title: Segmentectomy versus wedge resection for non-small cell lung cancer in high-risk operable patients.
abstract: BACKGROUND
  Patients with early-stage lung cancer and limited pulmonary reserve may not be appropriate candidates for lobectomy. In these situations, sublobar resection (wedge or segmentectomy) is generally performed. Many physicians believe that segmentectomy is superior because it allows for an improved parenchymal margin and nodal sampling.
  
  
  METHODS
  We performed an analysis using operative and pathology reports collected as part of planned data collection for American College of Surgeons Surgical Oncology Group (ACOSG) Z4032. This was a prospective trial in which patients with clinical stage I lung cancer and limited pulmonary function were randomized to sublobar resection with or without brachytherapy. The operative approach (video-assisted thoracic surgery [VATS] vs thoracotomy), extent of resection, and degree of lymph node evaluation were at the discretion of the individual surgeon. The primary aim of this analysis was to compare the parenchymal margin achieved between segmentectomy and wedge resection. Secondary aims included the extent of nodal staging and whether the operative approach (VATS vs open) had an effect on margin status and nodal evaluation.
  
  
  RESULTS
  Among 210 patients, 135 (64%) underwent a VATS approach and 75 (36%) a thoracotomy. A segmentectomy was performed in 57 patients (27%) and a wedge resection in 153 patients (73%). There were no significant differences in the degree of nodal upstaging, stations sampled, or parenchymal margin obtained between VATS and thoracotomy. However, significant differences were observed between patients who underwent a segmentectomy and those who underwent a wedge resection with regard to parenchymal margin (1.5 cm vs 0.8 cm, p = 0.0001), nodal upstaging (9% vs 1%, p = 0.006), and nodal stations sampled (3 vs 1, p < 0.0001) . Notably, 41% of patients treated by wedge resection had no nodes sampled at the time of operation compared with 2% of those who underwent segmentectomy (p < 0.0001).
  
  
  CONCLUSIONS
  In ACOSG Z4032, wedge resection, regardless of the approach, was associated with a smaller parenchymal margin and a lower yield of lymph nodes and rate of nodal upstaging when compared with segmentectomy.
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: mkent@bidmc.harvard.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Kent
authors.forename: Rodney
authors.initials: R
authors.lastname: Landreneau
authors.forename: Sumithra
authors.initials: S
authors.lastname: Mandrekar
authors.forename: Shauna
authors.initials: S
authors.lastname: Hillman
authors.forename: Francis
authors.initials: F
authors.lastname: Nichols
authors.forename: David
authors.initials: D
authors.lastname: Jones
authors.forename: Sandra
authors.initials: S
authors.lastname: Starnes
authors.forename: Angelina
authors.initials: A
authors.lastname: Tan
authors.forename: Joe
authors.initials: J
authors.lastname: Putnam
authors.forename: Brian
authors.initials: B
authors.lastname: Meyers
authors.forename: Benedict
authors.initials: B
authors.lastname: Daly
authors.forename: Hiran C
authors.initials: HC
authors.lastname: Fernando
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy
keywords: 10