Safety and Feasibility of Wedge Resection in Lung Cancer Patients with Pre-Existing Interstitial Lung Disease: Real-World Data from Multicenter, Shizuoka Registry.

Acute exacerbation of interstitial lung disease (AE-ILD) is a life-threatening complication in lung cancer patients with pre-existing ILD. Anatomical resection is recognized as a significant risk factor for AE-ILD. We investigated the safety and feasibility of wedge resection in lung cancer patients with ILD. This retrospective study analyzed clinical stage IA-IIIA primary lung cancer patients with ILD, as recorded in the Shizuoka Registry across eight institutions from January 2019 to May 2023. Patients were categorized into a wedge resection group (WG) and an anatomical resection group (AG), which included segmentectomy, lobectomy, and bilobectomy. Perioperative outcomes were compared between the groups. The WG comprised 36 patients, while the AG included 81. The WG had significantly older patients (77 vs. 72 years, < 0.01) and smaller tumors (18 vs. 24 mm, < 0.01). Wedge resection was associated with shorter operative time (100 vs. 205 min, < 0.01) and less blood loss (5 vs. 30 mL, = 0.02). The incidence of postoperative complications did not differ significantly ( = 0.84). AE-ILD occurred in three patients (8%) in the WG and four patients (4%) in the AG. Perioperative mortality was 0% in the WG and 2% in the AG; both deaths were due to AE-ILD. Marginal recurrence was observed in four patients (11%) in the WG. Although AE-ILD incidence was higher, no deaths due to IP-AE were observed in the WG. While wedge resection cannot completely prevent postoperative AE-ILD, it may reduce perioperative mortality in lung cancer patients with ILD.