Wedge resection versus segmentectomy in peripheral clinical stage IA lung cancer concerning ground-glass opacity.

Purpose: Recent randomized controlled trials have shown the non-inferiority of sublobar-to-lobar resection for small peripheral non-small cell lung cancer (NSCLC); however, whether wedge resection (WR) or anatomical segmentectomy (SG) is superior remains unclear. We hypothesized that ground-glass opacity (GGO) is associated with the outcomes of WR and SG.

Methods: Between 2010 and 2022, 219 consecutive patients with clinical stage IA peripheral NSCLC who underwent sublobar resection for frailty at our institution were retrospectively reviewed. Based on the high-resolution computed tomography findings, the tumors were classified into two groups: part-solid (GGO (+)) and solid (GGO (-)). The long-term outcomes were compared between the WR and SG groups.

Results: In the part-solid group (n = 124; median CTR, 0.62), WR was equivalent to SG in terms of 5-year disease-free survival [DFS] (98% vs. 91%; p = 0.2) and recurrence rate (0% vs. 4.3%; p = 0.3). In the solid tumor group (n = 95), WR was inferior to SG in terms of the 5-year DFS (43% vs. 80%; p < 0.01) and recurrence rate (32% vs. 3.7%; p < 0.01).

Conclusions: In our study population, WR was not inferior to SG for part-solid tumors. However, for solid tumors, the long-term outcomes of SG are superior to those of WR.