When wedge resection is good enough: Survival outcomes and nodal involvement of ground-glass–dominant stage IA non–small cell lung cancer

Abstract

Objective

Whether the indications for wedge resection can be extended to early-stage non–small cell lung cancer (NSCLC) remains unclear. We investigated the survival outcomes and nodal involvement of ground-glass-opacity–dominant stage IA NSCLC undergoing wedge resection, segmentectomy, or lobectomy.

Methods

We retrospectively investigated the prognostic and clinicopathological outcomes of patients who underwent lung resection for ground-glass-opacity–dominant clinical stage IA (diameter ≤3 cm; consolidation-to-tumor ratio ≤0.5) NSCLC between 2017 and 2022. Patients with tumors ≤2 cm and consolidation-to-tumor ratio ≤0.25 were excluded. Propensity score matching was performed to equalize the preoperative characteristics of patients undergoing wedge resection and segmentectomy. Overall and relapse-free survival rates were estimated, and differences were compared.

Results

Of the 398 patients who met the inclusion criteria, 77, 258, and 63 underwent lobectomy, segmentectomy, and wedge resection, respectively. Two (0.5%) patients experienced disease recurrence, and 6 (1.5%) patients died; however, no lung cancer-related deaths were observed. Two patients developed locoregional recurrence, all of which were nodal. No patients had pN1/2 disease. The 5-year overall and relapse-free survival rates were 97.6% and 96.4%, respectively. Relapse-free survival did not differ significantly according to the extent of lung resection (91.7%, 97.7%, and 100%; P = .146). Even after propensity score matching, overall and relapse-free survival did not differ significantly between wedge resection and segmentectomy.

Conclusions

Patients with ground-glass-opacity–dominant clinical stage IA NSCLC showed an excellent prognosis, with no survival differences between procedures. In those patients, wedge resection without nodal dissection may be oncologically equivalent to anatomic resection.