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Pulmonary wedge resection

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

A pulmonary wedge resection, or a segmentectomy, is a surgical procedure to take out a tumor in the lung and some of the surrounding tissue. A small, triangle-shaped slice of the lung is removed.

The operation differs from more extensive lung cancer surgeries, such as a lobectomy (in which an entire lobe of the lung is removed) or a pneumonectomy (in which a full lung is removed).

Why it may be performed

A wedge resection is most often used to treat non-small cell lung cancer, the most common type of cancer in the lung. Less often, it may be used on small cell lung cancer tumors or neuroendocrine tumors in the lung.

Surgery is typically the first line of treatment for early-stage lung cancers, especially non-small cell lung cancers. However, there are many types of lung cancer surgeries, and deciding which to use depends on the tumor’s location and size and the patient’s lung function and overall health.

A smaller part of the lung is removed in wedge resection than in other surgical options, potentially helping you retain more lung function. This approach is best suited for non-small cell lung cancer tumors if the patient has low lung function and is considered to be unable to cope with a more invasive surgery. For patients who are able to withstand a more extensive approach, lobectomy to remove an entire lobe of the lung is usually the first choice because it decreases the chances that small amounts of cancer are left behind.

Small cell lung cancer is rarely treated with a wedge resection or any other surgery, as this type of lung cancer tends to spread beyond the lungs before it’s diagnosed. When surgery is used to treat small cell lung cancer, a lobectomy is the most common operation.

Similarly, a lobectomy is the most common surgical treatment for lung neuroendocrine tumors. However, wedge resection may be a treatment option for very small lung neuroendocrine tumors that are easily accessible near the border of the lung.

How to prepare

  • Quit smoking: Smokers have an increased risk of surgical complications, as tobacco use decreases and delays the body’s ability to heal wounds. The risk of surgical complications related to lung cancer surgery is estimated to decrease by half when patients quit four to six weeks before surgery and remain abstinent for four weeks post-surgery, according to the American College of Surgeons.
  • Check on medication safety: Before undergoing any lung cancer surgery, such as wedge resection, ask your care team about any medications or supplements you take, both prescription and over-the-counter. Your care team can tell you which medicines are safe to continue taking before and after surgery.
  • Follow instructions on eating and drinking leading up to the surgery: You may need to refrain from both after midnight on the day of surgery.

Your care team may also provide you with more specific instructions leading up to the surgery.

  • You may be advised to practice deep breathing and aerobic exercise to strengthen your lungs.
  • Some patients may receive an incentive spirometer before or after surgery. This device measures how much air goes in and out of your lungs and helps increase your lung capacity. When using it, you inhale slowly and deeply into the mouthpiece, hold your breath for a couple of seconds, and exhale.

What to expect

Before a wedge resection surgery, you’re given general anesthesia through an intravenous (IV) line. The surgeon performing the procedure usually begins by doing a thoracotomy. A thoracotomy starts with an incision in the chest. The location and size of the incision vary depending on the location of the tumor and the type of lung surgery. However, the incision usually ranges from 3 to 8 inches and extends anywhere from the armpit to the back. To reach the lung, your surgeon needs to cut deeper into the skin, severing some muscle and separating the ribs.

Most of the time, lung cancer surgeries start with the thoracotomy approach, but some surgeons may use a less invasive method called video-assisted thoracic surgery (VATS). The VATS procedure uses a tube with a light and a camera, which is inserted into a smaller incision in the chest. The lighted tube, called a thoracoscope, helps the doctor see the area while surgical tools are inserted into other small incisions to remove the necessary lung tissue.

The VATS procedure comes with a lower risk of complications than a thoracotomy. The incisions are smaller, and patients tend to recover more quickly. However, it’s only used on very small, early-stage lung tumors.

During the wedge resection surgery, a small, triangle-shaped piece of the lung is removed to take out the tumor and a bit of the tissue that surrounds the tumor.

Lung cancer surgeries, such as wedge resection, take up to six hours to complete.

After surgery, you’re likely to wake up with tubes in your chest. These tubes prevent fluid and air from getting stuck in the chest cavity. Air and fluid leaking from a lung suggest that it isn’t properly healed yet, which is why the tubes remain in your chest until there’s no excess fluid and air left to drain, which may take between one to five days. The entire hospital stay may last around two to five days. Before leaving the hospital, you may need a chest X-ray to ensure there is no air leakage, indicating that the lungs are working correctly to contain air.

After you wake up and during your recovery in the hospital, it’s common to feel pain at the incision site and the surrounding area. Communicating openly about your pain with the hospital staff helps ensure that it’s kept under control. You may be asked to regularly rate your pain on a scale of one to 10, with one indicating no pain and 10 indicating the worst pain imaginable. You should always alert your doctor before the pain becomes severe so that you never reach that point.

Benefits, risks and results

The benefit of a wedge resection is that it’s designed to preserve greater lung function than other, more extensive lung cancer surgeries. It may be a beneficial option for smaller, non-small cell lung tumors and some small cell or neuroendocrine lung tumors that may be removed using this approach.

On the other hand, evidence suggests wedge resections are less likely to remove all of the cancer cells in the lungs, compared with more extensive surgeries. The more tissue removed, the higher the likelihood that even small pieces of cancer are eradicated. This means that wedge resection comes with a higher rate of recurrence (the cancer coming back) than a lobectomy or pneumonectomy.

Before deciding which lung cancer surgery to use, you and your care team should carefully consider the risks and benefits on a case-by-case basis.

A wedge resection and other lung cancer surgeries may lead to complications and side effects, including:

  • Allergic reactions to anesthesia
  • Blood loss
  • Blood clots in legs or lungs
  • Infections at the incision site
  • Pneumonia

In rare cases, these surgeries cause death. The estimated mortality rate of a wedge resection is lower (1.4 percent) than with other lung cancer procedures. A lobectomy carries a mortality rate of less than 3 percent to 4 percent, while the rate for a pneumonectomy is 5 percent to 8 percent, according to the Radiological Society of North America and the American College of Radiology. Older patients and those with other health problems are generally most at risk of death.

The recovery process after a wedge resection may take weeks or months. During this time, pain in the chest area is common, particularly if the surgeon used the thoracotomy technique, as this requires the ribs to be spread apart. Surgeries that use the VATS technique may result in a speedier recovery time.

Throughout the process of recovery, it’s important to keep in close contact with your care team. If you notice any of the following symptoms after a wedge resection or another lung cancer surgery, call your doctor right away.

  • Persistent pain despite pain medication
  • Constipation lasting four days
  • Pain or swelling in ankle or leg
  • Urinary tract infection symptoms (painful urination)
  • Skin rash
  • Swelling or drainage at the wound site
  • Fever
  • Pneumonia symptoms (fever, nausea, vomiting, coughing, trouble breathing, chills)

Life after surgery

Getting back to everyday life may be difficult after a wedge resection. However, the preservation of lung capacity that a wedge resection provides should make it easier to recover from than other, more extensive surgeries.

Many patients struggle to catch their breath and perform physical activities following lung cancer surgery. Research evidence suggests that even 3 1/2 years after lung cancer surgery, about 70 percent of people cannot meet physical activity guidelines, according to the Cochrane Database of Systematic Reviews.

On top of the physical debilitation, you may struggle with mental health concerns when undergoing lung cancer treatments such as surgery. After lung cancer surgery, studies have shown that people experience a decrease in their overall quality of life.

However, in studies of people with non-small cell lung cancer, exercising after lung surgery seems to improve lung function and quality of life, helping people return to their favorite activities. You’re encouraged to engage in an exercise routine after lung cancer surgery to maintain your physical and mental fitness. Ask your doctor about when you may safely start exercising and which kinds of exercises to perform. Even mild exercise seems to be beneficial.

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