Prognosis of wide wedge resection in patients with stage IA1 and IA2 lung adenocarcinoma with total tumor size including the lepidic component greater than 2 cm: a single center retrospective study

Background: Stage I lung adenocarcinoma with a lepidic component has a good prognosis after sublobar resection. The purpose of this study is to evaluate the prognosis of wide wedge resection in patients diagnosed with stage IA1 and IA2 lung adenocarcinoma (based on the eighth edition of the TNM, staging system) in which the total tumor size, including the lepidic component, is more than 2 cm. Methods: From 2010 to 2018, 180 consecutive patients were diagnosed with stage IA1 and IA2 lung adenocarcinoma with a total tumor size (including the lepidic component) of more than 2 cm, and they underwent wide wedge resection or lobectomy at a hospital in Korea. The patients were determined as stage IA1 or stage IA2, and their clinicopathological characteristics and prognosis were compared between the wedge resection group and the lobectomy group. Results: The clinicopathological characteristics were not statistically different between the wedge resection group and the lobectomy group. There were no recurrences and cancer-related deaths during the follow-up period for patients with stage IA1 lung adenocarcinoma in the wedge resection group and the lobectomy group. However, the 5-year recurrence-free survival rates of the wedge resection group and the lobectomy group were statistically different (73.9% and 90.8%, respectively; P=0.031) in stage IA2 lung adenocarcinoma. In a multivariate analysis of risk factors for recurrence, wedge resection [hazard ratio (HR) =15.883; P=0.026] and lymphovascular invasion (HR =13.854; P=0.023) were significant risk factors for recurrence in patients with stage IA2 lung adenocarcinoma. Conclusions: In the cases of lung adenocarcinoma with a total tumor size (including the lepidic component) of more than 2 cm, a good prognosis can be expected with wide wedge resection in stage IA1, but not an appropriate surgical choice for the cases in stage IA2.