The fundamental problem of confounding by medical operability in retrospective comparisons of surgery versus stereotactic body radiation therapy for early-stage lung cancer

The standard of care for early-stage non-small cell lung cancer (NSCLC) is lobectomy with lymph node (LN) dissection (1). Sublobar resection [e.g., wedge resection (WR) or anatomic segmentectomy] is an alternative for patients unsuitable for lobectomy, owing to a greater degree of lung preservation and potentially less postoperative morbidity and/or mortality (2). However, the broader candidacy of sublobar resection comes at the theoretical expense of a decrease in the “oncologic quality” of resection, which may lead to poorer tumor-related outcomes.