The standard treatment for stage I NSCLC is lobectomy with mediastinal lymph node sampling or dissection. The role of limited resection for stage IA lesions, especially those ≤ 2 cm in diameter is controversial despite many proponents. Patients with physiologic limitation prohibiting lobectomy should be evaluated for sublobar resection, as it seems to offer increasingly similar overall and cancer-free survival rates. Limited resection should be done with systematic or complete lymph node sampling.
As limited resection leads to better postoperative lung function of pulmonary function and decreased morbidity, it may become the preferred strategy for these patients in the future. Non-randomized series comparing patients undergoing sublobar resection because of compromised lung function and those undergoing formal lobectomy show similar long-term survival and cancer-free survival especially for stage IA tumours less than 2 cm.