Journal Review in Thoracic Surgery: Lobar vs Sublobar Resection for Stage 1A NSCLC – CALGB & JCOG

Behind The Knife: The Surgery Podcast

Medicine, Health & Fitness, Education, Science

4.8 • 1.4K Ratings

🗓️ 7 December 2023

⏱️ 49 minutes

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Summary

In this episode our team reviews the two groundbreaking RCTs which challenged the long-held dogma that a lobectomy is the only acceptable oncologic procedure for NSCLC. Listen as we compare and contrast the North American CALGB trial and Japanese JCOG trial which were both designed to investigate survival and recurrence outcomes by randomizing stage 1A patients to lobectomy versus a sublobar resection.

Learning Objectives:
-Compare and contrast the patient characteristics of the CALGB and JCOG trials
-Understand the methodology each trial and be able to explain their nuanced differences
-Analyze the results of the CALGB and JCOG trials and how they apply to patients today

Hosts:
Kelly Daus MD, Peter White MD, Eric Vallieres, MD and Brian Louie MD

Referenced Material
https://pubmed.ncbi.nlm.nih.gov/36780674/
Altorki N, et al. Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med. 2023 Feb 9;388(6):489-498. doi: 10.1056/NEJMoa2212083. PMID: 36780674; PMCID: PMC10036605.

https://pubmed.ncbi.nlm.nih.gov/35461558/’
Saji H, et al. West Japan Oncology Group and Japan Clinical Oncology Group. 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. Lancet. 2022 Apr 23;399(10335):1607-1617. doi: 10.1016/S0140-6736(21)02333-3. PMID: 35461558.

https://pubmed.ncbi.nlm.nih.gov/37473998/
Altorki N, et al. Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance). J Thorac Cardiovasc Surg. 2023 Jul 18:S0022-5223(23)00612-8. doi: 10.1016/j.jtcvs.2023.07.008. Epub ahead of print. PMID: 37473998.

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Transcript

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0:00.0	Behind the surgery podcast relevant and engaging content designed to help you dominate the day.
0:13.0	Hello and welcome back to another journal review in thoracic
0:27.0	surgery with your Swedish Medical Center thoracic surgery team.
0:30.5	I'm Kelly Dawes a third year surgical resident here at Swedish and today I'm
0:35.3	joined by the fabulous doctors Brian Louie and Peter White. We are really
0:40.8	excited to share with you guys this journal club today comparing two landmark trials investigating LOBAR for sub-LOBAR resell bar section for peripheral stage 1A non- small cell lung cancer.
0:54.0	The Japanese J-Cog trial was published in Lancet in April of 2022 and the US, Canadian, and
1:01.4	and Australian cow g-g-b trial was published in the New England Journal of Medicine in February of 2023.
1:08.0	They also have a brand new subset analysis comparing wedge to segmentectomy, which was published this summer.
1:14.8	We've got a lot to get through in this episode, and joining us to help ensure we do justice
1:20.1	to such a groundbreaking journal club is Dr. Eric Valier,
1:24.0	our chair of thoracic surgery here at Swedish Medical Center.
1:27.5	Dr Valier, we're honored to have you here with us today.
1:30.0	All right, well, before we dive the discussion, these two groundbreaking trials, it's really
1:36.0	important to understand the historical context and provide some background as to why these trials
1:41.4	were even developed.
1:42.8	And so in order to understand their impact
1:45.8	on how we manage patients with early stage lung cancer,
1:49.2	Brian, why don't you kind of review
1:51.1	some of that literature for us.
1:53.0	Thanks, Peter.
1:54.0	You know, we need to go back almost 30 years ago in 1995
	...

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