Lobectomy-First vs. Lymphadenectomy-First for Operable NSCLC (LOFTY)

Prior treatment

• Patients who have undergone anti-tumor therapy (radiotherapy, chemotherapy, targeted therapy, immunotherapy) before surgery;
• Patients who meet all of the following criteria are eligible for sublobar resection (segment/wedge resection): (1) Ground glass opacity (GGO) with a solid component \<= 50%; (2) The largest diameter of nodule is \<= 2 cm; (3) The nodule is located in the outer third of the lung field;
• Patients with previous medical history of unilateral thoracotomy;

Other illness

• Patients with previous medical history of other malignant tumors or combined with second primary cancer at the time of enrollment;
• Patients with active bacterial or fungal infection that is difficult to control;
• Patients with a history of severe heart disease, heart failure, myocardial infarction or angina pectoris in the past 6 months.

Other

• Patients with preoperative diagnosis of pure GGO;
• Women who are pregnant or breastfeeding;
• Patients with serious psychosis;

• Age from 18 to 80 years old;
• The first clinical diagnosis before surgery was non-small cell lung cancer, including adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and other unknown types;
• Clinical stage T1-2N0-1 (cI-II): Maximum diameter of tumor \<= 5 cm and short diameter of mediastinal lymph node \<= 1cm in thin layer computed tomography (CT);
• The patient's physical condition is able to tolerate lobectomy: (1) Goldman index 0-1; (2) Predicted forced expiratory volume in 1s (FEV1) \>= 40% and diffusing capacity of the lung for carbon monoxide (DLCO) \>= 40%; (3) Total bilirubin \<= 1.5 upper limit of normal; (4) Alanine aminotransferase (ALT)/Aspartate aminotransferase (AST) \<= 2.5 upper limit of normal; (5) Creatinine \<= 1.25 upper limit of normal and creatinine clearance rate (CCr) \>= 60 ml/min;
• Performance status of Eastern Cooperative Oncology Group (ECOG) = 0-1;
• All relevant examinations were completed within 28 days before the operation;
• Patients who understand this study and have signed an approved Informed Consent.