Eastern Cardiothoracic Surgical Society

Wedge Resection Versus Lobectomy For Stage 1A Non-Small Cell Lung Cancer (NSCLC) in the Elderly: A Surveillance, Epidemiology and End Results (SEER) Database Analysis
Mohan M. John, Syed S. Razi, Sandeep Sainathan, Christos Stavropoulos,  Bronx Lebanon Hospital Center, Bronx, NY

OBJECTIVE: There is limited data available regarding the long-term outcomes of lung resection for non-small cell lung cancer (NSCLC) in the elderly population (>75 years). We investigated the prognostic significance of wedge resection versus lobectomy in this group of patients with stage IA NSCLC using the SEER database.

METHODS: The SEER database was queried for patients >75 years of age who underwent limited lung resection for stage IA squamous cell carcinoma and adenocarcinoma of the lung from 1998 to 2005. Overall and cancer-specific survival rates were analyzed. Survival curves were constructed using the Kaplan-Meier survival analysis method and log-rank test was used to compare the survival curves.

RESULTS: A total of 1401 patients >75 years of age with stage IA NSCLC were included in this study. Lobectomy was performed in 1000 patients, and 401 patients underwent wedge resection. Age, female gender, black race and poorly differentiated tumors were found to be independent negative predictors of overall survival. The overall survival was lower in the wedge resection group (HR 1.37, CI 1.02-1.57, p<0.05). However, there was no significant difference in cancer-specific survival between the two groups (HR 1.13, CI 0.93-1.37, p=0.21).

CONCLUSIONS: Wedge resection is not inferior to lobectomy for stage IA NSCLC in the elderly, and should be considered a viable alternative in this high-risk population.