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Wedge Resection vs Radiofrequency Ablation To Treat Early Stage NSCLC In High-Risk Patients
Olivia Fanucchi, MD, Marcello C. Ambrogi, MD, PhD, Franca MA Melfi, MD, Paolo Dini, MD, Federico Davini, MD, Stylianos Korasidis, MD, Pietro Bertoglio, MD, Alfredo Mussi, MD.
Division of Thoracic Surgery, Pisa, Italy.

OBJECTIVE: Surgeons are frequently faced with patients with early stage NSCLC who are at high risk for major pulmonary resection due to their poor clinical status. So limited resections, such as wedge resection (WR), or non-surgical therapies, like radiofrequency ablation (RFA), can be considered as alternative treatments. The aim of the study was to retrospectively compare results of both procedures in our recent experience.
METHODS: We reviewed patients with stage I NSCLC who underwent wedge resection or RFA during the period 2006-2010. We compared mortality and morbidity, recurrence rate, actuarial overall and cancer-related survival for each cohort.
RESULTS: Forty-one patients (8 females, 33 males, mean age 70 years) underwent minimally-invasive wedge resection, while 43 patients (10 females, 33 males, mean age 74 years) were treated with percutaneous RFA. There was no mortality in either group, while morbidity rates were 31.7% and 9.3%, respectively (p=0.011). Despite a higher local recurrence rate for RFA (33%) in respect to WR (12%)(p=0.026) at a median follow-up of 29 and 34 months, respectively, the 1- and 3-year actuarial survival (cancer-related) rates were 94% (100%) and 54% (67%), 100% (100%) and 67% (94%), respectively, without significant differences.
CONCLUSIONS: Wedge resection and RFA appear to be safe and viable compromises for treatment of early stage NSCLC, in patients with inadequate pulmonary reserve or high co-morbidity score. RFA is associated with an increased risk of local recurrence, so it should be reserved for patients with true contraindication to surgery.

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