Safety and Feasibility of Wedge Resection in Lung Cancer Patients with Pre-Existing Interstitial Lung Disease:...

Background/Objectives: Acute exacerbation of interstitial lung disease (AE-ILD) is a life-threatening complication in lung cancer patients with pre-existing ILD. Anatomical resection is recognized as a significant risk factor for AE-ILD. We investigated the safety and feasibility of wedge resection in lung cancer patients with ILD. Methods: This retrospective study analyzed clinical stage IA-IIIA primary lung cancer patients with ILD, as recorded in the Shizuoka Registry across eight institutions from January 2019 to May 2023. Patients were categorized into a wedge resection group (WG) and an anatomical resection group (AG), which included segmentectomy, lobectomy, and bilobectomy. Perioperative outcomes were compared between the groups. Results: The WG comprised 36 patients, while the AG included 81. The WG had significantly older patients (77 vs. 72 years, p < 0.01) and smaller tumors (18 vs. 24 mm, p < 0.01). Wedge resection was associated with shorter operative time (100 vs. 205 min, p < 0.01) and less blood loss (5 vs. 30 mL, p = 0.02). The incidence of postoperative complications did not differ significantly (p = 0.84). AE-ILD occurred in three patients (8%) in the WG and four patients (4%) in the AG. Perioperative mortality was 0% in the WG and 2% in the AG; both deaths were due to AE-ILD. Marginal recurrence was observed in four patients (11%) in the WG. Conclusions: Although AE-ILD incidence was higher, no deaths due to IP-AE were observed in the WG. While wedge resection cannot completely prevent postoperative AE-ILD, it may reduce perioperative mortality in lung cancer patients with ILD.