Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer☆,☆☆,★,★★

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Abstract

Background: The role of nonanatomic wedge resection in the management of stage I (T1 N0 M0) non-small-cell lung cancer continues to be debated against the present gold standard of care—anatomic lobectomy.

Methods: We analyzed the results of 219 consecutive patients with pathologic stage I (T1 N0 M0) non-small-cell lung cancer who underwent open wedge resection (n = 42), video-assisted wedge resection (n = 60), and lobectomy (n = 117) to assess morbidity, recurrence, and survival differences between these approaches.

Results: There were no differences among the three groups with regard to histologic tumor type. Analysis demonstrated the wedge resection groups to be significantly older and to have reduced pulmonary function despite a higher incidence of treatment for chronic obstructive pulmonary disease when compared with patients having lobectomy. The mean hospital stay was significantly less in the wedge resection groups. There were no operative deaths among patients having wedge resection; however, a 3% operative mortality occurred among patients having lobectomy (p = 0.20). Kaplan-Meier survival curves were nearly identical at 1 year (open wedge resection, 94%; video-assisted wedge resection, 95%; lobectomy, 91%). At 5 years survival was 58% for patients having open wedge resection, 65% for those having video-assisted wedge resection, and 70% for those having lobectomy. Log rank testing demonstrated significant differences between the survival curves during the 5-year period of study (p = 0.02). This difference was a result of a significantly greater non-cancer-related death rate by 5 years among patients having wedge resection (38% vs 18% for those having lobectomy; p = 0.014).

Conclusion: Wedge resection, done by open thoracotomy or video-assisted techniques, appears to be a viable “compromise” surgical treatment of stage I (T1 N0 M0) non-small-cell lung cancer for patients with cardiopulmonary physiologic impairment. Because of the increased risk for local recurrence, anatomic lobectomy remains the surgical treatment of choice for patients with stage I non-small-cell lung cancer who have adequate physiologic reserve. (J Thorac Cardiovasc Surg 1997;113:691-700)

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From the Allegheny General Hospital Campus,a Allegheny University for the Health Sciences, and the Section of Thoracic Surgery,e School of Dentistry and Biostatistics,f University of Pittsburgh, Pittsburgh, Pa.; the Division of Thoracic Surgery,b Brigham and Womens Hospital, Harvard University Medical School, Boston, Mass.; Division of Cardiothoracic Surgery,c Medical City Hospital, Dallas, Tex.; Division of Cardiothoracic Surgery,g University of Southern Illinois, Springfield, Ill.; and the Division of Cardiothoracic Surgery,d St. Louis University Medical Center, St. Louis, Mo.

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Read at the Twenty-first Annual Meeting of The Western Thoracic Surgical Association, Coeur d'Alene, Idaho, June 21-24, 1995.

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Address for reprints: Rodney J. Landreneau, MD, Section Head, General Thoracic Surgery, Allegheny General Hospital, Suite 302, 490 East North Ave., Pittsburgh, PA 15212.

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0022-5223/97 $5.00 + 0 12/6/79780

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