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Outcomes: wedge resection versus lobectomy for non–small cell lung cancer at the Cancer Centre of Southeastern Ontario 1998–2009

Anna L. McGuire, Wilma M. Hopman, Dimitri Petsikas and Ken Reid
CAN J SURG December 01, 2013 56 (6) E165-E170; DOI: https://doi.org/10.1503/cjs.006311

Article Figures & Tables

Figures

  • Fig. 1
    Fig. 1

    Kaplan–Meier estimates of disease-free survival in patients who underwent lobectomy compared with those who underwent wedge resection for tumours smaller than 2 cm in diameter (p = 0.65).

Tables

  • Table 1

    Clinical characteristics of patients undergoing surgical resection for non–small cell lung cancer, by surgical procedure

    CharacteristicGroup; no (%)*p value†
    Lobectomy
    n = 352    		Wedge resection
    n = 71
    Age mean, yr64.764.90.78
    Sex0.48
     Male165 (46.9)30 (42.3)
     Female187 (53.1)41 (57.7)
    Smoker323 (96.1)65 (98.5)0.48
    Comorbidities
     Coronary artery disease87 (24.9)19 (26.8)0.74
     COPD101 (28.9)33 (46.5)0.004
     Psychiatric33 (9.4)6 (8.4)0.80
     Type II diabetes34 (9.7)6 (8.5)0.74
    Chemotherapy
     Adjuvant57 (16.9)10 (14.9)0.70
     Neoadjuvant7 (2.1)1 (1.5)> 0.99
    Tumour stage0.007
     T1a96 (27.3)27 (38.0)
     T1b86 (24.4)16 (22.5)
     T2a117 (33.2)18 (25.4)
     T2b23 (6.5)2 (2.8)
     T328 (8.0)4 (5.6)
     T42 (0.6)4 (5.6)
    Cancer stage; AJCC seventh ed.0.020
     IA146 (41.5)35 (49.3)
     IB68 (19.3)16 (22.5)
     IIA81 (23.0)4 (5.6)
     IIB29 (8.2)5 (7.0)
     IIIA26 (7.4)11 (15.5)
     IIIB1 (0.3)0
     IV1 (0.3)0

    • AJCC = American Joint Committee in Cancer; COPD = chronic obstructive pulmonary disease.

    • ↵* Unless otherwise indicated.

    • ↵† All tests are χ2 tests (Pearson or Fisher exact, as appropriate) with the exception of age, which was based on a t test.

  • Table 2

    Pathological characteristics of patients undergoing surgical resection for non–small cell lung cancer, by surgical procedure

    CharacteristicGroup; no (%)*p value†
    Lobectomy
    n = 351    		Wedge resection
    n = 71
    Tumour size, mean, cm3.32.50.002
     T1a; AJCC seventh ed.96 (27.3)27 (38)0.007
     Stage IA; AJCC seventh ed.146 (41.5)35 (49.3)0.021
    Histology, no (%)0.44
     Adenocarcinoma230 (65.5)53 (74.6)
     Squamous cell94 (26.7)15 (21.1)
     Adenosquamous9 (2.6)0
     Large cell12 (3.4)3 (4.2)
     Other5 (1.4)0
    Tumour differentiation0.38
     Well46 (13.3)11 (16.2)
     Moderate134 (38.7)19 (27.9)
     Poor154 (44.5)36 (52.9)
     Undifferentiated12 (3.5)2 (2.9)
    Invasion present
     Lymphatic87 (25.3)21 (30.4)0.38
     Vascular101 (29.4)18 (26.5)0.63

    • AJCC = American Joint Committee in Cancer.

    • ↵* Unless otherwise indicated.

    • ↵† All tests are χ2 other than tumour size, which was assessed using a t test.

  • Table 3

    Tumour and cancer stage–specific disease-free survival and overall survival rates

    Stage*Group; no. (%)
    Disease-free survivalOverall survival
    Lobectomy, n = 223Wedge resection, n = 43p value†Lobectomy, n = 223Wedge resection, n = 42p value†
    Tumour stage0.0430.081
     T1a67 (30.0)18 (41.9)71 (30.5)22 (52.4)
     T1b58 (26.0)9 (20.9)57 (24.5)9 (21.4)
     T2a67 (30.0)11 (25.6)73 (31.3)8 (19.0)
     T2b15 (6.8)1 (2.3)12 (5.1)1 (2.4)
     T314 (6.3)1 (2.3)18 (7.7)1 (2.4)
     T42 (0.9)3 (7.0)2 (0.9)1 (2.4)
    Cancer stage0.0080.088
     IA110 (49.3)107 (45.9)23 (53.5)26 (61.9)
     IB43 (19.2)45 (19.3)9 (20.9)7 (16.6)
     IIA39 (17.5)46 (19.8)1 (2.3)2 (4.8)
     IIB19 (8.5)22 (9.5)2 (4.7)2 (4.8)
     IIIA10 (4.5)11 (4.7)8 (18.6)5 (11.9)
     IIIB1 (0.5)1 (0.4)00
     IV1 (0.5)1 (0.4)00

    • AJCC = American Joint Committee on Cancer.

    • ↵* Tumour stage and cancer stage are based on the AJCC, seventh edition.

    • ↵† p values are based on the Pearson χ2 test.

  • Table 4

    Outcomes for patients with tumours smaller than 2 cm in diameter

    OutcomeGroup; no. (%)*p value
    Lobectomy, n = 96Wedge resection, n = 33
    Tumour recurrence26 (27.7)8 (26.7)0.92†
     Distant; brain, bone, adrenal112
     Regional; mediastinal or hilar lymph nodes63
     Local; within lung parenchyma93
    Overall mortality24 (25)6 (19.4)0.52†
    Complication; prolonged air leak18 (18.9)2 (6.1)0.10†
    Length of hospital stay, mean d7.96.20.043‡
    Tumour diameter, mean cm1.61.50.13‡

    • ↵* Unless otherwise indicated.

    • ↵† χ2 test.

    • ↵‡ Mann–Whitney U test.

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In this issue

Canadian Journal of Surgery: 56 (6)
CAN J SURG
Vol. 56, Issue 6
1 Dec 2013

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Outcomes: wedge resection versus lobectomy for non–small cell lung cancer at the Cancer Centre of Southeastern Ontario 1998–2009
Anna L. McGuire, Wilma M. Hopman, Dimitri Petsikas, Ken Reid
CAN J SURG Dec 2013, 56 (6) E165-E170; DOI: 10.1503/cjs.006311
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