Is wedge resection equivalent to segmentectomy in pathological stage IA - ≤ 2 cm - non-small cell lung cancers

Q: What clinical question does the study address?

It compares oncological outcomes of wedge resection versus segmentectomy in patients with pathological stage IA NSCLC (≤2 cm).

Q: How were patients selected and how was bias controlled?

Patients with pT1a-bN0M0 NSCLC who underwent wedge resection or segmentectomy were identified from the SEER database (2010–2020). Cox regression and propensity-score matching were used to reduce confounding.

Q: Which surgical approach showed better overall survival?

Segmentectomy demonstrated significantly better overall survival after propensity-score matching, while lung cancer-specific survival showed no statistically significant difference.

Sep 21, 2026

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Background: Sublobar resection (wedge resection and segmentectomy) is an oncologically equivalent alternative to lobectomy for early-stage non-small cell lung cancer (NSCLC) ≤ 2 cm, yet the optimal sublobar approach remains debated. Methods: Using Surveillance, Epidemiology, and End Results data (2010–2020), patients with pT1a-bN0M0 NSCLC treated with wedge resection or segmentectomy were compared with Cox regression and propensity-score matching. Overall survival (OS) and lung cancer-specific survival (LCSS) were estimated via Kaplan–Meier analyses. Results: In 4190 patients, wedge resection had fewer total lymph nodes removed. Before matching, segmentectomy showed higher 5-year OS with similar LCSS; after matching, segmentectomy maintained superior OS and no LCSS difference. Cause-of-death analysis indicated more deaths from other causes after wedge resection. Conclusions: Both procedures yield comparable oncological outcomes, but segmentectomy offers better OS.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Introduction

Background and rationale for sublobar resection

Evidence from trials and observational studies

Unresolved question comparing wedge resection vs segmentectomy

Methods

Data source and patient selection

Statistical analyses (Cox regression, PSM)

Survival comparisons (Kaplan–Meier)

Results

Baseline comparison and lymph node retrieval

Pre- and post-matching OS and LCSS outcomes

Cause-of-death patterns

Conclusions

DOI: 10.1111/1759-7714.15377 ORIGINA L ARTICLE Is wedge resection equivalent to segmentectomy in pathological stage IA ( ≤2 cm) non-small cell lung cancers? Zhirong Zhang 1 | Feng Li 2 | Shuo Chen 1 | Bin Hu 1 1Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China 2Department of Pulmonary Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China Correspondence Bin Hu, Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China. [Email:](Email: hubin705@aliyun.com)[ hubin705@aliyun.com](Email: hubin705@aliyun.com) Abstract Background: Sublobar resection (wedge resection and segmentectomy) has been established as an oncologically equivalent option to lobectomy for early-stage patients with non-small cell lung cancer (NSCLC) ≤ 2 cm. However, the optimal approach of sublobar resection remains subject to debate. In the present study we aimed to compare the oncological outcomes of wedge resection and segmentectomy in these patients. Methods: We identified patients with pT1a-bN0M0 NSCLC who underwent wedge resection and segmentectomy from the Surveillance, Epidemiology, and End Results database between 2010 and 2020 . A Cox regression model and propensity-score matching (PSM) analysis were used. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared using the Kaplan–Meier method. Results: A total of 4190 patients met our selection criteria, including wedge resection in 3137 and segmentectomy in 1053 . Patients undergoing wedge resection were less likely to have total lymph nodes resected (4 vs. 7, p < 0.001) . Before PSM, patients undergoing segmentectomy had a higher 5-year OS rate (87.75% vs. 82.72%; p = 0.0023), while exhibiting a similar LCSS rate (93.45% vs. 92.73%; p = 0.32) . After PSM, segmentectomy consistently demonstrated significantly better OS and there was no statistically significant difference in LCSS. Analysis of causes of death revealed that a higher incidence of deaths related to other causes among patients undergoing wedge resection compared to those undergoing segmentectomy. Conclusions: Both wedge resection and segmentectomy yield comparable oncological outcomes for patients with NSCLC ≤ 2 cm, although segmentectomy exhibits superior OS due to less death related to other causes. KEYW ORD S non-small cell lung cancer, segmentectomy, survival, wedge resection INTRODUCTION The efficacy of oncological outcomes associated with performing lobectomy or sublobar resection (including segmentectomy and wedge resection) for early-stage non-small cell lung cancer (NSCLC) has been a subject of debate and investigation since the 1970s and 1980s.1–3 In the era dominated by plain chest radiography as the most prevailing imaging modality, the results of the Lung Cancer Study Group’s randomized controlled trial, indicated that a 75% increase in recurrence rates and a 30% higher overall death rate with sublobar resection compared to lobectomy for patients with lung cancer ≤3 cm,4 has been controversial for a long time. Consequently, sublobar resection has been performed in the management of lung cancer in highly selected patients who are not candidates for a full lobectomy due to advanced age, severely compromised pulmonary function, or other comorbidities.5 However, in several observational studies, owing to major advances in early detection and staging of NSCLC, sublobar resection, particularly segmentectomy, has been proven to achieve oncological equivalence for early-stage patients with lung cancer ≤ 2 cm.5–10 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use an

FAQs

What clinical question does the study address?

It compares oncological outcomes of wedge resection versus segmentectomy in patients with pathological stage IA NSCLC (≤2 cm).

How were patients selected and how was bias controlled?

Patients with pT1a-bN0M0 NSCLC who underwent wedge resection or segmentectomy were identified from the SEER database (2010–2020). Cox regression and propensity-score matching were used to reduce confounding.

Which surgical approach showed better overall survival?

Segmentectomy demonstrated significantly better overall survival after propensity-score matching, while lung cancer-specific survival showed no statistically significant difference.

Sep 21, 2026

Upload by Aria