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The Journal of Thoracic and Cardiovascular Surgery, Vol 90, 656-661, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LE Errett, J Wilson, RC Chiu and DD Munro
Although lobectomy is the procedure of preference for patients with
peripheral, clinical Stage I bronchogenic carcinomas, wedge resection of
the tumor may be a satisfactory alternative in poor-risk patients. Between
1965 and 1982, 197 patients with peripheral bronchogenic carcinomas were
operated upon. Clinical staging was established by radiography,
bronchoscopy, and mediastinoscopy. Ninety-seven patients underwent
lobectomies and 100 had wedge resections. The decision to perform the wedge
resection was made preoperatively in the majority of cases based on the
assessment of operative risks. Compared to lobectomy patients, those who
had wedge resections were older (70.3 +/- 0.5 versus 64.9 +/- 0.5 years, p
less than 0.001) and had a lower 1 second forced expiratory volume (1.56
+/- 0.03 versus 1.94 +/- 0.03 ml, p less than 0.001), a lower arterial
oxygen tension (70.5 +/- 1.1 versus 75.6 +/- 1.2 mm Hg, p less than 0.01),
and a higher arterial carbon dioxide tension (41.7 +/- 0.6 versus 38.7 +/-
0.3 mm Hg, p less than 0.001). Despite their compromised preoperative
respiratory functional status, the wedge resection group had a 30 day
operative mortality (3% versus 2.1%) and morbidity comparable to those of
the lobectomy group. Actuarial life-table analysis indicates the cumulative
survival rate at 2 years after operation to be virtually identical between
wedge and lobectomy groups (72% versus 74%), and even at 6 years the
differences in survival rates (69% versus 75%) were not statistically
significant. We conclude, therefore, that by performing wedge resections in
selected poor-risk patients, one may reduce the operative mortality and
morbidity to an acceptable range without seriously compromising their
long-term survival.
ARTICLES
Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients
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