Pitfall of Wide Wedge Resection: Risk of Overlooking Surgical Margin Shortage

Area of Science:

• Thoracic Surgery
• Surgical Pathology
• Pulmonary Imaging

Background:

• Sublobar resections are increasingly common for lung cancer due to favorable outcomes.
• Maintaining adequate resection margins is crucial for oncological safety.
• Advances in stapling devices have facilitated minimally invasive lung resections.

Purpose of the Study:

• To investigate if deep wedge resection causes subpleural alveolar injury.
• To determine if this injury leads to margin overestimation via internal cavities.
• To correlate wedge resection depth with artifact formation.

Main Methods:

• Retrospective analysis of 33 patients undergoing wedge resection.
• CT imaging of inflated lung specimens to visualize internal architecture.
• Ex vivo porcine lung models to simulate deep wedge resection and compression effects.

Main Results:

• CT revealed "empty spaces" adjacent to the staple line in 30.3% of specimens.
• These cavities were significantly associated with deeper wedge resections (≥26.3 mm) and increased stapler use.
• Porcine models showed stapler compression caused internal parenchymal rupture without pleural tearing.

Conclusions:

• Deep wedge resection can induce stapler-related parenchymal rupture, potentially leading to overestimated pathological margins.
• Further large-scale studies are needed to correlate these findings with oncological outcomes.
• Appropriate selection between wedge resection and segmentectomy for deep peripheral lesions requires clarification.