What Is a Wedge Resection?

What to expect when undergoing this procedure

Rendering of lungs showing wedge resection

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A wedge resection involves the removal of cancerous lung cells along with a wedge-shaped section of lung tissue surrounding a tumor.

If your doctor has recommended a wedge resection to treat your lung cancer, you should clearly understand how the operation works and whether it's the best option for helping eliminate your cancer and preventing it from recurring. 

Purpose of a Wedge Resection

A wedge resection surgically cuts cancerous cells away from healthy lung tissue. It is most effective in treating early-stage lung cancer. In some cases, wedge resection may also be used for diagnostic purposes, both related to lung cancer and not.

A doctor may recommend a wedge resection over other procedures for a variety of reasons.

Small Tumor Removal

A wedge resection is usually done for very small lung cancer tumors such as early-stage non-small cell lung cancers. Surgery can sometimes be performed for limited-stage small cell lung cancers, but this is rare.

The procedure is most often recommended if a tumor is less than 4 centimeters (cm) in diameter. Although, ideally, tumors should measure less than 2 cm to qualify for a wedge resection.

The cancer is usually located on the outer parts of the lungs (the periphery) and is classified as stage 0 or stage 1 (A or B) non-small cell lung cancer. Based on the TNM classification of lung cancer, these tumors would be T1N0M0.

Metastatic Cancer Treatment

Cancer cells in the lungs may not be due to primary lung cancer, but might instead be metastases that have spread from other parts of the body, as in the case of breast cancer, melanoma, or colon cancer metastatic to the lungs.

In these instances, the wedge resection may be performed in order to remove isolated metastases that spread to the lungs.

Diagnostic Reasons

Sometimes a wedge resection is done to diagnose tissue that appears suspicious on a scan. It's usually used in this way if a traditional as a lung biopsy can't be done.

The procedure may also be done to evaluate noncancerous lung conditions such as tuberculosis or aspergillosis and to remove emphysema blebs.

Similar Procedures

A wedge resection is different from other, more aggressive types of lung cancer surgery, including a pneumonectomy (an operation that removes an entire lung), a lobectomy (a procedure in which a lobe of a lung is removed), or a segmentectomy (a procedure that removes more than a wedge-shaped size of lung tissue but less than an entire lobe).

Among the reasons your doctor may recommend a wedge resection instead of one of these other options:

  • Compromised health status: When a wedge resection is performed for people with lung cancer, it is often done for people who would not tolerate having a lobectomy, such as people with other serious medical conditions or those who have compromised lung function. When this is the case, the goal is to remove the tumor while preserving as much lung tissue as possible.
  • Age: While there are misconceptions about patients in their 70s, 80s, and 90s being too frail for surgery, older people with lung cancer often tolerate these treatments as well as younger people with the disease. While a pneumonectomy still seems to be highly risky at an advanced age, studies show that those age 80 or older don't have a higher risk for complications from a lung resection compared to adults 10 or more years younger.
  • Personal choice: Some people choose a less invasive procedure such as this for quality-of-life reasons and accept a somewhat higher risk of lung cancer recurrence in exchange for a quicker recovery that will allow them to get back to enjoying life right away.

Depending on how advanced your tumors are, a wedge resection should be comparable to a lobectomy or segmentectomy.

A wedge resection is considered a nonanatomic procedure. That is, it doesn’t involve the removal of a distinct piece of the anatomy (like the removal of an entire lung). In contrast, surgeries that do remove an entire piece of the anatomy are called anatomic procedures.

Risks and Contraindications

Wedge resection can be very effective for early-stage lung cancer, but once tumors exceed 4 cm or if they are located in a section of the lung that cannot easily be removed, this type of surgery is not practical.

In this case, your doctor may recommend another type of lung surgery or non-surgical treatments such as chemotherapy or radiation.

Because a wedge resection is not very involved surgery, complications are fairly uncommon. When they do occur they may include: 

  • Hemothorax (bleeding in the chest cavity)
  • Infection
  • Atelectasis (collapse of part or all of a lung)
  • Bronchopleural fistula, an abnormal passageway that develops between the lungs and the membranes that line the lungs (the pleura)
  • Persistent air leak that requires prolonged need of a chest tube

Before the Procedure

Before surgery, your surgeon will want to make sure you are able to tolerate the procedure—both from a general health standpoint and with regard to lung function.

You will need to go through a series of pre-operative evaluations and tests to determine this. These may include:

Be sure you are clear as to why a wedge resection is being recommended for you and how this surgery stacks up in terms of possible outcomes compared to other options in your specific case.

During the Procedure

A wedge resection can be done either through a thoracotomy (open chest surgery) or via video-assisted thoracoscopic surgery (VATS).

Thoracotomy

This is the more traditional procedure for removing cancerous lung tissue.

In an open thoracotomy, a long incision is made in the chest and the ribs are spread apart to get access to the lungs. The tissue is surgically removed, and the wound is closed using stitches or staples.

VATS

Three or four small cuts are made around the area where the wedge resection is being done. A thoracoscope, a small tube with a light and a tiny camera, is inserted into the chest. It sends images to a computer screen, guiding the surgeon to the cancer where he uses small instruments to cut away the tissue.

VATS is a less invasive procedure, but it's not always possible to use this procedure if the tumor is in a hard-to-reach spot.

Along with surgery, internal radiation—known as brachytherapy—may be administrated. During the wedge resection, a small amount of radiation is directed to the site of the tumor to ensure that the doctors eliminate all the malignant cells.

The rate of post-operative complications is much lower for VATS compared to thoracotomies. Studies estimate that between 6% and 34.2% of VATS operations result in complications, while that may be as high as 58% with open chest thoracotomies.

After the Procedure

Following surgery, the length of time you are in the hospital depends on what type of procedure is done (VATS requires a significantly shorter stay than open thoracotomy) and your progress during recovery.

chest tube is placed in your chest during the procedure, and it usually stays in place for 24 to 48 hours post-surgery. During this time, a respiratory therapist will visit with you, encouraging you to take deep breaths to reduce the risk of infection.

When you are discharged, your surgeon will give you specific instructions for follow-up and provide you with a prescription for medications to ease any pain you have when you return home.

If considering pulmonary rehabilitation after lung cancer surgery, keep in mind that, while it seems to make a significant difference in the quality of life for some people, the research on this treatment is still being studied. Since this is a fairly new concept, you may need to ask your doctor for a referral and check that it is covered your insurance, if applicable.

Prognosis

The prognosis of a wedge resection will vary depending on your particular tumor, your general health, and other treatments you receive.

It was thought for a long time that survival among those who could tolerate lung cancer surgery was higher in people who underwent a lobectomy versus a wedge resection. However, a review of 54 studies looking at close to 39,000 patients has changed that thought. For people who had a wedge resection but could have tolerated a lobectomy, the survival rate was not significantly different between the two procedures.

That said, wedge resections may only be comparable to more aggressive surgeries when the tumors are very small. According to other research, when tumors measured greater than 1 cm, the survival rates for patients were better for those who had lobectomy or segmentectomy versus a wedge resection.

A Word From Verywell

A wedge resection, though less extensive than a lobectomy, segmentectomy, or pneumonectomy, is still major surgery. Be sure to ask for a second opinion before moving ahead with treatment to be sure that the recommended path is right for you.

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