What Is Wedge Resection?

Introduction

In the realm of medical interventions, surgical procedures play a pivotal role in addressing various health concerns. One such procedure, employed with precision and purpose, is the wedge resection. As we delve into the intricacies of this surgical technique, it becomes essential to not only comprehend the technical aspects but also to empathetically consider the human experience intertwined with it. In this article we evaluate the medical significance and uses of the wedge resection technique, examining all aspects so you can know what to expect. 

Understanding the purpose

A wedge resection is a surgical procedure to take out a piece, or a ‘wedge’, of tissue from the body. It is primarily used to remove or evaluate tumours in the lungs, known as a pulmonary wedge resection or a segmentectomy, but can be used to correct an astigmatism after corneal surgery and remove tumours from the liver. The liver responds particularly well to a wedge resection due to its regenerating abilities able to make up for the small amount of tissue removed.¹ For early-stage lung cancer, a wedge resection can be used to remove entire small tumours with a diameter less than 4 cm.² It requires less aftercare than alternative procedures which are more invasive and have a longer recovery process making it a more desirable option for more elderly and ill patients. 

Anatomy and procedure overview

To remove a tumour from the lung there are two different approaches which are chosen depending on the location of the tumour and any factors dictating how quickly you can recover from the procedure.³ A thoracotomy is the traditional approach to wedge resection. It involves initially a long incision in the chest and your ribs being spread apart so that the surgeon can examine your lungs. The wedge of tissue is surgically removed and the wound is closed and stitched or staples back up, in total the process takes from 3-6 hours. Alternatively, a video-assisted thoracoscopic surgery (VATS) only takes around 3 hours.⁴ Here, three small incisions are made in the area of the tissue to be removed and small instruments are inserted into your torso, guided by a small camera inserted in a tube. This process is less invasive but cannot be used to access tissue in more difficult-to-reach locations, such as on the side of the lung.

Corneal lung resections are used post-keratoplasty, after a cornea transplant in your eye, to correct high levels of astigmatism, a non-spherical eye shape. The procedure is considered safe and predictable with few long-term side effects, thus, is frequently used.⁵

Preoperative and postoperative care

Before the operation, and when considering the choices of procedure, your doctor will examine your medical history and may send you for tests such as lung function tests or an ultrasound. This can help the doctors to prepare for the surgery as well as devise a more suitable and effective recovery plan. Other tests may include blood tests, chest X-rays, MRI and CT scans or a lung perfusion scan (this shows the blood flow in your lungs)⁶. You may be required to begin fasting the day before the operation, and the nurse may give you an antiseptic mouthwash and nasal cream to apply. After the operation, you will be given pain relief and will have a chest drain, which removes the build-up of fluids via a one-way tube after lung surgery. Once you are sufficiently recovered, you can be released from the hospital, usually after about a week. Your lung function can recover quicker if you take deep breaths,walk around, and eventually do exercise. 

Corneal stabilisation can take months after a wedge resection, but other than wearing an eyepatch, to stop you from rubbing your eye, for about a few days after the operation there is no significant aftercare. You should try to avoid manual labour or dusty places for the first 3 or 4 weeks after the surgery.⁷ Your eye may feel more sensitive to the cold or the sun, but after a year there are usually no side effects. 

Benefits and risks

The benefits of a pulmonary wedge resection are primarily the quick recovery after the procedure. Compared to other lung surgeries, a thoracotomy and especially a VATS are quick and have less of a risk of further illnesses caused by the incisions. These preserve lung function and can also act as a diagnosis tool when a traditional biopsy is not able to be performed. 

However, a pulmonary wedge resection also comes with risks:²

• Recurrence - due to only a small amount of tissue being removed, there is a higher chance when removing a tumour that the cancer can come back than more invasive alternatives. This is due to it being more likely a small part of the tumour or cancerous tissue being missed and remaining in the body. 
• Blood clots - most major surgeries come with an increased risk of blood clots due to the opening of arteries and veins.
• Infection - due to the chest being opened in a thoracotomy there can be complications with the wound getting infected in the healing process. This risk is much lower for a VATS due to the wound being much smaller. It can often be cured with antibiotics if it is caught quickly, or they may be used as a preventative measure.
• Atelectasis - this is the collapse of the lung, or part of a lung, after the surgery. It can be caused by an airway obstruction or pressure on the lung. 
• Postoperative pneumonia - this is one of the leading complications with lung surgery. It is more common in elderly patients or with those who smoke.⁸ More invasive surgeries have a higher risk of developing pneumonia.

Many of these issues can be solved or prevented in the aftercare. Precautionary steps include doing chest physiotherapy and taking courses of broad-spectrum antibiotics and pain medications.⁹ Your doctor will also consider potential issues when preparing for the surgery to limit the postoperative risks and speed up your recovery. 

Alternative approaches

While there are alternative procedures to remove tumours on the lungs, they are more invasive and thus require a long recovery time, often reducing the quality of life post-operation. These are primarily:

• Lobectomy - this is the removal of a lobe of the lung. There are five lobes between your two lungs, three on the right and two on the left, so, depending on which lobe is removed, you can still have a satisfactory lung function so it does not alter your life significantly. As expected, your lung capacity is reduced, but this can be improved with chest physiotherapy and regular exercise. 
• Pneumonectomy - this is the removal of an entire lung. This is a serious procedure and often will only be considered as a last option for widespread cancer over an entire lung, or when a lobectomy or multiple wedge resections have been attempted. This has a long recovery period and will diminish your ability to do exercise. 
• Biopsy - in early-stage cancers, when a wedge resection is removing a lesion or tumour believed to be cancerous, your doctor often will choose to do a biopsy before a wedge resection to make sure it is necessary. In fact, it will most likely be considered before a wedge resection. This is when a small amount of tissue is taken from an area to be medically examined. 

Alternatively to a corneal wedge, glasses or contact lenses can be worn to correct the astigmatism.

Collaborative decision-making

Collaborative decision-making with a medical professional regarding wedge resections is a cornerstone of patient-centred care. You and your doctor should go over the pros and cons of each of the options to ensure you are fully aware of the coming challenges. This shared decision-making process not only empowers patients by fostering a sense of control over your healthcare journey but also ensures that the chosen path aligns with your individual needs and aspirations. 

Summary

As a surgical procedure, the applications of the wedge resection lie primarily in the pulmonary region, but can stretch to further organs and, in theory, could remove tumours from any area of the body. The corneal wedge removal is vital to any who are unable to have their vision corrected by contact lenses or glasses. The choice between traditional thoracotomy and the minimally invasive VATS, both with their distinct advantages, reflects the evolution of surgical techniques tailored to individual patient needs. Both you and your doctor should carefully consider the alternative options, finalising an informed decision, to ensure each is aware and happy with the circumstances and procedures.

Frequently asked questions

How long does it take to heal from a wedge resection?

It usually takes 4 weeks to fully recover from a wedge resection. This can depend on your age, prior illnesses and the size of the wedge.² 

What is the difference between a wedge resection and a lobectomy?

In a wedge resection only a small piece of tissue is removed. In a lobectomy, an entire lobe, a fifth of your lungs, is removed. Thus, wedge resections are a less invasive procedure and have a quicker and easier recovery. 

What is the survival rate for a wedge resection?

Studies have shown the survival rate for a wedge resection after 5 years is approximately 85%, mostly due to recurrence of cancer.¹⁰

Kitty Reeves

Bachelor of Science - BSc, Physics, University of Birmingham

Kitty Reeves is a recent physics graduate from the university of Birmingham, where she focussed on medical and biological physics. She has previous experience working on machine learning to aid in MRI brain scans and has taught physics and maths for several years.

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