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Sawabata et al. Pulmonary wedge resection for NSCLC

Table 3: Retrospective study of pulmonary wedge resection for clinical stage I NSCLC using registry data
GGO 5-YSR (%) {4-YSR (%)}, RR
Age, T1a < 2 cm, Margin Local
Author Year n dominant, OP Mortality Sublober/
years n (%) positive relapse Seg Lob P
n (%) wedge
Mery et al. [35] 2005 1,403 NA NA NA Wedge NA NA NA NA NA NA
NA < 60 (50) NA (67) 0.03
NA 60-75 (40) NA (54) 0.0009
NA > 75 (32) NA (39) 0.5
Kates et al. [30] 2011 688 > 70 (43%) 688 (100) NA Sublober NA NA NA 1.1 NA Ref NS
(< 1 cm) (Cox)
Witson et al. [32] 2012 768 > 80 (12%) 407 (53) NA Wedge NA NA NA (47) (69) (68) < 0.001
Yendamuri et al. [31] 2013 361 NA 361 (100) 61 (17) Wedge NA NA NA {50} {60} {75} < 0.05
(1998- (wedge
2004) vs. Lob)
737 NA 737 (100) 115 (16) Wedge NA NA NA {64} {73} {80} NS
(2005-
2008)
Smith et al. [29] 2013 1,568 Mean 70 Mean size 187 (12) Wedge NA NA NA Ref 0.8 NA < 0.05
1.82 cm (pure) (Cox)
Warwick et al. [33] 2013 210 Median 72 NA NA Wedge NA NA NA (45) NA (68) 0.003
Khullar et al. [34] 2015 7,297 Mean 68.9 NA NA Wedge 292 (4%) 11 (2%) NA (54) (58) (71) < 0.001
(wedge
vs. Lob)
NSCLC: non-small cell lung cancer; OP: operation; GGO: ground glass opacity; YSR: year survival rate; RR: relative risk; NA: not assessed
or not available; RFS: relapse free survival rate; Ref: reference; NS: not significant; Seg: segmentectomy; Lob: lobectomy

from the Surveillance, Epidemiology and End Results operating room time, estimated blood loss, chest tube
(SEER) registry revealed that, segmentectomy was duration or length of hospital stay was uncovered.
associated with significant improvement in overall However, the LN dissected group had higher probability
survival (HR 0.80, 95% CI: 0.69-0.93) and lung cancer- of freedom from loco-regional recurrence compared to
specific survival (HR 0.72, 95% CI: 0.59-0.88) compared the no lymph node (NLN) group (5-year: 92% vs. 74%,
to wedge resection. Thus, it was concluded that these P = 0.025) and higher probability of freedom from local
results suggest that segmentectomy should be the recurrence (P = 0.024) in propensity matched groups.
preferred technique for limited resection of patients with The conclusion therefore was that LN removal appears
stage IA NSCLC. [29] However, margin status of wedge to decrease loco-regional recurrence and may be
resection was not registered in the SEER registry. associated with a survival benefit. [36]

In addition, it is reported that survival outcome of Intentional pulmonary sublobar resection for
pulmonary wedge resection is similar to lobectomy solid lesions
for patients with tumors of less than 2.0 cm. [30,31] The As a standard practice, lung cancer patients with
registry data shows that demonstrate inferior [29,32-34] limited pulmonary function undergo limited resections,
or non-inferior [30,31] survival outcomes of pulmonary such as wedge resection or segmentectomy, which
wedge resection to lobectomy [Table 3]. Furthermore, are referred to as “compromised resections”. However,
there is a report showing that the outcome of surgery some surgeons prefer ‘intentional’ sublobar resections
was age-dependent. [35] in patients with normal lung functions.

Lymph node (LN) dissection is also worthy of In 1997, Kodama et al. [37] conducted a 10-year study
consideration because this is a standard procedure of 63 patients who received limited resections (46
performed during lobectomy. However, because of segmentectomies and 17 wedge resections) and
potential side effects, caution should be exercised 77 patients who underwent the standard operation
in choosing to perform this procedure. Stiles et al. [36] (lobectomy plus complete mediastinal LN dissection)
evaluated all patients undergoing wedge resection as curative-intent treatments for T1N0M0 NSCLC.
for peripheral clinical stage IA NSCLC, and grouped The 5-year survival rate was 93% in the intentional/
them into those with and without LN dissection. Of 196 limited resection group, and this was not different from
patients undergoing wedge resection, of whom 138 that of the 77 patients who underwent the standard
(70%) had LNs (median = 4 nodes) resected and the operation. The frequency of local/regional recurrence
remainder did not, there were no significant differences in the intentional resection group was 8.7% (4/46),
in the clinical or pathologic characteristics between with mediastinal involvement in 3 patients. It was thus
the two groups. Additionally, no difference in terms of concluded that sublobar resection should be considered
16 Mini-invasive Surgery ¦ Volume 1 ¦ March 31, 2017