Journal of Surgery

Comparing Lobectomy and Segmentectomy: Which Elements Affects an Optimal Oncological Outcome?

Abstract

Theoni Kontou, Michail Galanis*, Theodoros Kolokotronis and Efstratios Koletsis

In this research work in recent years, Low Dose Computed Tomography (LDCT) is being used for lung cancer screening in high risk groups. According to USPSTF guidelines, people aged between 55 and 80 years old, who have a smoking history of 30 pack-years or have quit for less than 15 years, are recommended to take a LDCT scan. Other possible candidates for lung cancer screening can be patients with radon exposure, family history associated with lung cancer or history of pulmonary fibrosis or chronic obstructive lung disease. Detecting lung cancer at an early stage raises the question of optimal treatment and overall survival. This article aims to compare segmentectomy vs. lobectomy as surgical options, in case of stage I Non-Small-Cell Lung Carcinoma (NSCLC), ideally IA.

In order to compare the two previously referred strategies, data has been collected from articles (40 studies have been reviewed), reviews and systematic analyses in PubMed Central and also reviewing recent literature. Tumor size and location, patient age, comorbidities and nodal status have been examined as factors that affect the choice between segmental or lobar tumor resection. R0 resection and distance between resection margin and tumor was taken into consideration.

Segmentectomy could be an equal alternative to lobectomy in early stage NSCLC (tumor<2 cm). It could mainly be preferred for >75 y.o. and/or multimorbid patients with low cardiopulmonary reserve and struggle to survive a lobectomy. However, the anatomical segmentectomy requires among other a peripheral tumor position. Some segments, such as posterior segments of left upper lobe, are not removed separately. In this case, for anatomic reasons a bi- or tri-segmentectomy could be performed.

As far as early stage NSCLC is concerned anatomic segmentectomy is an acceptable procedure in a selective group of patients. For a better tumor and stage classification a systematic lymph node dissection should be performed.