Margin positivity is not associated with the extent of resection for non-small cell lung cancer.

Abstract

Extent of resection for non-small cell lung cancer is often guided by provider discretion, with evolving evidence on comparative outcomes. Although less invasive, the oncologic adequacy of sublobar resection remains uncertain. We sought to assess the association between the extent of resection and margin positivity. We retrospectively queried a single institution for non-small cell lung cancer patients undergoing wedge resection, segmentectomy, or lobectomy from 2021 to 2024. Operative characteristics, margin status, lymph node status, perioperative outcomes, and 2-year survival and recurrence were compared across resection types. Multivariable logistic regression assessed associations between resection type and margin positivity. We identified 490 patients who met inclusion criteria (wedge: 64; segmentectomy: 110; and lobectomy: 316). Patients undergoing wedge resection had a higher average number of comorbidities, whereas patients undergoing lobectomy had larger tumors. Positive margins were similar across groups (wedge: 4.7%; segmentectomy: 1.8%; and lobectomy: 4.7%; P = .400). Wedge resection had a lower average number of lymph nodes harvested as well as shorter intraoperative blood loss, operative time, and hospital stay. Overall complication rates were similar. Two-year survival and recurrence were comparable between groups. Upon multivariable analysis, the extent of resection was not associated with margin positivity. Findings were consistent in the subgroup of tumors ≤2 cm. Positive margins are infrequent and do not appear to differ by resection type. Despite fewer lymph nodes harvested, wedge resection demonstrated similar short-term recurrence and survival to anatomic resection. These findings suggest that anatomic resection may not be necessary solely to achieve negative margins and support the selective use of wedge resection in appropriately chosen patients.