Prospective cohort study of Suture-Line recurrence and clinical outcomes in stage 1A Non-Small cell lung cancer.

Background: Increased lung cancer screening has made early-stage non-small-cell lung cancer (NSCLC) more common, with lung-sparing surgery as the standard curative treatment. Our study evaluated patients who underwent surgery for pathologic stage 0/1A NSCLC and presented with suture-line recurrences-either isolated or with additional findings-and compared these patients to other types of recurrence.

Methods: We analyzed 653 patients with pathologic stage 0/1A NSCLC from the IELCART cohort (2016-2023). Recurrences were categorized by the presence or absence of suture line involvement, and survival outcomes were assessed.

Findings: Among 653 patients (median age 69), 44 (11.3 %) experienced recurrences, including 22 suture-line recurrences. Sublobar resections (19/22 vs. 11/22, p = 0.01) and smaller margins (8 mm vs. 20 mm, p < 0.001) were more frequent in patients with suture-line recurrences. Of the 22 suture-line recurrences, 13 were isolated, and 9 had additional findings. Isolated recurrences were diagnosed later (31.0 vs. 14.0 months, p = 0.01) and treated with surgery (6/13) or radiotherapy (7/13), both well-tolerated. Patients with isolated suture-line recurrences demonstrated better survival outcomes compared to all other recurrence types (overall survival: 72.0 % vs. 45.7 %, p = 0.02; lung cancer-specific survival: 90.0 % vs. 76.1 %, p = 0.19).

Interpretation: Recurrences after stage 0/1A lung cancer surgery are rare, with half involving the suture line. Suture-line recurrences arise around two years post-surgery, often following sublobar resections with resection margins under 1 cm. For isolated suture-line recurrences, treatment with either radiotherapy and completion surgery were effective, yielding comparable outcomes and improved survival compared to any other recurrence types.