Comparison of Wedge Resection and Anatomical Lung Resection in Elderly Patients With Early-Stage Nonsmall Cell Lung Cancer With Visceral Pleural Invasion: A Population-Based Study.

Abstract

Background: As the global population ages, the prevalence of early-stage nonsmall cell lung cancer (NSCLC) among octogenarians is rising. This demographic frequently presents with comorbid conditions, diminished cardiopulmonary function, and increased frailty, which elevate the risks associated with standard treatments. While lobectomy combined with lymph node dissection is still considered the gold standard for managing NSCLC, octogenarians are at significantly higher risk of perioperative mortality. Although wedge resection has been suggested as a less invasive option, previous research has insufficiently explored the influence of visceral pleural invasion (VPI) on postoperative outcomes. This study seeks to evaluate whether wedge resection can provide survival outcomes equivalent to those of anatomical resection in this high-risk population.

Methods: We conducted a retrospective analysis using SEER data from 2010 to 2019, focusing on octogenarians diagnosed with stage I NSCLC and VPI. Propensity score matching, Kaplan-Meier survival analysis, log-rank testing, and Cox multivariate regression were employed to evaluate and compare the outcomes associated with two different surgical techniques.

Results: We identified 523 octogenarians with stage I NSCLC and VPI, from a cohort of 1587 patients. In this study cohort, 372 (71.1%) patients received anatomical resection, while 151 (28.9%) patients underwent wedge resection. Following multivariable adjustment and propensity score matching, there were no statistically significant differences in lung cancer-specific survival (CSS; HR 0.99, 95% CI: 0.57-1.73) or overall survival (OS; HR 1.02, 95% CI: 0.68-1.53) observed between the two surgical groups. Additionally, multivariate Cox regression analysis indicated that the choice of surgical approach was not an independent prognostic factor for either CSS (HR 1.29, 95% CI: 0.62-2.69) or OS (HR 1.50, 95% CI: 0.68-1.62).

Conclusions: This study demonstrates that wedge resection is a viable surgical option for octogenarians with stage I NSCLC and VPI. Notably, the addition of lymph node dissection to wedge resection significantly enhances survival outcomes compared to wedge resection performed without lymph node dissection.