Wedge Resection for Early-Stage Non-Small Cell Lung Cancer: Are We There Yet?

Abstract

The optimal extent of resection for early-stage non-small cell lung cancer (NSCLC) remains one of the most debated questions in thoracic surgery. Although lobectomy has traditionally represented the standard of care, contemporary randomized trials have redefined the role of sublobar resection. For appropriately selected patients with small, peripherally located tumors, segmentectomy has shown oncologic equivalence to lobectomy, whereas the evidence supporting wedge resection remains less definitive. This review synthesizes the available evidence comparing wedge resection and segmentectomy, contextualized against lobectomy as the historical benchmark. A comprehensive literature review was performed, focusing on studies published over the last 30 years reporting outcomes of anatomic and non-anatomic, lobar and sublobar lung resections in patients with stage I NSCLC. Wedge resection offers a less-invasive option for early-stage NSCLC, with potential benefits in pulmonary preservation and perioperative safety. However, current evidence remains mixed, and although wedge resection may be appropriate in carefully selected standard-risk patients, its routine use awaits further high-level validation. Careful patient selection, attention to margins, appropriate lymph node evaluation, and consideration of tumor biology are critical in determining patients for whom a wedge resection can be oncologically adequate.