Outcomes: wedge resection versus lobectomy for non-small cell lung cancer at the Cancer Centre of Southeastern Ontario 1998-2009.

Surgical resection in the form of lobectomy or pneumonectomy remains the standard of care for stage I and II non–small cell lung carcinoma (NSCLC) despite advances in chemotherapy and radiation therapy.1 Owing to the primary causative relationship of smoking to NSCLC and associated cardiopulmonary comorbidities, many patients are deemed medically unfit to withstand full lobectomy. The best management for these patients remains controversial; many modalities are available, necessitating further investigation on this topic.2 These modalities include sublobar resection (wedge resection or anatomic segmental resection), observation, conventional fractionated or stereotactic body radiotherapy (SBRT) and radiofrequency ablation.3–7 Many surgeons still prefer sublobar resections over SBRT and ablative therapies despite successful local control rates having been reported with SBRT, particularly by Timmerman and colleagues.8 Controversy remains as to whether sublobar resections are adequate oncologic procedures for patients with severely impaired pulmonary function who could not withstand lobectomy.2,9 This relates to concern that despite preservation of pulmonary function, tumour resection margins may be compromised with inadequate nodal sampling, possibly understaging the primary tumour.10 This could lead to increased rates of local and systemic recurrence and decrease disease-free and overall survival.11 All but 1 previous study examining sublobar resections for NSCLC have been retrospective in nature, many revealing conflicting results.12–32 The prospective trial by Ginsberg and Rubinstein13 concluded that lobectomy was preferred over limited resections owing to decreased rates of local recurrence. This landmark study did not account for tumour diameter or location of the early-stage lesions. It has since been postulated that sublobar resection is an adequate oncologic surgery for peripheral lesions less than 2 cm in diameter, especially in the setting of a second primary lung cancer, adenocarcinoma in situ, or ground-glass opacities.29,33–40 All previous studies have used the sixth edition American Joint Committee in Cancer (AJCC) tumour-node-metastasis (TNM) classification and focused on comparing outcomes of segmental resection to lobectomy.41 Only 1 previous non-Canadian study has focused on comparing outcomes of wedge resection to lobectomy; however, this study also used the sixth edition AJCC TNM classification.31 The purpose of the present study was to determine whether there is a significant difference in tumour recurrence and survival in patients who undergo wedge resections versus lobectomy for NSCLC based on the seventh edition AJCC TNM classification and thus to determine whether wedge resection is an adequate oncologic procedure to offer patients.42–46