Wedge Resection versus Thermal Ablation for Stage IA Non-Small Cell Lung Cancer (≤ 3cm): A Systematic Review and Meta-Analysis

Abstract Background : The comparative effectiveness of wedge resection versus thermal ablation for stage IA non-small cell lung cancer (NSCLC) (≤ 3cm) remains unclear, as previous meta-analyses have included heterogeneous surgical comparators and mixed-stage populations. This meta-analysis aimed to compare long-term oncologic outcomes and perioperative profiles between wedge resection and thermal ablation specifically in stage IA NSCLC. Methods : We systematically searched PubMed, Cochrane Library, Web of Science, CNKI, and Wanfang databases from inception to March 2026 for retrospective cohort studies comparing wedge resection with thermal ablation (radiofrequency or microwave) in stage IA NSCLC. The primary outcome was 5-year overall survival (OS), with secondary outcomes including hospital stay and costs. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models, with sensitivity analyses performed to assess robustness. Results : Three retrospective cohort studies were included in the quantitative synthesis. The primary meta-analysis included two studies (79 ablation patients, 72 surgery patients) restricted to stage IA tumors and pure wedge resection comparators. The pooled RR for 5-year mortality was 1.47 (95% CI: 0.96–2.24; P = 0.07), with no heterogeneity (I² = 0%). A sensitivity analysis including a third study with mixed IA/IB and 3-year OS data yielded a pooled RR of 1.63 (95% CI: 1.12–2.38; P = 0.01; I² = 0%). Consistent with these findings, a single propensity-matched study reported a significantly lower risk of progression or death for wedge resection versus ablation (HR = 2.24; 95% CI: 1.31–3.83; P = 0.003). Thermal ablation was consistently associated with shorter hospital stays (0–2 vs. 5–6 days) and substantially lower costs. Conclusions : Among propensity-matched patients with stage IA NSCLC (≤3 cm), wedge resection offers a consistent survival benefit trend over thermal ablation, with zero heterogeneity across primary and sensitivity analyses. Ablation remains a reasonable alternative for medically inoperable patients, given its shorter recovery time and its markedly lower costs. These findings underscore the importance of patient selection and multidisciplinary decision-making, as well as the need for future studies to report outcomes separately by tumor size and T stage.