The selection of lobectomy or wedge resection in stage I lung cancer remains controversial. We investigated the impact of each procedure on long term survival in a multi-center analysis.
The records of 293 patients were reviewed for age, sex, type of resection, tumor size, number of lymph nodes dissected, and pathology. Data was obtained through the Federal Social Security Death Index and Cancer Registries. Kaplan-Meier, Wilcox, Logistic Regression, and t-test analyses were used to examine survival, predictors of mortality, and correlations.
217 patients underwent lobectomy and 76 had wedge resection for Stage I lung cancer. The groups were similar with respect to age, tumor size and other co-morbidities. Overall, there was a trend towards improved survival in patients who had lobectomy (mean survival 5.8±0.3 vs. 4.1±0.3 years, respectively; p=0.112, see Graph 1). This trend gained statistical significance in smaller cancers, where lobectomies for tumors less than 30mm had better survival when compared to patients that had wedge resection (p=0.029, see Graph 2).
Although the overall difference in survival between lobectomy and wedge resection is insignificant, patients with tumors smaller than 30mm showed a statistically significant survival benefit after lobectomy.
Tumor size, therefore, is an important factor to be considered in pre-operative planning. Randomized trials are necessary to confirm these findings.
Dennis Rassias, None.