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Editorials |

Wedge Resection: When a Little Is Not Enough

Joseph B. Zwischenberger, MD
Author and Funding Information

Affiliations: Galveston, TX ,  Dr. Zwischenberger is Professor of Surgery, University of Texas Medical Branch.

Correspondence to: Joseph B. Zwischenberger, MD, Professor of Surgery, Medicine and Radiology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555; e-mail: jzwische@utmb.edu


Chest. 2007;131(1):6-7. doi:10.1378/chest.06-2286
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The treatment of stage 1 lung cancer remains controversial. The landmark study > 10 years ago as reported by Ginsberg and Rubinstein1 for the Lung Cancer Study Group (LCSG) demonstrated the superiority of lobectomy over wedge resection in (T1N0, stage IA) lung cancer. This prospective randomized outcomes study1 demonstrated a 30% increase in the overall death rate and a tripling of the recurrence rate in patients who underwent limited resection in a 5-year follow-up in patients with non-small cell histopathology. Limited resection was defined as segmentectomy or “large adequate wedge resection” with 2 cm of normal lung margin with lymph node sampling, T1N0 status, and clear surgical margins. This LCSG sentinel study1 influenced the next decade of practice. In this issue of CHEST (see page 136), Kraev et al2 report on the 10-year survival of patients with stage 1 lung cancer treated either with wedge resection or lobectomy. The length of follow-up begs reflection. Previous reports commonly followed up patients for 2 to 5 years postoperatively. Kraev et al2 demonstrate that the Kaplan-Meier survival curves do not begin to diverge until 3 years out, when an apparent although statistically insignificant survival advantage is seen with lobectomy. This survival advantage reaches statistical significance when applied to tumors < 3 cm in size (T1 N0, stage 1A). These data are consistent with Ginsberg and Rubinstein1 and with other reports demonstrating survival advantages for patients with stage 1A cancer undergoing lobectomy.


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