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Wedge resection vs. segmentectomy: when is each acceptable in early-stage lung adenocarcinoma?

Year: 2024
Type: editorial
Abstract: Clinicians who treat lung cancer surgically will inevitably be faced with the challenge of balancing a sufficiently aggressive surgical resection with lung preservation.The gold standard treatment for early-stage lung cancer has historically been lobectomy with mediastinal and hilar lymphadenectomy but recent work has demonstrated that in lesions ≤2 cm a wedge resection or segmentectomy is adequate in early-stage disease (1).The current article by Zhang et al. does a very nice job of comprehensively reviewing the currently published studies on this topic, and highlights gaps in evidence-based recommendations.This study focuses specifically on radiologically peripheral cT1N0 solitary subsolid pathologically invasive lung adenocarcinoma and aims to clarify when wedge resection is appropriate as opposed to segmentectomy.Based on a single center retrospective analysis of 1,503 patients, the authors concluded that wedge resection may be appropriate for peripherally located invasive lung adenocarcinoma measuring <2 cm with consolidation to tumor ratio (CTR) ≤0.5, but not appropriate for similarly described tumors measuring 2-3 cm with CTR ≤0.5 (2).Of note, lymph node dissection was performed in a consistent way in all patients in the original study and was as follows: right lungs: nodal stations 2R, 4R, 7, 8; left lungs: nodal stations 4L, 5, 6, 7, 8.For tumors located in the lower lobe of either side station 9 was required.For N1 nodes, station 10 was sampled in wedge resection cases while station 10 and 11 were sampled for segmentectomy cases.Because this study focuses solely on subsolid pulmonary nodules it is important to consider the value of CTR as a prognostic factor in these cases.Previous studies support that non-small cell lung cancer (NSCLC) patients with purely solid tumors (CTR =1) have inferior overall survival (OS) and disease-free survival (DFS) than those with pure ground-glass opacity (CTR =0) or part-solid nodules (0< CTR <1) (3).However, two recently published studies argue that CTR is not a prognostic factor for recurrence-free survival in stage I lung adenocarcinoma (4,5).By excluding studies that include nodules with a CTR of 0 or 1 and focusing solely on subsolid nodules the above authors found evidence that CTR did not have value as an independent prognostic factor in this population.While this does not negate the findings of Zhang et al., it is worth considering since CTR is one of the primary factors evaluated in their study, the implications of which could ultimately guide important management decisions.
DOI: 10.21037/jtd-24-76
Language: English
Field: Medicine
Open Access status: diamond
OpenAlex ID: W4398173031
Cites: 6
Cited by: 1
Related to: 10