Wedge Resection (Lung)
What the Examiner Expects
Non-anatomic resection of a peripheral lung lesion using surgical staplers, preserving the remainder of the lobe. Wedge resection is commonly used for diagnosis of indeterminate pulmonary nodules, resection of pulmonary metastases (metastasectomy), and definitive treatment of early NSCLC in patients with limited pulmonary reserve who cannot tolerate lobectomy. The examiner expects you to know that for early-stage NSCLC (< 2 cm peripheral tumors), recent trials (JCOG0802, CALGB 140503) have shown that sublobar resection is non-inferior to lobectomy, but anatomic segmentectomy is preferred over wedge resection for better oncologic margin and lymph node sampling.
Key Examiner Focus Points
- Non-anatomic parenchymal resection — removes the lesion with a margin of normal lung
- Indicated for peripheral nodules, metastasectomy, or patients who cannot tolerate lobectomy
- For early NSCLC (< 2 cm): sublobar resection (segmentectomy preferred over wedge) is acceptable per JCOG0802/CALGB 140503
- Adequate margin: ≥ 2 cm or ≥ size of the lesion
- VATS approach is standard
Common Curveballs
Frozen section of a wedge-resected nodule shows adenocarcinoma with a positive margin
If the patient can tolerate it, proceed to completion lobectomy with mediastinal lymph node dissection in the same operation. If the patient cannot tolerate lobectomy due to poor pulmonary reserve, re-excise for wider margins.
Patient has multiple bilateral pulmonary nodules suspicious for metastatic colon cancer
Pulmonary metastasectomy is appropriate if: the primary is controlled, there are no extrapulmonary metastases, all lesions can be completely resected, and the patient has adequate pulmonary reserve. Stage with PET/CT. May require bilateral procedures (staged VATS or median sternotomy).