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Wedge Resection Versus Segmentectomy in Early-Stage Lung Cancer Considering Resection Margin and Lymph Node
In Ha Kim1, Han Pil Lee2, Geun Dong Lee1
1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
Objectives:
The prognostic differences between wedge resection and segmentectomy in early-stage lung cancer remain controversial. This study aimed to compare the recurrence-free survival (RFS) between the 2 procedures, focusing on the impact of resection margin status and adequacy of lymph node (LN) evaluation.
Methods:
Patients who underwent sublobar resection for clinical stage IA1-IA2 primary lung adenocarcinoma between 2011 and 2021 were retrospectively reviewed. After 1:1 propensity score matching (PSM), RFS between wedge resection and segmentectomy was compared using a Cox proportional hazards model with a robust variance estimator.
Results:
Overall, 1205 patients were included, with 539 (44.7%) and 666 (55.3%) undergoing wedge resection and segmentectomy, respectively. After PSM, 636 patients (318 pairs) were matched. The median follow-up duration was 47 months, during which 73 events of recurrence or cancer-related death occurred. The RFS differed significantly between the wedge resection and segmentectomy before PSM (P = .010; 5-year RFS: 89.8% vs 93.4%); however, this difference became insignificant after matching (P = .087; 5-year RFS: 90.3% vs 92.6%). In the subgroup of patients with sufficient margins, no significant difference in RFS was observed between the 2 groups, both before (P = .20; 5-year RFS: 92.3% vs 94.0%) and after PSM (P = .29; 5-year RFS: 92.4% vs 93.3%). However, among patients with insufficient margin, segmentectomy was associated with better RFS after PSM (P = .046; 5-year RFS: 83.8% vs 93.5%).
Conclusions:
In patients with clinical stage IA1-IA2 lung adenocarcinoma, RFS did not differ significantly between wedge resection and segmentectomy when a sufficient surgical margin and adequate LN evaluation were achieved.
