Non-Small Cell Lung Cancer Patients With Tumors ≤ 2 Cm Are Suitable for Wedge Resection or Segmentectomy: A Real-World Study.

1
Introduction
Despite advances in oncology, lung cancer remains the leading cause of cancer‐related deaths worldwide; it accounts for nearly one‐fifth (18%) of all cancer mortality [1]. The low five‐year survival rates (less than 20%) indicate that management strategies clearly warrant optimization [2]. In 2011, the pivotal NLST study revealed that LDCT screening decreased lung cancer mortality by 20%, representing a major advancement in early detection [3]. This landmark finding not only redefined early diagnostic standards but also significantly improved the detection of subcentimeter pulmonary lesions. Therefore, precision‐oriented surgical strategies have gained prominence as a critical area of clinical investigation.
Since its establishment in 1995 as the gold‐standard radical procedure for early‐stage lung cancer, lobectomy has undergone rigorous reevaluation through evidence‐based medicine [4]. Recent studies suggest that sublobar resection—while achieving comparable oncological outcomes—may better preserve pulmonary function in select early‐stage cases, prompting a paradigm shift in treatment strategies [5]. Sublobar resection includes two main techniques. Anatomic segmentectomy involves meticulous dissection of segmental bronchovascular structures (arteries, bronchi, and intersegmental veins), uses inflation–deflation techniques to identify intersegmental planes, and preserves critical intersegmental venous drainage. In contrast, wedge resection is a nonanatomic method that prioritizes adequate margins, offers technical simplicity, and maximizes parenchymal preservation [5]. This evolution reflects the growing emphasis on tailored surgical interventions that balance oncologic efficacy with functional outcomes.
Pivotal clinical trials have refined surgical decision‐making by providing evidence on treatment outcomes for NSCLC. For example, the CALGB 140503 trial revealed that in peripheral NSCLC patients with ≤ 2 cm and a CTR ≤ 0.5, the long‐term survival outcomes (5‐year DFS/OS) of segmental resection and lobectomy are similar as long as complete lymph node assessment is performed. Additionally, segmentectomy preserved 5% more of the FEV1 [6]. More groundbreakingly, the JCOG0802 study revealed superior 5‐year OS with segmentectomy (94.3% vs. 91.1% for lobectomy, p = 0.0082) in peripheral NSCLC ≤ 2 cm [7]. Notably, segmentectomy significantly reduced nonlung cancer mortality (e.g., cardiovascular events and respiratory failure), potentially because of better preserved pulmonary function. Wedge resection is validated by JCOG0804 as the benchmark surgery for pure ground‐glass nodule (CTR < 0.25), achieving a 5‐year RFS rate of 99.7% without local recurrence [8]. However, for patients with high solid content (CTR > 0.25) in small (≤ 2 cm) NSCLC, the optimal surgical treatment remains unresolved. Our institutional experience with both wedge resection and segmentectomy provides an opportunity to evaluate their comparative effectiveness.

2
Materials and Methods
2.1
Patient Data
This retrospective cohort analysis included patients who underwent surgical resection for NSCLC (≤ 2 cm) at Beijing Chao‐Yang Hospital, Capital Medical University, from January 2018 to December 2020. Five‐year follow‐up data were collected for all patients. Two thoracic surgeons independently reviewed the CT images and calculated the CTR according to the Fleischner Society guidelines. All the data were automatically retrieved from our hospital database. The Institutional Review Board of Beijing Chao‐Yang Hospital approved this retrospective study and waived the need for informed consent. The exclusion criteria were (1) a history of malignancy; (2) severe systemic or underlying diseases affecting survival; (3) NSCLC tumors larger than 2 cm; (4) bilateral or multilobar pulmonary nodules; (5) severe pleural adhesions, excessive intraoperative bleeding causing prolonged surgery, or conversion to thoracotomy that compromised the intended surgical approach; and (6) incomplete follow‐up data.

2.2
Operation
Preoperative assessment included a systematic HRCT analysis. Additionally, commercial medical image processing software was used to precisely map segmental anatomy. All procedures were performed under balanced general anesthesia. Surgical decision‐making followed oncological principles and a minimally invasive philosophy, with technique selection (wedge/segmentectomy) based on a comprehensive evaluation of the CTR, tumor topography, and respiratory reserve. Wedge resection: Nodules were localized by intraoperative palpation, preoperative CT‐guided needle localization, or 3D reconstruction. A margin of ≥ 2 cm of normal parenchyma (or equal to the tumor's maximum diameter) was ensured. Segmentectomy: Preoperative 3D reconstruction guided the identification of segmental anatomy. The intersegmental plane was identified through a multimodal approach: (1) a ventilation‐assisted inflation–deflation technique, (2) fluorescence imaging using indocyanine green (ICG), and (3) direct anatomical surface marking. As for wedge resection, a ≥ 2 cm margin was maintained. Lymph node evaluation protocol: Unless precluded by the patient's functional condition, N1 and N2 lymph nodes were sampled or cleared without significantly increasing surgical risk. Postoperatively, the chest tubes were removed when the following standardized criteria were met: (1) radiographic confirmation of complete lung expansion without air leakage and (2) drainage output < 200 mL/24 h without complications.

2.3
Follow‐Up Data
Structured follow‐up included a baseline 3‐week assessment, followed by monthly monitoring for 3–6 months (years 1–2), monitoring at 6‐month intervals (years 3–5), and yearly monitoring thereafter. Thoracic CT imaging served as the primary modality for recurrence surveillance. Patients who could not visit our hospital for treatment were followed up by telephone, and the last follow‐up time was recorded.

2.4
Outcome Assessment
Patient data, operation duration, and intraoperative blood loss data were extracted from medical records and surgical records. Histopathological assessments, including both intraoperative frozen sections and definitive postoperative pathological examinations, were retrieved from the pathology database. Survival outcomes were rigorously defined as follows: OS: Duration from surgical intervention to all‐cause mortality or final clinical assessment. RFS: Interval between primary surgery and the earliest occurrence of locoregional recurrence, distant metastasis, mortality, or last oncological follow‐up. LCSS: Time elapsed from initial operation to tumor‐related death or most recent surveillance. Patients with incomplete follow‐up documentation were excluded from the final analysis. The complete flow chart is presented in Figure 1.

2.5
Statistics
All data analyses were completed with R software, version 4.2.2 (2022‐10‐31). In this study, we included patient baseline data in a logistic regression model to match the propensity score between wedge resection and segmentectomy and calculated the inverse probability according to these scores. Based on this weight, IPTW analysis was performed. Group comparability was verified by two‐sided statistical comparisons, with p values < 0.05 considered to indicate statistical significance. Normally distributed continuous variables are presented as the mean ± standard deviation (SD) and were analyzed using independent samples t tests. Nonnormally distributed data are expressed as medians with interquartile ranges (IQRs) [M (Q1, Q3)] and were compared using Mann–Whitney U tests. Categorical variables are expressed as numbers of cases and percentages [n (%)]. Pearson's χ
2 test or Fisher's exact test was used for group comparisons. Between‐group comparability was evaluated using standardized mean differences (SMDs) with conventional thresholds: SMD < 0.10 = balanced; 0.10–0.34 = small difference; 0.35–0.64 = medium difference; 0.65–1.19 = large difference; and ≥ 1.20 = very large difference. Survival analyses (OS, RFS, and LCSS) were performed using the Kaplan–Meier method. The final multivariate Cox model included variables meeting either statistical (univariate p < 0.1) or clinical significance criteria. Subgroup analysis was performed on patients with different CTRs.

3
Results
3.1
Patient Baseline Characteristics
The final cohort included 640 NSCLC patients (wedge resection: n = 295, 46.1%; segmentectomy: n = 345, 53.9%). The standardized preoperative workup included echocardiography, electrocardiography, pulmonary function testing, and coronary angiography for patients older than 60 years to exclude surgical contraindications.
Comparative analysis revealed that patients in the segmentectomy group were more likely to be smokers (p = 0.008) and nonquitters (p = 0.023). Compared with patients in the wedge resection group, patients in the lung segmentectomy group were more likely to have a larger tumor diameter (p = 0.001), CTR > 0 (p < 0.001), lymph node metastases (p = 0.021), invasive tumors (p = 0.042), and a higher TNM stage (p < 0.001). However, the baseline characteristics no longer significantly differed between the two groups after IPTW adjustment. Detailed baseline data before and after IPTW adjustment are presented in Table 1.

3.2
Short‐Term Outcomes
In total, 85 patients developed postoperative complications. Perioperative death did not occur among any of the enrolled patients. Patients who underwent wedge resection had a shorter surgical duration (p < 0.001), less intraoperative blood loss (p < 0.001), a shorter postoperative stay (p = 0.047), and fewer complications (p < 0.001). Short‐term outcomes are shown in Table 2.

3.3
Long‐Term Outcomes
3.3.1
Comparison of Long‐Term Survival Outcomes
A total of 640 patients completed long‐term follow‐up. The median follow‐up was 86.5 months for the wedge resection group and 88.4 months for the segmentectomy group. The 5‐year OS rates were 96.61% for the wedge resection group and 97.39% for the segmentectomy group (p = 0.562). The 5‐year RFS rates were 93.89% versus 93.04% (p = 0.663), and the 5‐year LCSS rates were 94.91% versus 96.52% (p = 0.314) for the wedge resection and segmentectomy groups, respectively. Similarly, after IPTW adjustment, no significant differences in survival outcomes were observed between the two groups: OS (p = 0.759), RFS (p = 0.982), LCSS (p = 0.790), 5‐year OS (p = 0.244), 5‐year RFS (p = 1.000), and 5‐year LCSS (p = 0.129). The long‐term outcomes are summarized in Table 3. The Kaplan–Meier survival curves for OS, RFS, and LCSS are shown in Figure 2.

3.3.2
Cox Multivariate Analysis of OS, RFS, and LCSS
Through univariate Cox analysis, we found that advanced age (> 70 years), smoking status, lymph node metastasis status, invasive tumor status, and TNM stage were important factors for OS, RFS, and LCSS. However, multivariate Cox analysis (Tables 4, 5, 6) revealed that pleural invasion (p = 0.035 and p = 0.049) and lymph node metastasis (p < 0.001 and p < 0.001) were risk factors for OS and LCSS. Invasive tumors (p < 0.001, p < 0.001, and p < 0.001) were risk factors for OS, RFS, and LCSS (Tables 4, 5, 6).

3.4
Subgroup Analysis
3.4.1
Subgroup With a CTR > 0
From the enrolled patients (excluding those with pure GGO lesions), those with a CTR > 0 were selected for subgroup analysis. The total sample size before matching was 374 patients (149 patients who underwent wedge resection and 225 patients who underwent segmentectomy). The balance analysis of matching variables before and after matching revealed no statistically significant differences between the groups, as shown in Table 7. Kaplan–Meier curves for OS, RFS, and LCSS for wedge resection and segmentectomy among patients with a CTR > 0 are shown in Figure 3.

3.4.2
Subgroup With a CTR > 0.25
Patients with NSCLC with a CTR > 0.25 were selected for subgroup analysis. The total sample size before matching was 89 patients, including 42 who underwent wedge resection and 47 who underwent segmentectomy. The results of the balance analysis before matching revealed that compared with the wedge resection group, the segmentectomy group had significantly longer OS (p = 0.01), RFS (p = 0.045), LCSS (p = 0.005), 5‐year OS (p = 0.001), 5‐year RFS (p = 0.005), and 5‐year LCSS (p = 0.002). The results of the balance analysis after matching revealed that compared with the wedge resection group, the segmentectomy group had significantly longer OS (p = 0.046), RFS (p = 0.061), LCSS (p = 0.036), 5‐year OS (p = 0.045), 5‐year RFS (p = 0.023), and 5‐year LCSS (p = 0.015), as shown in Table 8. The Kaplan–Meier curves for OS, RFS, and LCSS in the wedge resection and segmentectomy groups for patients with a CTR > 0.25 are shown in Figure 4.

4
Discussion
4.1
Baseline Data
Wedge resection was associated with a significantly shorter surgical duration (90 min vs. 180 min; p < 0.001) and a lower incidence of postoperative complications (6.78% compared with 18.84%; p < 0.001). Additionally, patients who underwent wedge resection had marginally shorter postoperative stays (5 days vs. 6 days, p = 0.047). Moreover, before IPTW, nonsmoking status (p = 0.008), smoking volume (p = 0.007), and preoperative smoking cessation (p = 0.013) significantly differed between groups. However, this was a single‐center study. Moreover, the number of surgical cases increased between the years 2018 and 2020. Therefore, differences in surgeons, surgical proficiency, and surgical optimizations may have affected the results. Nevertheless, these changes simultaneously affected lung wedge resection and segmentectomy. In addition, smoking cessation before surgery was not actively controlled in this study. Nevertheless, our findings were consistent with those of previous studies on the relationship between smoking cessation and NSCLC. Improved NSCLC‐specific survival was noted in 44% (4301/9727) of former smokers, with a statistically significant reduction in risk after sustained cessation for more than 5 years (aHR 0.87, 95% CI 0.81−0.93) [9]. In addition, preoperative smoking was not a key control condition for the choice of surgery in this study. In future research, we will intentionally divide patients into different subgroups and include lung function data before and after surgery to confirm whether smoking affects the choice of surgical method. The clinical data concerning the effects of different surgical methods on postoperative lung function should be further clarified.
In addition, to control known confounding factors as much as possible, we used two advanced statistical methods, PSM and IPTW, to balance the baseline data. However, it must be soberly recognized that even with the use of PSM and IPTW, there are fundamental and unavoidable limitations to the conclusions of this study. PSM and IPTW can balance patients based on measurable and recorded covariates such as age, gender, lung function, tumor size, etc. However, the most critical confounding factor in this study, the thoroughness of lymph node dissection or sampling and the resulting pathological staging differences, cannot be quantified in real‐world databases. Pulmonary segmentectomy is highly associated with broader lymph node assessment in clinical practice. In the high‐risk subgroup with CTR > 0.25, the lung segmentectomy group has a higher probability of detecting occult lymph node metastasis through more thorough lymph node pathological examination, leading to an upregulation of pathological staging. Patients with upregulated staging are more likely to receive adjuvant therapy (chemotherapy, targeted therapy, or immunotherapy) recommended by guidelines. Therefore, the survival benefits we observed from the “surgical approach” are largely influenced by the benefits of “more appropriate adjuvant therapy” brought about by “more accurate staging.” In summary, although we used strict statistical methods for correction, the survival advantage of lung segmentectomy observed in the CTR > 0.25 subgroup in this study must be interpreted with extreme caution. It cannot be simply attributed to the anatomical advantage of segmentectomy in local control.

4.2
Survival Data Discussion
In this study, we used OS, RFS, and LCSS as endpoints. In patients with NSCLC tumors smaller than 2 cm, long‐term survival outcomes after wedge resection are comparable to those after segmentectomy. These results support wedge resection as a reasonable choice for the treatment of early‐stage NSCLC, especially for patients with GGO‐dominant tumors, because wedge resection reduces surgical trauma and shortens recovery without reducing treatment efficacy. However, among patients with a CTR > 0.25, those who underwent segmentectomy had longer OS, RFS, and LCSS. Moreover, the 5‐year OS rate, 5‐year RFS rate, and 5‐year LCSS rate were significantly greater in this group. These differences may be due to the biological behavior of the tumor, insufficient surgical margins, or differences in lymph node assessment. Specifically, tumors with a CTR > 0.25 are generally more aggressive, and the solid component may reflect higher malignant potential and risk of micrometastasis [10]. Segmentectomy may remove occult lesions more thoroughly via more extensive anatomical resection and comprehensive lymph node evaluation. Moreover, although this study followed NCCN guidelines (margins ≥ 2 cm or ≥ tumor diameter), the nonanatomical characteristics of wedge resection may increase local residual risk compared to segmentectomy, especially in tumors with more solid components [11]. Lastly, segmentectomy is usually accompanied by more systematic lymph node sampling, whereas wedge resection may miss micrometastases in lymph nodes in the lung segment, which affects long‐term prognosis [12, 13].

4.3
Discussion on Lymph Node Metastasis and Postoperative Adjuvant Therapy
Next, we focused on lymph node metastasis. In our study, tumors measuring less than 2 cm were predominantly characterized as stage I tumors, and adjuvant chemotherapy does not confer a substantial survival advantage to patients in this demographic [14]. A total of 57 cases of lymph node metastasis were documented, including 18 cases (6.10%, 18/295) in the wedge resection group, with 16 patients exhibiting N1 stage metastasis and 2 patients exhibiting N2 stage metastasis. The segmentectomy group included 39 cases (39/295, 13.22%) of lymph node metastasis, including 31 patients with N1 stage metastasis and 8 patients with N2 stage metastasis. Recent reports have indicated that among NSCLC patients diagnosed with cT1aN0M0 (tumors less than 2 cm, with no clinically apparent lymph node metastasis), 16.2% (51/315) had pathologically confirmed lymph node metastasis. Within this subset, the N1 metastasis rate was 12.4% (39/315 cases), whereas the N2 transfer rate was 13.0% (41/315 cases) [15]. In addition, studies have shown that for mixed ground glass nodules with a CTR < 50%, the N2 metastasis rate is 4.23%, whereas for those with a CTR > 50%, the N2 metastasis rate increases to 25.40% [16]. Our findings are similar to these results. With respect to postoperative treatment, among the 57 patients with positive lymph nodes, 11 patients in the wedge resection group received chemotherapy, 6 patients received chemotherapy and targeted therapy, and 1 patient received chemotherapy and immunotherapy. Twenty‐two patients in the segmentectomy group received chemotherapy, 11 patients received chemotherapy and targeted therapy, and 6 patients received chemotherapy and immunotherapy. First, according to the CSCO guidelines, patients with stage IB NSCLC with high‐risk factors, as well as those with stage II or higher, require platinum‐based dual‐drug adjuvant chemotherapy. EGFR‐sensitive mutation patients (such as those receiving targeted therapy in this study) are given priority recommendations for axitinib (after adjuvant chemotherapy) or ecatinib adjuvant therapy, which is partially consistent with the targeted therapy regimen in this study. Applicability of immunotherapy: PD‐L1‐positive (TC ≥ 1%) patients can be treated with atezolizumab adjuvant therapy or pembrolizumab, which is partially consistent with the immunotherapy regimen in this study. Research data indicate that the positivity rates for EGFR, ALK, and ROS1 in Asian NSCLC populations are 30%–50%, 3%–8%, and 1%–3%, respectively [17, 18]. Moreover, PD‐L1 positivity rates are 45%–65% for TPS ≥ 1% and 20%–30% for TPS ≥ 50% [19]. However, only 65%–80% of the Asian population receives testing or actual treatment, which is related to differences among countries, medical awareness, and medical policies. Our research findings have several limitations. First, to obtain accurate long‐term survival data for patients with NSCLC with a diameter of less than 2 cm who underwent different sublobectomy procedures, we did not exclude patients who had lymph node metastases. Although both the wedge resection group and the segmentectomy group included patients with N1 or N2 lymph node metastasis, long‐term survival data revealed differences in OS, RFS, and LCSS between the two groups when the CTR was > 0.25. Although we dissected lymph nodes in both groups of patients, segmentectomy usually allows easier lymph node dissection of the hilum and lobes, whereas wedge resection may miss deep lymph node micrometastases, leading to an underestimation of staging [20]. This difference in assessment may exaggerate the survival advantage of segmentectomy. Furthermore, heterogeneity in postoperative adjuvant therapies between the two patient groups—such as variations in targeted and immunotherapy drug selection and treatment duration—may confound survival analysis results. According to current guidelines, NSCLC patients with pathological stage II or above are typically recommended to receive adjuvant chemotherapy, while patients with driver gene mutations or high PD‐L1 expression may further receive targeted or immunotherapy. In the CTR > 0.25 subgroup of this study, the lung segmentectomy group was more likely to achieve pathological staging upregulation due to sufficient lymph node collection. The proportion of patients receiving postoperative adjuvant chemotherapy, targeted therapy, or immunotherapy was significantly higher in the wedge resection group. However, due to insufficient lymph node assessment, a certain proportion of cases in the wedge resection group may have their staging underestimated, resulting in missing out on the systemic adjuvant therapy that should have been received and could potentially prolong life. Moreover, the sample size of the lymph node metastasis subgroup was relatively small, which limits the reliability of the conclusions. Overall, this study failed to control for key confounding factors such as postoperative adjuvant therapy and lymph node assessment, and the sample size was insufficient, limiting the ability to draw independent conclusions about the impact of lymph node metastasis and surgical approach on survival. The survival advantage we observed (better in the segmentectomy group than in the wedge resection group) is likely entirely or largely attributed to the application of more accurate staging and appropriate adjuvant therapy, rather than the inherent advantage of segmentectomy in local control. Prospective studies are needed in the future to unify lymph node dissection criteria and standardize adjuvant therapy based on guidelines to clarify the true effects of surgical methods.
Overall, IPTW analysis revealed that all the results were robust after the clinical characteristics were balanced between the two groups. These findings are consistent with those of the JCOG0804 and JCOG0802 studies [21, 22]. However, our study still lacks comparisons of preoperative lung function and postoperative lung function (FEV1/DLCO and other data), making it difficult to comprehensively evaluate the effects of the two surgical methods on lung function and quality of life. In addition, for early NSCLC with high solid components, systematic lymph node assessment is crucial. The more thorough lymph node assessment strategy represented by segmentectomy ensures that high‐risk patients can receive necessary adjuvant therapy through precise staging, which may be a key link in improving the overall prognosis of this group. Future multicenter prospective studies are needed to validate these findings, particularly by comparing surgical outcomes across different CTR thresholds.

4.4
Discussion of Relevant Research Data
We demonstrate that patients with early‐stage NSCLC who undergo wedge resection have a high postoperative survival rate, but sufficient resection margins should not be ignored during surgery. The National Comprehensive Cancer Network (NCCN) defines an adequate surgical margin as either a distance of ≥ 2 cm from the tumor edge or at least equal to the total tumor size [23]. Akamine and colleagues reported that the probability of obtaining adequate surgical margins was significantly greater for segmentectomy (71.4%) than for wedge resection (59.5%) [24]. Although one study suggested that surgical margins are not a significant risk factor for patients with ground‐glass opacity (GGO) dominance, the level of evidence remains limited. In this study, we adhered to the surgical margins recommended by the NCCN [25, 26].
Furthermore, the CALGB140503 randomized controlled trial demonstrated comparable RFS and OS outcomes between wedge resection and segmentectomy in early‐stage NSCLC patients [27]. However, this randomized controlled study did not provide detailed information about the tumor CTR, which is directly related to prognosis. Patients with a tumor size ≤ 2 cm and a CTR ≤ 0.5 who undergo sublobar resection have excellent survival outcomes [28]. However, for these patients, the optimal choice of sublobar resection (segmentectomy or wedge resection) remains controversial. In this study, the 5‐year OS rates were 98.8% and 99.6%, and the 10‐year OS rates were 98.8% and 96.7% for wedge resection and segmentectomy, respectively. Another study of the CTR, JCOG0201, revealed that for NSCLC patients with a CTR ≤ 0.25 during long‐term follow‐up, the 10‐year OS rate was 94.0%, whereas tumors with a CTR ≤ 0.5 (GGO accounted for ≥ 50%) were almost noninvasive, and the lymph node metastasis rate was 0% (0/328 patients) [14, 29]. Among patients with < 3 cm tumors and a CTR of 0.25–0.5 who underwent segmentectomy, the 5‐year RFS rate was 98.0% in the JCOG1211 study [30]. Our research yielded the same results. However, the 5‐year OS and RFS rates were lower than those reported in the literature. In addition, we lacked 10‐year OS rate data. However, unlike previous studies that focused solely on early‐stage NSCLC, we included patients with lymph node metastasis and invasive tumors. This inclusion partly explains the lower 5‐year OS and RFS rates in our study compared with those reported in other studies. Moreover, multivariate Cox analysis revealed that pleural invasion and lymph node metastasis were risk factors for OS and LCSS, whereas invasive tumors were risk factors for OS, RFS, and LCSS.
Finally, as a single‐center retrospective analysis, this study has inherent limitations. Although our median follow‐up duration of 88.4 months provides substantial observational data, extended longitudinal follow‐up may be necessary to validate these findings. Local recurrence may take longer to occur (especially for tumors with high GGO components) [31]. To avoid the limitations of retrospective studies and obtain more convincing results, we plan to conduct a prospective clinical trial. This trial will compare the long‐term survival outcomes of segmentectomy and wedge resection in these patients. We are eagerly awaiting the results of long‐term follow‐up. For NSCLCs ≤ 2 cm (especially those with a CTR ≤ 0.25), wedge resection is a reasonable choice, but the margin should be strictly evaluated. However, caution should be exercised when the CTR is > 0.25, as long‐term survival is better in these patients after lung segmentectomy. Whether these findings apply exclusively to Asian populations remains unclear. Future international collaborative research will help establish universal criteria for selecting surgical methods.

5
Conclusion
Wedge resection is an optimal choice for NSCLCs ≤ 2 cm, especially for GGO‐dominant tumors. However, segmentectomy is more appropriate when the CTR is > 0.25. Future international multicenter studies may still need to further validate this conclusion in real‐world clinical practice.

Author Contributions
All the authors performed the material preparation and analysis. Pan wrote the first draft of the manuscript. All the authors contributed to the article and approved the submitted version.

Funding
This work was supported by Beijing clinical key specialty construction project.

Disclosure
The authors have nothing to report.

Conflicts of Interest
The authors declare no conflicts of interest.