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Sawabata et al. Pulmonary wedge resection for NSCLC

In order to retrieve articles, the author (N. S.) searched 1.21% for wedge resection versus 1.93% for anatomic
“PubMed” using key words relevant to the context of resection (P = 0.0118). Major morbidity occurred in
this review. Specifically, in addition to “lung cancer” and 4.53% of wedge resection patients versus 8.97%
[6]
“stage I”, either “wedge” or “SBRT” was chosen as key of anatomic resection patients (P < 0.0001). They
words. Incorporating the terms “wedge” and “SBRT”, concluded that wedge resection has a 37% lower
found a total of 169 and 250 articles, respectively. The mortality and 50% lower major morbidity rate than
author read the abstracts to select appropriate articles, anatomic resection and these perioperative benefits
which were then read in full. Article references were must be carefully weighed against the increase in
checked for useful studies that were not detected via loco-regional recurrence and possible decrease in
“PubMed” searches. long-term survival associated with the use of wedge
resection for primary lung cancers. [6]
Limited pulmonary resection varies such that
making a distinction between segmentectomy and Reports before 2000 that studied stage I NSCLC
wedge resection can sometimes be difficult. Some patients who received wedge/sublobar pulmonary
segmentectomies fall under wedge resection; however, resection provide a calculated 5-year overall survival
others with large amounts of resected pulmonary rate (5-YSR) of 60-70%, and a local recurrence rate
parenchyma are similar to lobectomy. Therefore, in this of approximately 25%. [7-9] Errette et al. reported
[8]
review, sublobar and wedge resections are discussed in 1985 that the 5-YSR of wedge resection and
together. All contributors read the draft manuscript for lobectomy cases were 69% and 75%, respectively,
comments, and when necessary, issues presented in which was not statistically significant. In the 1997
the text were rewritten after discussion. study of the efficacy of thoracoscopic surgery for
stage I NSCLC, Landreneau et al. reported a 5-YSR
[9]
RETROSPECTIVE STUDIES of 58%, 65%, and 70% for patients who received open
wedge resection, video-assisted wedge resection,
Pulmonary wedge resection for solid lesions and lobectomy, respectively. Although the calculated
Stage I lung cancer comprises tumors that are not larger survival rate was not statistically significant between
than 5 cm in diameter. It is usually technically difficult to the open and video-assisted wedge resection groups,
achieve complete tumor removal by wedge resection there was a difference in the 5-YSR between the
for stage I tumors that are 5 cm in size (T2AN0M0; wedge resection and lobectomy groups due to a
stage IB). It has therefore been speculated that such significantly greater non-cancer-related deaths that
cases were excluded from retrospective analyses occurred within 5 years among the wedge resection
of pulmonary wedge resections for solid lesions. In group (38% vs. 18%, P = 0.014).
addition, although the main subtypes of non-small cell
lung cancer (NSCLC), adenocarcinoma, squamous cell The results of retrospective institutional studies of
carcinoma, and large-cell neuroendocrine carcinoma pulmonary wedge resections for stage I NSCLC
are associated with different prognosis, there are a published in the 2000s are summarized in Table 1.
few studies of pulmonary wedge resections for these The mortality rate was very low; however, the long-
tumors. time survival rate was inferior to reports before 2000,
which were investigations based on non-biased patient
Among patients with early stage NSCLC, the rates populations, [10-13] while the rate of local recurrence did
of operative morbidity and mortality were reported to not change. [13,14] In addition, the 5-YSR was not different
be lowest in those who underwent wedge resection, between the wedge/sublobar resection and lobectomy
followed by segmentectomy, and then lobectomy. groups. [10,12,15] There have also been detailed analyses
This was the conclusion of a study that aimed at based on parameters speculated to be indicators of
investigating the grade of invasiveness of pulmonary prognosis. Kraev et al. [12] reported on the long-time
wedge resection, segmentectomy, and lobectomy survival of patients who underwent pulmonary wedge
using registry data. Linden et al. therefore state resection and lobectomy. Of 215 lobectomy and 74
[6]
that the Society of Thoracic Surgery database was wedge resection patients matched for age, tumor size,
reviewed for stage I and II NSCLC patients undergoing and other comorbidities, there was a non-significant
wedge resection and anatomic resection to analyze overall trend towards better survival times (mean
postoperative morbidity and mortality. Propensity survival time, 5.8 vs. 4.1 years, respectively; P = 0.112).
scores were estimated using a logistic model adjusted However, this trend gained significance in analysis
for a variety of risk factors. Between 2009 and 2011, of smaller cancers, where patients who underwent
3,733 wedge resection and 3,733 anatomic resection lobectomy had better survival times than those who
patients were matched. The operative mortality was underwent wedge resection for tumors less than 3 cm
Mini-invasive Surgery ¦ Volume 1 ¦ March 31, 2017 13