Segmentectomy versus lobectomy for stage I lung cancer in patients with good pulmonary function

The initial surgical operation of choice for lung cancer was pneumonectomy.¹ However, since the 1960's lobectomy with lymph node dissection has been the standard resection technique used by most surgeons for patients with good pulmonary function.^2,3 Anatomical segmentectomy may offer a lung-preserving alternative to lobectomy, much as lobectomy did to pneumonectomy. Anatomical segmentectomy was first described by Churchill and Belsey in 1939 for resection of bronchiectasis and tuberculosis.⁴ Segmentectomy for resection of lung cancer was subsequently performed by some surgeons; however, concerns were raised over the perceived higher risk of local recurrence.^5-9 In order to better define the role of lesser resection, in 1995 the Lung Cancer Study Group (LCSG) reported a randomized trial of 247 low-risk patients with clinical T1N0 peripheral NSCLC assigned to either limited resection (anatomical segmentectomy or wedge resection) or lobectomy.¹⁰ The study showed that locoregional recurrence was significantly higher in patients treated by sublobar resections. Although patients treated by lobectomy had a higher 5-year survival compared to those treated by limited resection, the difference in survival did not achieve statistical significance (73% vs. 56%, p = 0.06). This trial arguably established lobectomy as the surgical standard of care for early stage disease.