Segmentectomy versus wedge resection in physiologically vulnerable patients with stage IA lung cancer

This is the authors' abstract. We don't add key points for this paper.

OBJECTIVES: We compared major morbidity and exploratory oncological outcomes after wedge resection and segmentectomy in physiologically vulnerable patients with stage IA non-small cell lung cancer. METHODS: This single-centre retrospective cohort included consecutive patients with clinical stage IA1-IA2 non-small cell lung cancer who underwent curative-intent wedge resection or segmentectomy between January 2017 and December 2024 and met cardiopulmonary exercise testing vulnerability criteria (peak oxygen uptake <15 mL/kg/min and/or minute ventilation-to-carbon dioxide output slope >35). The primary endpoint was 90-day major morbidity. Analyses adjusted for tumour location and radiological size; inverse probability of treatment weighting was exploratory. Median follow-up was estimated by reverse Kaplan-Meier, with administrative censoring on 23 February 2026. RESULTS: Among 103 patients (47 wedge resection; 56 segmentectomy), median follow-up was 40.2 months. Major morbidity occurred in 6.4% and 12.5%, respectively (relative risk 1.96, 95% confidence interval 0.54-7.16); locoregional recurrence occurred in 14.9% and 7.1% (relative risk 0.48, 95% confidence interval 0.15-1.54). Neither comparison was statistically significant. Adjusted and weighted estimates were imprecise and did not show significant differences in major morbidity, event-free survival, overall survival, or locoregional recurrence. CONCLUSIONS: No statistically significant difference in major morbidity was observed. Locoregional recurrence was 14.9% after wedge resection and 7.1% after segmentectomy (relative risk 0.48, 95% confidence interval 0.15-1.54); this exploratory estimate was imprecise.