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We thank Sawabata and colleagues for their interest [1Sawabata N. Kawaguchi T. Yasukawa M. Kawai N. Taniguchi S. Recording margin distance is crucial in limited pulmonary resection for lung cancer (letter).Ann Thorac Surg. 2018; 106: 1592Abstract Full Text Full Text PDF Scopus (2) Google Scholar] in our study [2Cao J. Yuan P. Wang Y. et al.Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer.Ann Thorac Surg. 2018; 105: 1483-1491Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar]. Information on margin distance is not available from the Surveillance, Epidemiology, and End Results (SEER) database. The margin distance may be an important factor in survival for patients who undergo wedge resection. However, the optimal margin distance for wedge resection remains unclear. Mohiuddin and associates [3Mohiuddin K. Haneuse S. Sofer T. et al.Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (<2 cm) non-small cell lung cancer.J Thorac Cardiovasc Surg. 2014; 147: 1169-1177Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar] found that the optimal cutoff margin distance is 1.5 cm for small (<2 cm) non-small cell lung cancer (NSCLC), whereas Wolf and colleagues [4Wolf A. Swanson S.J. Yip R. et al.The impact of margins on outcomes after wedge resection for stage I non-small cell lung cancer.Ann Thorac Surg. 2017; 104: 1171-1178Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar] found that a margin distance greater than 1.1 cm was associated with overall survival, and Sawabata and colleagues [5Sawabata N. Maeda H. Matsumura A. Ohta M. Okumura M. Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer.Surg Today. 2012; 42: 238-244Crossref PubMed Scopus (46) Google Scholar] reported that a margin-to-tumor size ratio ≥1 is a sufficient tumor margin. Patients who undergo lobectomy or segmentectomy tend to have larger margins than do patients who undergo wedge resection. Furthermore, the extent of lymph node dissection is crucial for patients who undergo lobectomy, segmentectomy, or wedge resection for early-stage NSCLC [6Cao J. Xu J. He Z. et al.Prognostic impact of lymphadenectomy on outcomes of sublobar resection for stage IA non-small cell lung cancer ≤2 cm.J Thorac Cardiovasc Surg. 2018; 156: 796-805Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar]. Patients who undergo lobectomy or segmentectomy usually have systematic lymph node dissection or sampling, whereas patients undergoing wedge resection do not have a sufficient number of lymph nodes available for sampling, particularly intrapulmonary lymph nodes. We thus found that for tumors that are 1.1 to 2.0 cm, lobectomy and segmentectomy could lead to equivalent survival rates but showed better survival rates than did wedge resection on the basis of the large, population-based SEER database. In addition, the retrospective evaluation of margin distance may introduce the possibility of some inevitable bias [3Mohiuddin K. Haneuse S. Sofer T. et al.Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (<2 cm) non-small cell lung cancer.J Thorac Cardiovasc Surg. 2014; 147: 1169-1177Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar, 4Wolf A. Swanson S.J. Yip R. et al.The impact of margins on outcomes after wedge resection for stage I non-small cell lung cancer.Ann Thorac Surg. 2017; 104: 1171-1178Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar, 5Sawabata N. Maeda H. Matsumura A. Ohta M. Okumura M. Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer.Surg Today. 2012; 42: 238-244Crossref PubMed Scopus (46) Google Scholar]. Therefore, the optimal margin distance and surgical procedure choice for early-stage NSCLC needs to be determined by randomized prospective controlled trials. Recording Margin Distance Is Crucial in Limited Pulmonary Resection for Lung CancerThe Annals of Thoracic SurgeryVol. 106Issue 5PreviewI have read with interest the article by Cao and colleagues, which revealed that for tumors from 1.1 to 2.0 cm, lobectomy and segmentectomy could lead to equivalent survival rates but showed better survival rates than that observed with wedge resection [1]. Full-Text PDF