title: Limited resections in high-risk patients.
abstract: OBJECTIVE
  The role of limited, sublobar resection in patients with early-stage nonsmall cell lung cancer (NSCLC) remains controversial. Alternative treatments for surgical resection include stereotactic radiotherapy and radiofrequency ablation. In this review, the role of limited resection is discussed in patients presenting a s high-risk for s surgical intervention.
  
  
  RESULTS
  Clear definitions of high-risk patients are currently lacking, as well as, randomized prospective studies indicating which treatment to offer in this population. Awaiting results of two major ongoing trials, at this moment the decision-making process is heavily dependent on retrospective analyses. For selected patients sublobar resection may be a valid oncological option for clinical stage IA NSCLC.
  
  
  CONCLUSIONS
  Surgery remains the gold standard for NSCLC. In case of high-risk patients, a multidisciplinary consultation should advise the patient which treatment option to choose. In early-stage NSCLC, sublobar anatomical resection is preferred over nonsurgical procedures to determine nodal status and prognosis. In case of patients unfit for surgery, stereotactic radiotherapy is a good alternative. A randomized prospective study is necessary to determine survival in high-risk patients allocated to surgery (lobectomy or sublobar resection) or radiation-based treatment.
authors.affiliation: Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Wilrijkstraat, Edegem, Belgium.
authors.forename: Michèle
authors.initials: M
authors.lastname: De Waele
authors.forename: Paul
authors.initials: P
authors.lastname: Van Schil
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D017115:Catheter Ablation; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods; D012307:Risk Factors