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

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.