Table 1:

Best evidence papers

Author, date, country, level of evidence	Patient group	Outcomes		Key results	Comments
		5-year (or specified) survival rate	Locoregional recurrence
Nakamura et al. (2005), Japan Meta-analysis (level 1a)	Lobectomy: 1887 (Wedge resection + Segmentectomy): 903	Survival difference (5 years) = 3.6%	N/A	No significant difference in survival	Considerable heterogeneity, particularly after 5 years (Q = 33.6 P = 0.0004)
Ginsberg et al. (1995), USA Randomized control trial (level 1b)	Lobectomy: 125 (Wedge resection + Segmentectomy): 122	Overall death rate (persons/year): Lobectomy: 0.089 Limited resection: 0.117	(persons/year) Lobectomy: 0.020 Limited resection: 0.060	30% increase in the death rate with limited resection (P = 0.08) 300% increase in locoregional recurrence (P = 0.008)	Inconsistent mediastinal lymph node sampling
Kraev et al. (2007) USA Retrospective cohort study (level 2b)	Lobectomy: 215 Wedge resection: 74	Survival times: Lobectomy: 5.8 ± 0.3 years Wedge resection: 4.1 ± 0.3 years	N/A	No significant difference in the overall survival. Increased survival with lobectomy for tumours <3 cm in size (P = 0.029)	Small-cell lung cancers were also included
Landreneau et al. (1997), USA Retrospective cohort study (level 2b)	Lobectomy: 117 Wedge resection (open): 42 Wedge resection (VATS): 60	Lobectomy: 70% Wedge resection (Open): 58% Wedge resection (VATS): 65%	Wedge resection (Open): 30% Wedge resection (VATS): 26% Lobectomy-19%	Significant increase in survival with lobectomy (P = 0.02) No significant difference in locoregional recurrence	The 5-year survival differences were mainly due to non-cancer-related deaths
El-Sherif et al. (2006) USA Retrospective cohort study (level 2b)	Lobectomy: 577 Segmentectomy: 85 Wedge resection: 122	Lobectomy: 54% (Wedge resection + Segmentectomy)–40%	Lobectomy: 28% (Wedge resection + Segmentectomy): 29%	Significant increase in survival with lobectomy (P = 0.0038) No difference in locoregional recurrence Decrease in 5-year disease-free survival from 58% (lobectomy) to 50% (sublobar) in stage 1B patients (P = 0.0093)	Surgical approach unknown
Koike et al. (2002), Japan Prospective non-randomized analysis (level 2b)	Lobectomy: 159 Segmentectomy: 60 Wedge resection: 14	Lobectomy: 90% (Wedge resection + Segmentectomy)–89%	Lobectomy: 1.3% (Wedge resection + Segmentectomy): 2.7%	No significant difference in survival No significant difference in locoregional recurrence	Inconsistent mediastinal lymph node sampling
Keenan et al. (2004), USA Retrospective analysis (level 2b)	Lobectomy: 146 Segmentectomy: 54	(Kaplan-Meier 4-year survival) Lobectomy: 67% Segmentectomy: 62%	Lobectomy: 7.5% Segmentectomy: 11.1%	No significant difference in survival No significant difference in locoregional recurrence	Inconsistent mediastinal lymph node sampling
Read et al. (1990), USA Retrospective study (level 2b)	Lobectomy: 113 Segmentectomy: 107 Wedge resection: 6	Lobectomy: 74% Segmentectomy: 84%	Lobectomy: 11.5% Segmentectomy: 4.4%	No significant difference in survival
Warren et al. (1994), USA Retrospective analysis (level 2b)	Lobectomy: 103 Segmentectomy: 66	Lobectomy: 65% Segmentectomy: 45% Calculated from survival graphs	Lobectomy: 4.9% Segmentectomy: 22.7%	Significant increase in overall survival with lobectomy. (P = 0.035) No significant survival difference for tumours <3 cm Significant increase in locoregional recurrence with segmentectomy	Surgical approach unknown
Okada et al. (2006), Japan Prospective nonrandomized study (level 2b)	Lobectomy: 305 (Wedge resection + Segmentectomy): 262	Lobectomy: 89.6% (Wedge resection + Segmentectomy): 89.1%	N/A	No significant difference in survival	Significant crossover between groups
Okada et al. (2001), Japan Prospective nonrandomized study (level 2b)	Lobectomy: 139 Segmentectomy: 70 Stage 1 NSCLC <2 cm	Lobectomy: 87.3% Segmentectomy: 77.7%	N/A	No significant difference in survival	Significant crossover between groups
Harpole et al. (1995), USA Retrospective analysis (level 2b)	Lobectomy: 193 Wedge resection: 75 Pneumonectomy: 21	Lobectomy: 62% Wedge resection: 61% Pneumonectomy: 270%	Lobectomy: 9.3% Wedge resection: 16% Pneumonectomy: 214.3%	No significant difference in survival No significant difference in locoregional recurrence	Trend towards decreased survival in wedge resection over lobectomy with tumours >3 cm (P = 0.067)
Mery et al. (2005), USA Retrospective cohort study (level 2b)	Lobectomy: 9875 (Wedge resection + Segmentectomy)–1403 Pneumonectomy: 292	Median survival time: <65 years–71 months 65–74 years–47 months ≥75 years–28 months	N/A	Significant increase in survival with lobectomy in patients <75 years old	Considerable heterogeneity of data. Stage II NSCLC also included in study
Rami-Porta et al. Spain (2009) Evidence-based clinical practice guidelines		Sublobar resections should be avoided in patients who can tolerate lobectomy (Grade of recommendation: A) In patients unable to undergo lobectomy, sublobar resection is an alternative that will confer similar prognosis (Degree of recommendation: B) Wedge resection should be reserved for patients aged >71 years (Degree of recommendation: B) If the intra-operative diagnosis of bronchioloalveolar carcinoma is certain, because of its non-invasive nature and lack of nodal involvement, sublobar resection with no systematic nodal dissection may be sufficient treatment for this particular type of tumour (Degree of recommendation: B)
Okumura et al. (2007), Japan Retrospective study (level 2b)	Lobectomy: 1241 Segmentectomy: 144	Tumours ≤2 cm: Lobectomy: 18% Segmentectomy: 83% Tumours >2 cm: Lobectomy: 78% Segmentectomy: 58%	N/A	Significant increase in survival with lobectomy in tumours >2 cm (P = 0.057)
Nakamura et al. (2011), Japan Prospective non-randomized study (level 2b)	Lobectomy: 289 Segmentectomy: 38 Wedge resection: 84	Lobectomy: 82.1% Segmentectomy: 87.2% Wedge resection: 55.4%	Lobectomy: 18.0% Segmentectomy: 7.9% Wedge resection: 15.5%	Significant decrease in survival with wedge resection (vs. lobectomy and segementectomy) (P = 0.0003)