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Pulmonary wedge resection

This page was reviewed under our medical and editorial policy by

Peter Baik, DO, Thoracic Surgeon.

This page was updated on September 25, 2022.

A pulmonary wedge resection is a surgical procedure to take out a tumor in the lung and some of the surrounding tissue. Usually, 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 determine the etiology of lung nodules/lesions if a biopsy is not successful or feasible. It may also be used on precancerous or very early lung cancers. 

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 or segmentectomy 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.

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. This is usually performed via minimally invasive surgery, either using video-assisted thoracic surgery (VATS) or robotic-assisted thoracic surgery. 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.

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.

Wedge resections usually take one to two hours, depending on the number of wedge resections performed, or if there is significant scar tissue.

After surgery, you'll 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 one 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 to find out the etiology of nodules/lesions or to remove very early lung cancer or cancerous lesions from other types of cancer.

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 segmentectomy.

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
  • Prolonged air leak

In rare cases, these surgeries cause death. The estimated mortality rate of a wedge resection is slightly lower than with other lung cancer procedures. A lobectomy carries a mortality rate of about 1 percent, while the rate for a pneumonectomy is about 5 percent, according to the Society of Thoracic Surgeons. 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 or RATS 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 or more
  • 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 after a wedge resection is usually not difficult. 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. However, with wedge resection, most people are able to resume their pre-resection activities.  

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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