• Disease-free survival [ Designated as safety issue: No ]
  

• Overall survival [ Designated as safety issue: No ]
  
• Rate of loco-regional and systemic recurrence [ Designated as safety issue: No ]
  
• Pulmonary function as measured by expiratory flow rate 6 months postoperatively [ Designated as safety issue: No ]
  

OBJECTIVES:

Primary

• Compare the disease-free survival of patients with small (≤ 2 cm) peripheral stage IA non-small cell lung cancer undergoing lobectomy vs sublobar resection (wedge resection or segmentectomy).

Secondary

• Compare the overall survival of patients undergoing lobectomy vs sublobar resection.
• Compare the rates of loco-regional and systemic recurrence in patients undergoing lobectomy vs sublobar resection.
• Compare the pulmonary function of these patients, as measured by expiratory flow rates at 6 months postoperatively.
• Explore the relationship between characteristics of the primary lung cancer, as revealed by pre-operative CT scan and positron emission tomography (PET) imaging, and outcomes.
• Determine the false-negative rate of preoperative PET scan for identification of involved hilar and mediastinal lymph nodes.
• Assess the utility of annual follow-up CT scan after surgical resection in these patients.

OUTLINE: This is a multicenter, randomized study. Patients are stratified according to tumor size (< 1 cm vs 1-1.5 cm vs > 1.5-2.0 cm) (based on the maximum dimension determined from the preoperative scan), histology (squamous cell carcinoma vs adenocarcinoma vs other), and smoking status (never smoked [smoked < 100 cigarettes over lifetime] vs former smoker [smoked > 100 cigarettes AND quit ≥ 1 year ago] vs current smoker[quit < 1 year ago or currently smokes]). Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients undergo lobectomy by open thoracotomy or video-assisted thoracoscopic surgery (VATS).
• Arm II: Patients undergo a wedge resection or anatomical segmentectomy by open thoracotomy or VATS.

After completion of study treatment, patients are followed every 3 months for 1 year, every 6 months for 1 year, and then annually for up to 5 years.

DISEASE CHARACTERISTICS:

• Suspected or proven non-small cell lung cancer (NSCLC), meeting both preoperative and intraoperative criteria:

  • Preoperative criteria

    • Peripheral lung nodule ≤ 2 cm by CT scan

      • Center of the tumor must be located in the outer third of the lung in either the transverse, coronal, or sagittal plan
      • Tumor location must be suitable for either lobar or sublobar resection (wedge resection or segmentectomy)
    • No pure ground opacities or pathologically confirmed N1 or N2 disease

  • Intraoperative criteria

    • Histologically confirmed NSCLC

    • Confirmation of N0 status by frozen section examination of nodal levels 4, 7, and 10 on the right side and 5, 6, 7, and 10 on the left side*

      • Levels 4 and 7 nodes may be sampled by mediastinoscopy or at the time of thoracotomy or video-assisted thoracoscopic surgery (VATS) exploration* NOTE: *Nodes previously sampled by mediastinoscopy either immediately prior to or within 6 weeks of the definitive surgical procedure (thoracotomy or VATS) do not need to be resampled
• No evidence of locally advanced or metastatic disease

PATIENT CHARACTERISTICS:

• ECOG performance status 0-2
• No other malignancy within the past 5 years except for nonmelanoma skin cancer, superficial bladder cancer, or carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

• No prior chemotherapy or radiotherapy for this malignancy