What Is a Wedge Resection?

A wedge resection is a surgical procedure that is done to remove a wedge-shaped section of lung tissue, usually for treating lung cancer, but sometimes for other indications. A wedge resection is less invasive than some of the other surgical options used to remove lung cancer, and it may be appropriate if your cancer is relatively contained.

Your healthcare provider may recommend wedge resection surgery to treat your lung cancer, especially if you have been diagnosed with non-small cell lung cancer (NSCLC). 

Purpose of a Wedge Resection

A wedge resection is usually effective for the treatment of early-stage lung cancer. In some cases, this procedure may be used for the diagnosis of lung cancer or other conditions.

A healthcare provider may recommend this surgery over others for a variety of reasons.

Small Tumor Removal

A wedge resection is usually done to remove very small lung cancer tumors, such as early-stage NSCLC.

A wedge resection procedure is most often recommended if a tumor is less than 4 centimeters (cm) in diameter.

Cancer located in the outer parts of the lungs (the periphery) and classified as stage 0 or stage 1 NSCLC can be treated with wedge resection. Based on the TNM classification of lung cancer, these tumors would be T1N0M0.

Metastatic Cancer Treatment

Cancer in the lungs can be primary lung cancer or metastases that have spread from other parts of the body, such as breast cancer, melanoma, or colon cancer that is metastatic to the lungs.

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

Diagnostic Reasons

Sometimes a wedge resection is done to obtain a tissue sample for diagnosis of a lung lesion that appears on an imaging scan. It's usually used if a traditional 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 more invasive types of lung cancer surgery, including pneumonectomy (an operation that removes an entire lung), lobectomy (a procedure in which a lobe of a lung is removed), or segmentectomy (a procedure that removes more than a wedge-shaped size of lung tissue, but less than an entire lobe).

Your healthcare provider may recommend a wedge resection instead of one of these other options for several reasons:

• Faster recovery: Your healthcare provider might recommend this surgery because it is less invasive than others, spares more healthy lung tissue, and is associated with faster, easier patient recovery.
• Compromised health status: Sometimes a wedge resection is done for people who would not tolerate having a lobectomy due to other serious medical conditions or compromised lung function. When this is the case, the goal is to remove the tumor while preserving as much lung tissue as possible.
• Personal choice: Some people choose a wedge resection because it is a less invasive procedure than some of the other options. Patients may consider this a quality-of-life decision 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.

While a pneumonectomy still seems to be highly risky at an advanced age, studies show that those aged 80 or older don't have a higher risk for complications from a lung resection compared to adults 10 or more years younger.

Depending on how advanced your tumors are, the success rate for a wedge resection should be comparable to that of a lobectomy or segmentectomy.

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 considered the best option.

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

Serious complications are fairly uncommon after wedge resection. 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 pleura (membranes that line the lungs)
• Air leak

What to Expect

To ensure you're ready to handle surgery and the effort it will take to fully recover from the procedure, review the details of what happens before, during, and after a wedge resection. Discuss with your surgeon why a wedge resection is being recommended and how possible outcomes compare to the other treatment options.

As your healthcare provider reviews with you the details of how your wedge resection is performed, ask any questions you have about your surgery, preparation, and recovery.

Before the Procedure

To prepare for surgery, you'll need to go through a series of pre-operative evaluations. These may include:

• A thorough medical history and physical exam
• Blood tests that check your kidney and liver function
• Pulmonary function tests (PFTs)
• A heart evaluation, which may include an electrocardiogram or a stress test
• Imaging studies to evaluate the exact location of the tumor and to check whether cancer has metastasized; these may include magnetic resonance imaging (MRI) or computed tomography (CT) scan

Location

A wedge resection is performed in a hospital operating room. You'll be admitted to the hospital after the surgery so you can spend some time recovering.

Timing

The operation will take between three and six hours, depending upon what type of wedge resection your healthcare provider performs. After surgery, you'll stay in the post-operative recovery unit while you wake up from anesthesia. That may take approximately two more hours.

During the Procedure

On the day of surgery, you'll meet with your surgeon one more time to discuss the procedure and its potential complications, and you will be asked to sign a consent form. The medical team will also evaluate you to ensure that you are well enough for surgery.

After that, you'll be taken into the operating room and prepped. This will include administration of general anesthesia, which will allow you to sleep through the procedure and feel no pain.

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

1) Thoracotomy

This is the more traditional procedure for removing cancerous lung tissue. During an open thoracotomy, a long incision is made in the chest and the ribs are spread apart so your surgeon can get access to your lungs. The tissue is surgically removed, and the wound is closed using stitches or staples.

An open-chest procedure takes about three to six hours.

2) VATS

During 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, which the surgeon uses for guidance while using small instruments to cut away the cancer tissue.

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

Your healthcare provider will take about three hours to perform the VATS.

Addition of Radiation Treatment

Along with surgery, internal radiation—known as brachytherapy—may be administered.

During the wedge resection, a small amount of radiation is directed to the site of the tumor to ensure that the healthcare providers remove all the malignant cells.

Post-Surgery

Following surgery, the length of time you are in the hospital depends on what type of procedure is done and your progress during recovery.

A 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 work with you, guiding you to take deep breaths to reduce your risk of infection.

The rate of post-operative complications is much lower for VATS compared to thoracotomy. 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 thoracotomy.

After the Procedure

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.

You might be prescribed pulmonary rehabilitation after lung cancer surgery.

Prognosis

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

A review of 54 studies looking at close to 39,000 patients who had a wedge resection for treatment of lung cancer showed a survival rate similar to that of patients who had lobectomy.

That said, wedge resections may only be comparable to more aggressive surgeries when the tumors are very small. According to 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. You need to give yourself time to recover after surgery, but make sure to stay active and follow the instructions of your surgeon, oncologist, and respiratory therapist so you can optimize your lung function as you recover.