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Original Research: RESECTIONAL LUNG SURGERY |

Wedge Resection vs Lobectomy*: 10-Year Survival in Stage I Primary Lung Cancer

Alexander Kraev, MD; Dennis Rassias, MD; John Vetto, MD; Mikhail Torosoff, MD, PhD; Pasala Ravichandran, MD; Christina Clement, BS; Adebambo Kadri, MD; Riivo Ilves, MD
Author and Funding Information

*From the School of Medicine (Dr. Kraev), and the Departments of Surgical Oncology (Dr. Vetto) and Cardiothoracic Surgery (Dr. Ravichandran), Oregon Health & Science University, Portland, OR; the Department of Cardiothoracic Surgery (Drs. Rassias, Torosoff, Ilves, and Kadri), Albany Medical College, Albany, NY; and Oregon State University (Ms. Clement), Corvallis, OR.

Correspondence to: Alexander Kraev, MD, Oregon Health & Science University, Department of Surgical Oncology, Mail Code L223A, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; e-mail: Sasha@kraev.com



Chest. 2007;131(1):136-140. doi:10.1378/chest.06-0840
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Background: The selection of lobectomy or wedge resection in the treatment of patients with stage I primary lung cancer remains controversial. Clinical judgment based on comorbidities remains the main decision factor. We investigated the impact of procedure on long-term survival in a multicenter retrospective analysis.

Methods: The records of 289 patients who underwent surgical resection of stage I primary lung cancer between 1993 and 1998 at three tertiary medical centers were reviewed for age, sex, type of resection, tumor size, number of lymph nodes dissected, pathology, and recurrence. Long-term survival was obtained through the Federal Social Security Death Index and Cancer Registries. Kaplan-Meier, Wilcox, logistic regression, and power and t test analyses were used to examine survival, predictors of mortality, and correlations.

Results: A total of 215 patients underwent lobectomy, and 74 underwent wedge resection. The groups were similar with respect to age, tumor size, and other comorbidities. Overall, there was a nonsignificant trend toward better survival times in patients after lobectomy vs wedge resection (mean [± SD] survival time, 5.8 ± 0.3 vs 4.1 ± 0.3 years, respectively; p = 0.112). This trend gained significance in smaller cancers, where patients who underwent lobectomy for tumors < 3 cm in size had better survival times compared to those who underwent wedge resection (p = 0.029).

Conclusion: Although the overall difference in survival time between patients undergoing lobectomy and those undergoing wedge resection was not significant, patients with tumors < 3 cm in size had improved survival times after undergoing lobectomy. Thus, tumor size appears to be an important factor to be considered in preoperative planning. Randomized trials are necessary to confirm the superiority of lobectomy over wedge resection for stage IA lung cancers.

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