The evolving role of wedge resection in early-stage non-small cell lung cancer: a literature review.

Background and Objective: The surgical management of early-stage non-small cell lung cancer (NSCLC) is evolving due to advances in imaging, staging, and individualized patient selection. Although lobectomy has historically been the gold standard for stage I operable NSCLC, the detection of smaller peripheral tumors and minimally invasive techniques have revived interest in sublobar resections, especially wedge resection. This review aims to critically examine the current and potential role of wedge resection in this context. Methods: A narrative review was conducted using literature retrieved from PubMed, Scopus, and Google Scholar, covering the period from January 2000 to March 2024. Keywords included "non-small cell lung cancer", "wedge resection", "sublobar resection", and "early-stage lung cancer". Studies were selected based on relevance to surgical outcomes, recurrence, and evolving management strategies. Key Content and Findings: Wedge resection, traditionally reserved for high-risk or medically inoperable patients, has shown variable oncologic validity. Retrospective series, database analyses, and prospective trials, such as CALGB 140503, provide evidence for its selective use. However, segmentectomy appears to offer improved local control, especially in tumors with high-risk features like spread through air spaces (STAS). Limitations of wedge resection include inconsistent margins, suboptimal lymph node evaluation, and variability in technical quality. Emerging technologies and non-surgical alternatives, such as stereotactic body radiation therapy (SBRT), radiofrequency ablation (RFA), and particularly microwave ablation (MWA), offer new perspectives for high-risk patients. Conclusions: Wedge resection remains a valuable option in select patients with early-stage NSCLC, though its role continues to be redefined. Future integration of radiomics, intelligence (AI), and molecular profiling may enhance patient selection and refine surgical decision-making, potentially reshaping the place of wedge resection within personalized treatment strategies.