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Segmental and Wedge Resection

What are segmental and wedge resection surgeries?

Segmentectomy and wedge resection surgery are treatments to remove cancer from the lung. These types of surgeries remove only the lung mass and a small portion of the lung along with it, whereas other surgeries, like a lobectomy, remove one or more lobes of the lung. 

Wedge resection and segmentectomies are similar to each other, but they involve slightly different procedures:

  • Wedge resection surgery removes the cancerous tumor, as well as a wedge-shaped section of the lung around the tumor
  • Segmentectomy, also known as segmental resection surgery, removes a part of the lung larger than a wedge section, but smaller than a complete lobe

Both surgeries may also be referred to as a sub-lobar resection.

When do doctors recommend wedge resection surgery or segmentectomy?

While these procedures are less invasive than more extensive lung cancer surgeries, such as lobectomy or pneumonectomy, they may also have a higher chance of cancer recurrence.

There are several reasons a doctor might recommend a segmentectomy or wedge resection surgery. For example:

  • Very small tumors, like early stage non small-cell lung cancers, and limited stage small cell lung cancers, can sometimes be treated with segmentectomy and wedge resection surgery. If the tumor is less than two inches and in the outer parts of the lung and is in stage 0 or 1, doctors may recommend this surgery.
  • Doctors may want to do these procedures as a biopsy to study a suspicious nodule for cancer. Doctors may also perform this procedure for non-cancerous conditions, like tuberculosis or emphysema.
  • These procedures are safer for older people and people with certain health conditions. Doctors may choose to perform these surgeries instead of a lobectomy or pneumonectomy if a person has a serious health condition or a compromised lung because people with these conditions tend to tolerate less extensive surgeries better.

Doctors generally do not recommend these surgeries if the tumor is more than two inches or is in a location that makes it difficult to perform the surgery. Doctors usually don’t recommend segmentectomies and wedge resection surgeries for young and otherwise healthy people.

What to expect from a wedge resection surgery or a segmentectomy

Before either procedure, your doctor may perform certain tests to make sure your overall health is good enough for the surgery. These tests may include:

  • A physical exam and medical history
  • Imaging tests, such as an MRI or CT scan, to find out the location and size of the tumor or if it has spread
  • Blood tests to see how your kidneys and liver are functioning
  • Tests to see how your lungs and heart are functioning

There are two ways your doctor could perform a segmentectomy or wedge resection surgery:

  • Thoracotomy (open chest surgery)
  • Video-assisted thoracoscopic surgery (a less invasive surgery using a tiny video camera), also called VAT surgery

After your doctor locates the tumor, he or she will remove it along with a small section of the lung around it. Sometimes, doctors combine the surgery with a procedure that applies radiation directly to the tumor.

Recovering from wedge resection surgery or segmentectomy

There are two basic parts of recovery from a wedge resection surgery or segmentectomy – recovery in the hospital right after surgery and recovery at home. It may take weeks or even months before you’re feeling like you’re at 100 percent. During your recovery, it’s important to follow the instructions your healthcare team give you. This is the best way to make a speedy and complete recovery.

Recovering in the hospital: After the surgery, the length of time you remain in the hospital will depend on the type of surgery you had and how well you’re recovering from it. While in the hospital, you will have a tube in your chest to drain out any fluid buildup. A respiratory therapist will work with you to do breathing therapy, which should help you re-learn how to take deep breaths and reduce your changes of an infection like pneumonia. Before you leave the hospital, your doctor will provide you with a recovery plan, including instructions and medications.

Recovering at home: When you’re home after your surgery, you will probably be weaker than normal and feel tired and fatigued, which is normal. In time, especially if you follow your doctor’s instructions, you will regain your strength and begin to feel good again.

It’s important to move around and get up and walk at least a few times per day – even if you’re tired. There are many reasons to keep moving, including blood clot prevention and keeping your lungs working. 

After surgery, you will have some physical limitations. For example, you should avoid heavy lifting and may not be able to drive. Make sure you talk to your doctor about what limitations you have and why. You should also ask when you will be able to start doing normal activities again.

Your at-home recovery instructions will include information about:

  • Which medications you should take and how often you should take them (and what not to take)
  • When to start exercising, what type of exercise you can do, and how often you should do it
  • What you should and shouldn’t drink and how often you should eat and drink
  • How to care for your surgical wound
  • How to bathe to ensure you protect your wound and keep it dry
  • What type of symptoms to look out for and who to contact if you have questions or problems

Things to avoid during recovery for wedge resection surgery and segmentectomy

While you’re recovering, you should take steps to avoid illness. Stay away from people who have respiratory infections, such as colds or influenza. 

While you’re recovering, you should also avoid certain things, including:

  • Tobacco smoke (you should not smoke and should stay away from secondhand smoke)
  • Chemical fumes, like paints and cleaning solutions
  • Environmental pollution
  • Anything that irritates your lungs

When to call your doctor after surgery

During recovery, you should call your healthcare provider any time you have questions. 

If you have any signs of an infection or other complications of surgery, including the list below, call your doctor immediately:

  • Fever of 100.4 or higher (or above the limit your doctor recommends)
  • Redness or swelling near the surgical incision
  • Increasing pain, especially around the incision
  • Shortness of breath, difficulty breathing, or pain while breathing
  • Chest pain
  • Cough
  • Coughing up green, yellow, or bloody phlegm
  • Confusion

What are the risks and benefits of wedge resection surgery and segmentectomy?

Complications from wedge resection surgeries and segmentectomies aren’t very common. When they do occur, they may include:

  • Anesthesia complications
  • Infection
  • Bleeding in the chest cavity
  • Bleeding at the incision site
  • A collapsed lung
  • An abnormal passageway that develops between the lung and the lining of the lung
  • Prolonged need for a chest tube due to an air leak
  • Difficulty coming off the respirator

The benefits of wedge resection surgery and segmentectomy depend on many factors, including the type of cancer you have, what stage it’s at, where it’s located, your age and overall health, and other considerations. While experts aren’t entirely sure, there is some evidence that wedge resection surgeries and segmentectomies have similar survival rates to a lobectomy. Your doctor will recommend wedge resection or segmentectomy if he or she thinks the benefits outweigh the risks.

Lung cancer treatment at Beaumont

Through Beaumont’s Multidisciplinary Lung Cancer program, we develop an individualized treatment plan based on your unique situation. Your doctor will work closely with you to develop the most effective treatment plan for you.