study","volume":"34","author":"Dai","year":"2016","journal-title":"J Clin Oncol"},{"key":"2026110209465989200_ezag228-B60","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1016\/j.chest.2025.05.047","article-title":"Segmentectomy vs lobectomy for patients with 2- to 3-cm non-small cell lung cancer","volume":"168","author":"Mathey-Andrews","year":"2025","journal-title":"Chest"},{"key":"2026110209465989200_ezag228-B61","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/j.xjon.2025.01.014","article-title":"Pathologic upstaging and survival outcomes for patients undergoing segmentectomy versus lobectomy in clinical stage T1cN0M0 non-small cell lung cancer","volume":"24","author":"Jacobs","year":"2025","journal-title":"JTCVS Open"},{"key":"2026110209465989200_ezag228-B62","doi-asserted-by":"publisher","first-page":"ivad152","DOI":"10.1093\/icvts\/ivad152","article-title":"Oncologic outcomes of segmentectomy versus lobectomy for clinical T1c radiological pure-solid non-small-cell lung cancer","volume":"37","author":"Hattori","year":"2023","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"2026110209465989200_ezag228-B63","doi-asserted-by":"publisher","first-page":"900","DOI":"10.21037\/tlcr-20-1217","article-title":"Segmental resection is associated with decreased survival in patients with stage IA non-small cell lung cancer with a tumor size of 21-30 mm","volume":"10","author":"Yu","year":"2021","journal-title":"Transl Lung Cancer Res"},{"key":"2026110209465989200_ezag228-B64","doi-asserted-by":"publisher","first-page":"ivac246","DOI":"10.1093\/icvts\/ivac246","article-title":"Oncologic outcomes of segmentectomy for stage IA radiological solid-predominant lung cancer &gt;2 cm in maximum tumour size","volume":"35","author":"Hattori","year":"2022","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2026110209465989200_ezag228-B65","doi-asserted-by":"publisher","first-page":"ivad158","DOI":"10.1093\/icvts\/ivad158","article-title":"Segmentectomy for stage IA3 tumours: just another day in clinic","volume":"37","author":"Brunelli","year":"2023","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"2026110209465989200_ezag228-B66","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1016\/j.cllc.2024.01.004","article-title":"A multi-institutional, randomized, phase III trial comparing anatomical segmentectomy and lobectomy for clinical stage IA3 pure-solid non-small-cell lung cancer: West Japan Oncology Group Study WJOG16923L (STEP UP trial)","volume":"25","author":"Kamigaichi","year":"2024","journal-title":"Clin Lung Cancer"},{"key":"2026110209465989200_ezag228-B67","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1093\/jjco\/hyaf104","article-title":"A multi-institutional randomized phase III trial of lobectomy versus segmentectomy for radiologically solid-predominant non-small cell lung cancer with a ground-glass opacity and tumor diameter &gt; 2 cm and \u2264 3 cm: JCOG2217 (STRONG)","volume":"55","author":"Mitome","year":"2025","journal-title":"Jpn J Clin Oncol"},{"key":"2026110209465989200_ezag228-B68","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.lungcan.2022.04.005","article-title":"Prognostic impact of micropapillary and solid histological subtype on patients undergoing curative resection for stage I lung adenocarcinoma according to the extent of pulmonary resection and lymph node assessment","volume":"168","author":"Jeon","year":"2022","journal-title":"Lung Cancer"},{"key":"2026110209465989200_ezag228-B69","doi-asserted-by":"publisher","first-page":"101687","DOI":"10.1016\/j.xjon.2026.101687","article-title":"European prognosis evaluation of early-stage lung adenocarcinoma patterns after lobectomy versus segmentectomy based on clinical stage settings","volume":"30","author":"Lula","year":"2026","journal-title":"JTCVS Open"},{"key":"2026110209465989200_ezag228-B70","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.athoracsur.2026.02.016","article-title":"Is sublobar resection optimal for peripheral nodules \u22642 cm with micropapillary or solid histologic components?","volume":"122","author":"Xu","year":"2026","journal-title":"Ann Thorac Surg"},{"key":"2026110209465989200_ezag228-B71","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1016\/j.jtcvs.2025.08.024","article-title":"Lobectomy improves disease-free survival over sublobar resection for high-risk stage IA non-small cell lung cancer","volume":"171","author":"Caso","year":"2026","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B72","first-page":"932","article-title":"Segmentectomy vs lobectomy for peripheral early-stage non-small cell lung cancer in patients with radiologically high risk tumors","volume-title":"Ann Thorac Surg Short Rep","author":"Hurley","year":"2026"},{"key":"2026110209465989200_ezag228-B73","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/j.jtcvs.2023.07.008","article-title":"Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: a post hoc analysis of CALGB 140503 (alliance)","volume":"167","author":"Altorki","year":"2024","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B74","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.athoracsur.2021.05.051","article-title":"American college of surgeons commission on cancer standard for curative intent pulmonary resection","volume":"113","author":"Nissen","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"2026110209465989200_ezag228-B75","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1016\/j.ejcts.2006.08.008","article-title":"ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer","volume":"30","author":"Lardinois","year":"2006","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026110209465989200_ezag228-B76","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1016\/j.jtcvs.2025.06.007","article-title":"The extent of lymph node dissection is not associated with disease-free survival following lobar or sublobar resection: results from Cancer and Leukemia Group B 140503 (Alliance)","volume":"170","author":"Altorki","year":"2025","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B77","doi-asserted-by":"publisher","first-page":"3081","DOI":"10.1200\/JCO-25-00610","article-title":"Phase III study of mediastinal lymph node dissection for ground glass opacity-dominant lung adenocarcinoma","volume":"43","author":"Zhang","year":"2025","journal-title":"J Clin Oncol"},{"key":"2026110209465989200_ezag228-B78","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1016\/j.jtcvs.2024.09.003","article-title":"Mediastinal lymph node dissection in segmentectomy for peripheral c-stage IA (\u22642 cm) non-small-cell lung cancer","volume":"169","author":"Adachi","year":"2025","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B79","doi-asserted-by":"publisher","first-page":"271","DOI":"10.5761\/atcs.oa.22-00216","article-title":"Extent of lymph node dissection in patients with small-sized peripheral non-small cell lung cancer during intentional segmentectomy","volume":"29","author":"Maniwa","year":"2023","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"2026110209465989200_ezag228-B80","doi-asserted-by":"publisher","first-page":"100363","DOI":"10.1016\/j.jtocrr.2022.100363","article-title":"Defining factors that allow for a more personalized approach to stage I NSCLC","volume":"3","author":"Donington","year":"2022","journal-title":"JTO Clin Res Rep"},{"key":"2026110209465989200_ezag228-B81","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1164\/rccm.201902-0294OC","article-title":"Genomic underpinnings of tumor behavior in in situ and early lung adenocarcinoma","volume":"201","author":"Qian","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"2026110209465989200_ezag228-B82","doi-asserted-by":"publisher","first-page":"6083","DOI":"10.1038\/s41467-020-19855-x","article-title":"Tumor evolutionary trajectories during the acquisition of invasiveness in early stage lung adenocarcinoma","volume":"11","author":"Wang","year":"2020","journal-title":"Nat Commun"},{"key":"2026110209465989200_ezag228-B83","doi-asserted-by":"publisher","first-page":"902056","DOI":"10.3389\/fonc.2022.902056","article-title":"Combined radiomic and visual assessment for improved detection of lung adenocarcinoma invasiveness on computed tomography scans: a multi-institutional study","volume":"12","author":"Vaidya","year":"2022","journal-title":"Front Oncol"},{"key":"2026110209465989200_ezag228-B84","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1038\/s41598-023-28242-7","article-title":"Artificial intelligence-based radiomics for the prediction of nodal metastasis in early-stage lung cancer","volume":"13","author":"Shimada","year":"2023","journal-title":"Sci Rep"},{"key":"2026110209465989200_ezag228-B85","doi-asserted-by":"publisher","first-page":"e205601","DOI":"10.1001\/jamasurg.2020.5601","article-title":"A genomic-pathologic annotated risk model to predict recurrence in early-stage lung adenocarcinoma","volume":"156","author":"Jones","year":"2021","journal-title":"JAMA Surg"},{"key":"2026110209465989200_ezag228-B86","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1016\/j.annonc.2022.02.007","article-title":"Residual ctDNA after treatment predicts early relapse in patients with early-stage non-small cell lung cancer","volume":"33","author":"Gale","year":"2022","journal-title":"Ann Oncol"},{"key":"2026110209465989200_ezag228-B87","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1200\/JCO.21.01929","article-title":"Circulating tumor DNA minimal residual disease detection of non-small-cell lung cancer treated with curative intent","volume":"40","author":"Pellini","year":"2022","journal-title":"J Clin Oncol"},{"key":"2026110209465989200_ezag228-B88","doi-asserted-by":"publisher","first-page":"2900","DOI":"10.1002\/ijc.70373","article-title":"Somatic copy number variation as a prognostic marker for recurrence in never-smokers with early-stage lung adenocarcinoma","volume":"158","author":"Vanstraelen","year":"2026","journal-title":"Int J Cancer"},{"key":"2026110209465989200_ezag228-B89","doi-asserted-by":"publisher","first-page":"446","DOI":"10.3390\/life12030446","article-title":"Near-infrared fluorescence tumor-targeted imaging in lung cancer: a systematic review","volume":"12","author":"Neijenhuis","year":"2022","journal-title":"Life (Basel)"},{"key":"2026110209465989200_ezag228-B90","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0000000000006525","article-title":"Prediction of spread through air spaces (STAS) by intraoperative frozen section for patients with cT1N0M0 invasive lung adenocarcinoma: a multi-center observational study (ECTOP-1016)","volume":"281","author":"Cao","year":"2025","journal-title":"Ann Surg"},{"key":"2026110209465989200_ezag228-B91","doi-asserted-by":"publisher","first-page":"100965","DOI":"10.1016\/j.landig.2025.100965","article-title":"Deep learning model for pathological invasiveness prediction using smartphone-based surgical resection images in clinical stage IA lung adenocarcinoma (SuRImage): a prospective, multicentric, diagnostic study","volume":"8","author":"Yao","year":"2026","journal-title":"Lancet Digit Health"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezag228\/71384332\/ezag228.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/11-12\/ezag228\/71384332\/ezag228.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/68\/11-12\/ezag228\/71384332\/ezag228.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T14:47:04Z","timestamp":1793630824000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezag228\/8834108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":91,"journal-issue":{"issue":"11-12","published-print":{"date-parts":[[2026,11,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezag228","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,9,24]]},"article-number":"ezag228"}}