Wedge resection versus segmentectomy in early-stage lung cancer considering resection margin and lymph node evaluation: A retrospective study.

Objectives: The prognostic differences between wedge resection and segmentectomy in early-stage lung cancer remain controversial. This study aimed to compare the recurrence-free survival (RFS) between the two procedures, focusing on the impact of resection margin status and adequacy of lymph node (LN) evaluation.

Methods: Patients who underwent sublobar resection for clinical stage IA1-IA2 primary lung adenocarcinoma between 2011 and 2021 were retrospectively reviewed. After 1:1 propensity score matching (PSM), RFS between wedge resection and segmentectomy was compared using a Cox proportional hazards model with a robust variance estimator.

Results: Overall, 1,205 patients were included, with 539 (44.7%) and 666 (55.3%) undergoing wedge resection and segmentectomy, respectively. After PSM, 636 patients (318 pairs) were matched. The median follow-up duration was 47 months, during which 73 events of recurrence or cancer-related death occurred. The RFS differed significantly between the wedge resection and segmentectomy before PSM (P = 0.010; 5-year RFS: 89.8% vs 93.4%); however, this difference became insignificant after matching (P = 0.087; 5-year RFS: 90.3% vs 92.6%). In the subgroup of patients with sufficient margins, no significant difference in RFS was observed between the two groups, both before (P = 0.20; 5-year RFS: 92.3% vs 94.0%) and after PSM (P = 0.29; 5-year RFS: 92.4% vs 93.3%). However, among patients with insufficient margin, segmentectomy was associated with better RFS after PSM (P = 0.046; 5-year RFS: 83.8% vs 93.5%).

Conclusions: In patients with clinical stage IA1-IA2 lung adenocarcinoma, RFS did not differ significantly between wedge resection and segmentectomy when a sufficient surgical margin and adequate LN evaluation were achieved.