Measuring the margin distance in pulmonary wedge resection

for the IELCART Investigators

Research output: Contribution to journalArticlepeer-review


Background: Margin distance contributes to survival and recurrence during wedge resections for early-stage non-small cell lung cancer. The Initiative for Early Lung Cancer Research on Treatment sought to standardize a surgeon-measured margin intraoperatively. Methods: Lung cancer patients who underwent wedge resection were reviewed. Margins were measured by the surgeon twice as per a standardized protocol. Intraobserver variability as well as surgeon–pathologist variability were compared. Results: Forty-five patients underwent wedge resection. Same-surgeon measurement analysis indicated good reliability with a small mean difference and narrow limit of agreement for the two measures. The median surgeon-measured margin was 18.0 mm, median pathologist-measured margin was 16.0 mm and the median difference between the surgeon–pathologist margin was −1.0 mm, ranging from −18.0 to 12.0 mm. Bland–Altman analysis for margin measurements demonstrated a mean difference of 0.65 mm. The limit of agreement for the two approaches were wide, with the difference lying between −16.25 and 14.96 mm. Conclusions: A novel protocol of surgeon-measured margin was evaluated and compared with pathologist-measured margin. High intraobserver agreement for repeat surgeon measurements yet low-to-moderate correlation or directionality between surgeon and pathologic measurements were found. Discussion: A standardized protocol may reduce variability in pathologic assessment. These findings have critical implications considering the impact of margin distance on outcomes.

Original languageEnglish
Pages (from-to)1350-1358
Number of pages9
JournalJournal of Surgical Oncology
Issue number7
StatePublished - Dec 2022


  • early stage NSCLC
  • measurement variability
  • recurrence
  • tumor margin distance
  • wedge resection


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