Non-Small Cell Lung Cancer Patients With Tumors ≤ 2 Cm Are Suitable for Wedge Resection or Segmentectomy: A Real-World Study.

BACKGROUND: The role of wedge resection in the treatment of non-small cell lung cancer (NSCLC) with solid components ≤ 2 cm remains controversial. This study compared the efficacy of wedge resection with that of segmentectomy in these patients. MATERIALS AND METHODS: This real-world retrospective study included NSCLC patients who underwent wedge resection or segmentectomy at Beijing Chao-Yang Hospital, Capital Medical University, from January 2018 to December 2020. Patient data were retrospectively reviewed. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were applied to minimize baseline disparities. Survival outcomes, including overall survival (OS), recurrence-free survival (RFS), and lung cancer-specific survival (LCSS), were examined via Cox proportional hazards modeling. RESULTS: A total of 640 patients were enrolled (wedge resection: 295; segmentectomy: 345). After IPTW, no difference in baseline characteristics was observed between the two groups. Additionally, long-term outcomes did not significantly differ between the groups. However, compared with segmentectomy, wedge resection was associated with a shorter operation duration (p < 0.001), less intraoperative blood loss (p < 0.001), fewer complications (p < 0.001), and shorter postoperative stay (p = 0.047). In the subgroup with a consolidation-to-tumor ratio (CTR) > 0.25, segmentectomy resulted in longer OS (p = 0.046), LCSS (p = 0.036) as well as higher 5-year OS (p = 0.045), 5-year RFS (p = 0.023), and 5-year LCSS (p = 0.015). CONCLUSION: Wedge resection is an optimal choice for patients with NSCLC ≤ 2 cm, especially for patients with Ground-Glass Opacity (GGO) dominant tumors. However, segmentectomy is more appropriate when the CTR is > 0.25.