Introduction
Surgical approach to lung cancer resection is often guided by provider discretion, with mixed evidence on comparative outcomes. Although wedge resection is less invasive, its oncologic adequacy remains uncertain. We assessed margin status and recurrence between wedge resection, segmentectomy, and lobectomy to inform surgical decision-making.
Methods
We retrospectively reviewed all patients undergoing wedge resection, segmentectomy, or lobectomy for lung cancer at our institution between 2021 and 2024. Operative characteristics, pathology, including margin status, and recurrence were evaluated. Categorical variables between patients with and without positive margins were compared using chi-square, and continuous variables using t-test, with significance defined as p < 0.05.
Results
A total of 576 patients underwent resection: 78 wedge resections, 116 segmentectomies, and 382 lobectomies. Patients undergoing wedge resection had a higher average number of comorbidities (wedge: 3.2; segmentectomy: 2.7; lobectomy: 2.5; P = 0.017). Tumor size was largest in lobectomy patients (wedge: 14.3mm; segmentectomy: 17.6mm; lobectomy: 26.2mm; P < 0.001). There was no difference in the rate of positive margins among the three approaches (wedge: 3.8%, 3/78; segmentectomy: 1.7%, 2/116; lobectomy: 4.5%, 17/382; P = 0.410). Median lymph nodes harvested were fewer with wedge resection (wedge: 3.5; segmentectomy: 7.8; lobectomy: 11.1; P < 0.001). Wedge resection was associated with shorter operative time, intraoperative blood loss, and length of hospital stay. Complications were similar overall, though hypoxia occurred least frequently after wedge resection (wedge: 9%, 7/78; segmentectomy: 19.8%, 23/116; lobectomy: 11.3%, 43/382; P = 0.030). Two-year survival was statistically similar among groups, as was two-year recurrence (wedge: 33.3%, 9/27; segmentectomy: 16.7%, 10/60; lobectomy: 25.3%, 46/182; P = 0.200). A sub-analysis of tumors <2cm demonstrated consistent findings, with no difference in complications, recurrence, or survival.
Conclusions
Positive margins after lung resection are infrequent and do not differ by extent of resection. Despite lower nodal yield, wedge resection demonstrated similar two-year recurrence and survival to segmentectomy and lobectomy. These findings suggest that anatomic resection should not be pursued solely to achieve negative margins and support the selective use of wedge resection in appropriate patients. Further research incorporating preoperative imaging or pathology may further refine patient selection for sublobar resection.
Tables and Figures
Figure 1. Kaplan-Meier analysis of recurrence-free survival by procedure type.
References
Akamine T, Yotsukura M, Yoshida Y, Nakagawa K, Yatabe Y, Watanabe SI. Feasibility and effectiveness of segmentectomy versus wedge resection for clinical stage I non-small-cell lung cancer. Eur J Cardiothorac Surg. 2023;63(3):ezad018. doi:10.1093/ejcts/ezad018.
Li Z, Xu W, Zhao C, et al. Sublobar resection for small-sized non-small cell lung cancer: A comprehensive comparison between subsegmentectomy, segmentectomy and wedge resection. Eur J Surg Oncol. 2024;50(9):108541. doi:10.1016/j.ejso.2024.108541.