Wedge resection versus segmentectomy in peripheral clinical stage IA lung cancer concerning ground-glass opacity

Purpose Recent randomized controlled trials have shown the non-inferiority of sublobar-to-lobar resection for small peripheral non-small cell lung cancer (NSCLC); however, whether wedge resection (WR) or anatomical segmentectomy (SG) is superior remains unclear. We hypothesized that ground-glass opacity (GGO) is associated with the outcomes of WR and SG. Methods Between 2010 and 2022, 219 consecutive patients with clinical stage IA peripheral NSCLC who underwent sublobar resection for frailty at our institution were retrospectively reviewed. Based on the high-resolution computed tomography findings, the tumors were classified into two groups: part-solid (GGO (+)) and solid (GGO (−)). The long-term outcomes were compared between the WR and SG groups. Results In the part-solid group ( n = 124; median CTR, 0.62), WR was equivalent to SG in terms of 5-year disease-free survival [DFS] (98% vs. 91%; p = 0.2) and recurrence rate (0% vs. 4.3%; p = 0.3). In the solid tumor group ( n = 95), WR was inferior to SG in terms of the 5-year DFS (43% vs. 80%; p < 0.01) and recurrence rate (32% vs. 3.7%; p < 0.01). Conclusions In our study population, WR was not inferior to SG for part-solid tumors. However, for solid tumors, the long-term outcomes of SG are superior to those of WR.