title: Wedge resection vs lobectomy: 10-year survival in stage I primary lung cancer.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA. Sasha@kraev.com
authors.forename: Alexander
authors.initials: A
authors.lastname: Kraev
authors.forename: Dennis
authors.initials: D
authors.lastname: Rassias
authors.forename: John
authors.initials: J
authors.lastname: Vetto
authors.forename: Mikhail
authors.initials: M
authors.lastname: Torosoff
authors.forename: Pasala
authors.initials: P
authors.lastname: Ravichandran
authors.forename: Christina
authors.initials: C
authors.lastname: Clement
authors.forename: Adebambo
authors.initials: A
authors.lastname: Kadri
authors.forename: Riivo
authors.initials: R
authors.lastname: Ilves
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome