Survival and safety: wedge resection, segmentectomy, and lobectomy in NSCLC

BACKGROUND: This study aimed to compare the clinical outcomes of three surgical methods (wedge resection, segmentectomy and lobectomy) in non-small cell lung cancer (NSCLC). METHODS: We retrospectively analyzed 130 NSCLC patients who underwent thoracoscopic surgery. Patients were categorized into wedge resection (n = 50), segmentectomy (n = 40) and lobectomy (n = 40) groups. Baseline characteristics, perioperative parameters (operative time, drainage time, length of hospital stay, intraoperative blood loss), postoperative adverse events (reoperation, atrial arrhythmia, pulmonary embolism, prolonged air leak, pulmonary infection, pneumothorax, pleural effusion, atelectasis), and survival rates stratified by tumor diameter (< 1.0 cm, 1.1-2.0 cm) were recorded and compared. RESULTS: Baseline characteristics were comparable among the three groups (P > 0.05). For tumors < 1.0 cm, the overall survival (OS) rates were similar among wedge resection, segmentectomy, and lobectomy groups (88% vs. 90.48% vs. 91.30%) (P > 0.05). In tumors measuring 1.1-2.0 cm, the observed OS rates were 92.00% for wedge resection, 63.16% for segmentectomy, and 64.71% for lobectomy (P < 0.05). The three surgical approaches showed significant differences in the number of lymph nodes sampled, the detection rate of positive lymph nodes, and the resection method (P < 0.05), while no statistically significant difference was observed in the margin status (P > 0.05). Wedge resection was associated with the shortest operative time and drainage time (P < 0.05), while length of hospital stay and intraoperative blood loss did not differ significantly across the three approaches (P > 0.05). The incidence of postoperative adverse events presented no discernible difference in the three surgical approaches (P > 0.05). CONCLUSIONS: For tumors smaller than 1 cm, wedge resection was associated with OS similar to that of segmentectomy and lobectomy. For selected tumors measuring 1.1-2.0 cm, wedge resection was associated with higher observed OS in this cohort and with shorter operative and drainage times; prospective validation is needed.