A wedge resection is a surgical procedure to remove a small piece of cancerous tissue from a lung. Some pleural mesothelioma patients benefit from a wedge resection for diagnosis or as part of a treatment plan.
What Is a Wedge Resection?
Of the many surgical procedures to treat or manage pleural mesothelioma, wedge resection is among the more conservative. During the surgical procedure known as wedge resection, a surgeon removes a wedge-shaped piece of lung tissue. The tissue removed typically contains both the tumor and some of the healthy tissue around it.[1]
Surgical Treatment for Pleural Mesothelioma
Pleural mesothelioma patients typically undergo multimodal treatment, a combination of strategies for the best outcome.
For patients who qualify for surgical treatment, wedge resection is one of the more conservative options. Surgeons remove only small portions of a lung where a tumor is growing, as well as a healthy margin around it.
They can often do this with a minimally invasive procedure. Just a few small incisions are used to perform the surgery. This minimizes the risks of complications like infection and also speeds recovery.[2] Surgeons also use wedge resection to treat lung cancer.
Wedge Resection Surgery to Diagnose Mesothelioma
In addition to being used for cancer treatment, a wedge resection may be performed for diagnosis. If more tissue is needed for examination than a needle biopsy can provide, this surgery can remove enough cancerous tissue to study.
Who Is Eligible for Wedge Resection?
Typical treatment for mesothelioma includes a combination of chemotherapy, surgery, and radiation therapy.[3] Surgery is often the best way to attempt to achieve remission or extend survival time, but not all patients are candidates for surgical procedures.
Mesothelioma is resectable when the treatment team determines that a surgical procedure is a valid option for slowing the spread of cancer or curing it. Whether or not pleural mesothelioma is resectable depends on several factors.
The most important factor is the stage. Most cases of stage 1 are resectable, many cases of stage 2 are, and some people in stage 3 may be considered for surgical procedures.
Stage 4 is not generally resectable because the tumors are too widespread. Surgeries during this stage are largely palliative.[4]
If your medical team decides that your mesothelioma is potentially resectable, you can use their advice to determine if you would like to go ahead with surgery and, if so, with what type.
Mesothelioma surgeries are generally aggressive to match tumor growth. Surgeons will always try to remove as little tissue as possible to minimize complications and preserve function.
Can Mesothelioma Be Cured with Wedge Resection Surgery?
Pleural mesothelioma is challenging to treat and nearly impossible to cure because it forms multiple, small tumors. The growth pattern makes it challenging to remove all cancerous tissue surgically.
Mesothelioma patients eligible for surgery often elect for more radical procedures than a wedge resection to increase the chance of going into remission. But a wedge resection can be part of a more radical surgery.
For instance, a patient may undergo a pleurectomy/decortication surgery, which removes the pleura and additional tissue. The surgeon can use wedge resection to remove tumors that have infiltrated lung tissue.[5]
In earlier stages of mesothelioma, a wedge resection, used along with pleurectomy and decortication, may be curative. This strategy is primarily useful before cancer has spread widely in the lungs. Slowing the spread of the tumors can prolong life expectancy.
What Happens During Wedge Resection for Mesothelioma?
During wedge resection, a surgeon removes a tumor from the lung as part of a wedge-shaped piece of tissue. The surgeon removes healthy tissue around the margins of the tumor to reduce the risk that it will regrow.
Is Wedge Resection an Open Surgery?
Surgeons can perform wedge resection as an open surgery, using a large incision known as a thoracotomy. Alternatively, they can perform it as a thoracoscopy, using smaller incisions and a small scope for a minimally invasive procedure.
Pleural mesothelioma often spreads extensively throughout the chest cavity. This makes it unlikely that a minimally invasive procedure will be adequate to remove cancerous tissue. Most mesothelioma patients require a thoracotomy and open surgery.
How Long Does Wedge Resection Mesothelioma Surgery Take?
The duration of the procedure varies by patient. If it is a simple wedge resection with no complications, it might take only about three hours.
Pleural mesothelioma patients usually undergo more involved procedures during which the wedge resection is just one part. These surgeries can take several hours.
The Risks of a Wedge Resection
When performing surgical procedures to slow the spread of cancer or cure it, surgeons must always balance the benefits against the risks. The more extensive the surgery, the greater the risk of complications and serious complications.
A wedge resection is relatively conservative compared to the more extensive surgeries often done to manage pleural mesothelioma. Still, there are some potential risks:
- Complications related to anesthesia
- Infections
- Bleeding at the incision site
- Internal bleeding in the chest cavity
- Air leaks that may lead to a collapsed lung
- A hole between the lung and pleural tissue
If VATS, or video-assisted thoracoscopic surgery, is a possibility for your treatment, the risks are less but still significant.
Recovering from Surgery
Recovery from a wedge resection takes less time than from a more extensive procedure, especially if you underwent a VATS procedure.
However, when used for pleural mesothelioma, a wedge resection is often part of a more radical surgery. You may need to be in the hospital for up to ten days or two weeks to recover.
Once home, you will need to monitor your symptoms and the incision sites and contact your medical team if you have any concerns. Look for swelling, redness, or bleeding at the incisions, a fever, difficulty breathing, chest pain, coughing, or shortness of breath.
A wedge resection can be a useful tool in managing pleural mesothelioma. Unless you are in the very early stages, it is unlikely this procedure will be curative, but it may help you live longer and have fewer symptoms. Talk to your doctor about surgical options to make the best decisions for your treatment.
