How Frequent Is Suture-Line Recurrence After Surgery for Early-Stage NSCLC?

Recurrences after surgery for stage 0 or 1A non–small cell lung cancer (NSCLC) are rare, but half of recurrences involve the suture line, according to a recent study.

Louis Gros, MD, of the Icahn School of Medicine at Mount Sinai, and colleagues conducted the study and published their findings in Lung Cancer. It was important to conduct the study because increased lung cancer screening has made early-stage NSCLC “more common,” with lung-sparing surgery being the “standard curative treatment.”

Dr. Gros and colleagues evaluated 653 patients from the 2016-2023 Initiative for Early Lung Cancer Research on Treatment (IELCART) cohort who underwent surgery for pathologic stage 0 or 1A NSCLC. The median patient age was 69 years.

The study investigators evaluated recurrences, which were categorized by the presence or absence of suture line involvement, as well as survival outcomes.  Dr. Gros and colleagues then compared patients who had suture-line recurrence (isolated or with additional findings) with patients who did not have suture line recurrence.

The study showed that 44 patients (11.3%) experienced recurrences, with half of those being suture-line recurrences. The investigators found that sublobar resections were more common in patients who had suture-line recurrences (19 of 22 patients) compared with those who did not have suture-line recurrences (11 of 22 patients; P=0.01). In addition, smaller margins of 8 mm versus 20 mm were also more frequent in patients who had suture-line recurrences (P<0.001).

Among the 22 patients who had suture-line recurrences, 13 had isolated recurrences, but 9 had additional findings. Patients with isolated recurrences were diagnosed later (31 months) than those with additional findings (14 months [P=0.01]). The patients with isolated recurrences were treated with surgery in 6 of 13 cases and with radiotherapy in 7 of 13 cases, with both treatment types being “well-tolerated,” according to the study authors.

In addition, patients with isolated suture-line recurrences “demonstrated better survival outcomes compared to all other recurrence types,” Dr. Gros and colleagues explained, noting that the overall survival rate was 72% in this population of patients, compared with 45.7% in those with other recurrence types (P=0.02). In addition, the lung cancer–specific survival rate was 90% in these patients, compared with 76.1% in those with other recurrence types (P=0.19).

“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,” Dr. Gros and colleagues concluded. “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.”

Reference

Gros L, Yip R, Flores RM, et al. Prospective cohort study of suture-line recurrence and clinical outcomes in stage 1A non-small cell lung cancer. Lung Cancer. 2025;202:108465. doi:https://doi.org/10.1016/j.lungcan.2025.108465