Segmentectomy versus wedge resection in physiologically vulnerable patients with stage IA lung cancer

We compared major morbidity and exploratory oncological outcomes after wedge resection and segmentectomy in physiologically vulnerable patients with stage IA non-small cell lung cancer.

This single-centre retrospective cohort included consecutive patients with clinical stage IA1-IA2 non-small cell lung cancer who underwent curative-intent wedge resection or segmentectomy between January 2017 and December 2024 and met cardiopulmonary exercise testing vulnerability criteria (peak oxygen uptake <15 mL/kg/min and/or minute ventilation-to-carbon dioxide output slope >35). The primary endpoint was 90-day major morbidity. Analyses adjusted for tumour location and radiological size; inverse probability of treatment weighting was exploratory. Median follow-up was estimated by reverse Kaplan-Meier, with administrative censoring on 23 February 2026.

Among 103 patients (47 wedge resection; 56 segmentectomy), median follow-up was 40.2 months. Major morbidity occurred in 6.4% and 12.5%, respectively (relative risk 1.96, 95% confidence interval 0.54-7.16); locoregional recurrence occurred in 14.9% and 7.1% (relative risk 0.48, 95% confidence interval 0.15-1.54). Neither comparison was statistically significant. Adjusted and weighted estimates were imprecise and did not show significant differences in major morbidity, event-free survival, overall survival, or locoregional recurrence.

No statistically significant difference in major morbidity was observed. Locoregional recurrence was 14.9% after wedge resection and 7.1% after segmentectomy (relative risk 0.48, 95% confidence interval 0.15-1.54); this exploratory estimate was imprecise.