Wedge Resection Verses Lobectomy for Stage 1 Non-small-cell Lung Cancer

Background: Lobectomy remains the gold standard with regard to potentially curative resection of non-small-cell lung carcinoma. We aimed to investigate whether there is a survival difference in stage 1 non-small-cell lung cancer patients who undergo lobectomy compared to a wedge resection.

Methods: We retrospectively analyzed a prospective database of 1283 patients who had potentially curative resection for stage 1 non-small-cell lung cancer. Only patients with adenocarcinoma, squamous or adenosquamous carcinoma were included. We benchmarked our 5-year survival against the 6th International Association for the Study of Lung Cancer results. Three techniques were used to assess the effect of a lobectomy compared to a wedge resection with regard to long-term survival: Cox multivariate regression analysis, neuronal network analysis, and propensity matching.

Results: Benchmarking failed to reveal any significant difference compared to the 6th International Association for the Study of Lung Cancer results. Crude analysis demonstrated superiority of lobectomy compared to wedge resection, p = 0.02. Cox regression analysis confirmed that age, body mass index, female sex, being a current smoker, tumor diameter, and preoperative forced expiratory volume in 1 s were all significant factors determining long-term survival. Wedge resection was not a significant factor. Neuronal network analysis concurred with the Cox regression analysis. Propensity matching with 1:1 matching demonstrated that wedge resections was not inferior to a lobectomy, p = 0.10.

Conclusions: Cox regression analysis, neuronal network analysis, and propensity matching in stage 1 non-small-cell lung cancer demonstrate no difference in long-term survival after wedge resection compared to lobectomy.