A wedge resection of the lung is a common surgical procedure where a small, localized, triangular piece of lung tissue is removed; this limited or sublobar resection is less extensive than removing an entire lobe (lobectomy) or the whole lung (pneumonectomy). It is a targeted technique designed to address a problem area while preserving healthy lung tissue. This approach is used in thoracic surgery for both diagnostic purposes and the treatment of certain lung conditions.
What Defines a Wedge Resection
A wedge resection primarily removes a suspicious lesion located near the surface or periphery of the lung. Unlike a segmentectomy or lobectomy, a wedge resection is considered a non-anatomic resection because it does not follow the natural boundaries of the lung’s bronchovascular segments. The surgeon cuts out a wedge-shaped slice of tissue that includes the target lesion and a margin of healthy tissue. This method is chosen when a patient presents with a small, peripheral lung nodule that requires removal for definitive diagnosis, especially if previous biopsies were inconclusive.
The procedure is also a treatment option for small, early-stage non-small cell lung cancer (NSCLC) and for metastatic tumors that have spread to the lung. It is favored for patients with limited cardiopulmonary reserve, such as those with severe emphysema or chronic obstructive pulmonary disease (COPD), who might not tolerate the loss of lung function that comes with a larger resection. While a lobectomy is the standard treatment for lung cancer, a wedge resection is a lung-sparing alternative that maintains the patient’s long-term breathing capacity.
The Surgical Approach
A wedge resection can be performed using two main surgical methods: the traditional open approach called thoracotomy, or a minimally invasive technique. A thoracotomy requires a larger incision (typically 15 to 20 centimeters) between the ribs to allow direct access to the lung. This open method may be necessary for larger tumors, complex cases, or if the surgeon needs to convert from a minimally invasive approach during the operation.
The preferred method is often a minimally invasive technique, which includes Video-Assisted Thoracoscopic Surgery (VATS) or Robotic-Assisted Surgery. VATS involves making two to four small incisions (about 3 to 4 centimeters long) through which specialized instruments and a camera (thoracoscope) are inserted. Regardless of the access method, the surgeon uses advanced stapling devices to cut and seal the wedge of lung tissue, simultaneously removing the lesion and closing the remaining lung surface. Minimally invasive techniques are associated with smaller incisions, less post-operative pain, and a faster recovery time compared to an open thoracotomy.
Immediate Post-Operative Recovery
Following the procedure, patients are moved to a recovery area for monitoring as they wake up from general anesthesia. A chest tube is inserted during the operation to drain air or fluid from the chest cavity and help the remaining lung re-expand fully. For a VATS procedure, the hospital stay is often shorter (one to five days), whereas an open thoracotomy may require five to seven days.
Pain management is a focus, with patients receiving medication through intravenous lines or an epidural catheter for targeted relief. Nurses and respiratory therapists encourage the patient to sit up, walk short distances, and perform deep-breathing exercises soon after surgery. Early mobility and specific exercises are important for preventing complications such as pneumonia and promoting the quick removal of the chest tube, which is typically left in place for one to three days, depending on the extent of drainage.
Potential Complications and Follow-up Care
Like any major surgery, a lung wedge resection carries risks. A persistent air leak from the staple line is one of the most common complications and may require the chest tube to remain in place for several extra days. Other issues include bleeding, infection at the incision site, and pneumonia. The risk of developing blood clots in the legs or lungs is present, which is why early walking and the use of compression stockings are encouraged.
After the surgery, the resected tissue is sent to a pathologist for detailed analysis, which is important if the procedure was performed for a suspicious nodule. If the wedge resection was for early-stage cancer, the pathology report confirms the final diagnosis, tumor margins, and whether lymph nodes were involved. Follow-up care is tailored to these results, often including regular imaging scans (such as CT scans) to monitor for signs of recurrence, especially since sublobar resections carry a slightly higher risk of the cancer returning than a full lobectomy.