Meta-analysis shows sublobar resection linked to worse survival outcomes compared with lobectomy for early-stage non-small cell lung cancer patients

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Frontiers in Medicine Published June 7, 2026 Medically reviewed June 7, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Sublobar resection is associated with higher hazards for survival in Stage I NSCLC, though evidence certainty is low.

An extensive umbrella review evaluated existing meta-analyses comparing sublobar resection against lobectomy for Stage I non-small cell lung cancer. The pooled hazard ratio for overall survival was 1.09 for Stage I disease, suggesting a slight survival disadvantage with the less invasive procedure. For Stage IA specifically, the hazard ratio was 1.10, though confidence intervals crossed unity in some analyses.

sublobar resection also demonstrated inferior disease-free survival with a pooled hazard ratio of 1.13. These findings held true for Stage IA as well, where the hazard ratio remained at 1.13. The review highlights that while sublobar resection is less invasive, it may compromise long-term oncologic outcomes in early-stage disease.

However, the certainty of this evidence is predominantly low or very low. Substantial heterogeneity, small-study effects, and overlap among primary evidence limit the strength of conclusions. Consequently, these results should not replace recent randomized trials but rather clarify the quality and applicability of current meta-analytic data.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

BackgroundWhether sublobectomy achieves survival outcomes comparable to lobectomy in Stage I non-small cell lung cancer (NSCLC) remains controversial. With increasing adoption of parenchymal-sparing surgery, a comprehensive evaluation of available evidence is warranted.MethodsA bibliometric analysis (2015–2025) was conducted alongside an umbrella review. PubMed, Embase, Web of Science, and CINAHL were searched for systematic reviews and meta-analyses comparing lobectomy and sublobectomy in Stage I NSCLC. Methodological quality was assessed using AMSTAR-2, and certainty of evidence was graded with GRADE. Summary hazard ratios (HRs) and heterogeneity were recalculated using random-effects models after removal of duplicate primary studies.ResultsEighteen reviews were included (9 high quality, 4 moderate, 5 critically low). Bibliometric analysis showed recent research bursts related to overall survival, disease-free survival, pulmonary segmentectomy, multicenter studies, and robotic-assisted thoracoscopic surgery. For overall survival (OS), pooled HRs varied and several analyses showed substantial heterogeneity (I² >70%). In recalculated pooled analyses, Stage I NSCLC showed an HR of 1.09 (95% CI 1.02–1.16; I² = 71.6%) and Stage IA an HR of 1.10 (95% CI 0.99–1.22; I² = 77.1%). For disease-free survival (DFS), HRs were 1.13 (95% CI 1.04–1.23; I² = 9.4%) for Stage I and 1.13 (95% CI 1.01–1.27; I² = 21.8%) for Stage IA. Evidence certainty was predominantly low or very low.ConclusionSublobar resection was associated with small but statistically significant higher hazards for OS and DFS in the broader Stage I population, whereas Stage IA OS did not differ significantly. However, OS estimates were limited by substantial heterogeneity, small-study effects, overlap among primary evidence, and predominantly low or very low certainty. This umbrella review clarifies the quality, bias, overlap, and applicability of existing meta-analytic evidence rather than replacing recent randomized trials.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251150573, identifier CRD420251150573.