Cancer Research Lab

Lobectomy may provide better survival than wedge resection for lung cancers < 3 cm in size (stage IA), according to a report in the January issue of Chest.

The best surgical approach for stage I primary lung cancer is controversial, lead author Dr. Alexander Kraev, from Oregon Health and Science University in Portland, and colleagues note. The focus of the present study was to compare the long-term outcomes (10 years) of lobectomy and wedge resection as treatments for stage I cancers of various sizes and types.

The study involved 289 patients who underwent surgical resection between 1993 and 1998 at three tertiary medical centers. Long-term survival was assessed using data from the Federal Social Security Death Index and Cancer Registries.

Seventy-four patients underwent wedge resection and the rest were treated with lobectomy, the report indicates.

In the overall analysis, lobectomy was tied to better survival times than was wedge resection, but the association fell short of statistical significance (p = 0.112). When the analysis was confined to patients with tumors < 3 cm, however, lobectomy did provide a significant survival advantage (p = 0.029).

“Prospective randomized trials focusing on tumor size stratification are necessary to confirm the superiority of lobectomy over wedge researctio0n for the treatment of lung cancers of smaller size,” the authors conclude.

“Until a randomized controlled trial can demonstrate otherwise, lobectomy in stage 1A lung cancer will remain the standard of care for those patients who can tolerate the procedure,” Dr. Joseph B. Zwischenberger, from the University of Texas Medical Branch in Galveston, comments in a related editorial.