The importance of lymph node dissection accompanying wedge resection for clinical stage IA lung cancer†

Abstract

Accompanying wedge resection for lung cancer, LN sampling adds no morbidity and does not increase length of stay. Positive nodes are identified in 4.3% of patients thought eligible for wedge resection. LN removal appears to decrease locoregional recurrence and may be associated with a survival benefit.

Surgical management of ground glass opacities of the lung

“…First, in terms of patient selection, sublobar resection achieves best results for stage Ia disease (with tumours smaller than 2 cm in diameter) and with lesions having a consolidation:tumour ratio on CT imaging greater than 75% (i.e., with a solid component of less than 25%) . Second, in terms of operative strategy, a lymph node dissection should be performed, and a segmentectomy is preferred over a wedge resection . In these selected patients, if such thorough sublobar surgery can be performed, sublobar resection can provide overall and cancer‐specific survival as good as conventional lobectomy …”

“…Second, in terms of operative strategy, a lymph node dissection should be performed, and a segmentectomy is preferred over a wedge resection . In these selected patients, if such thorough sublobar surgery can be performed, sublobar resection can provide overall and cancer‐specific survival as good as conventional lobectomy …”

“…32,40,41 Second, in terms of operative strategy, a lymph node dissection should be performed, and a segmentectomy is preferred over a wedge resection. 42,43 In these selected patients, if such thorough sublobar surgery can be performed, sublobar resection can provide overall and cancer-specific survival as good as conventional lobectomy. [39][40][41][42][43] In 'compromised' patients with poor lung function, medical comorbidities and/or advanced ageare unable to tolerate resection of an entire lobe of lungsublobar resection may be their only realistic chance at cure of NSCLC.…”

Pathologic N1 disease in lung cancer: the segmental and subsegmental lymph nodes

“…It is impossible within the remaining lobe during wedge resection and exposes wedge resections to local recurrence risk. Omission of segmental and intralobar LN retrieval might explain the high incidence of loco-regional recurrence observed after segmentectomy by Hattori and coworkers (23) and after wedge resection by Stiles and coworkers (24). Given the major impact on the prognosis of peripheral LN metastasis, the absence of intrapulmonary resection of these LNs should be a warning signal when considering local surgical therapy or local nonsurgical procedures such as stereotactic body radiation therapy.…”

Pulmonary wedge resection for clinical stage I non-small cell lung cancer: a review of a mini-invasive treatment

“…However, because of potential side effects, caution should be exercised in choosing to perform this procedure. Stiles et al [36] evaluated all patients undergoing wedge resection for peripheral clinical stage IA NSCLC, and grouped them into those with and without LN dissection. Of 196 patients undergoing wedge resection, of whom 138 (70%) had LNs (median = 4 nodes) resected and the remainder did not, there were no significant differences in the clinical or pathologic characteristics between the two groups.…”