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

Brendon M. Stiles, Nasser K. Altorki

Research output: Chapter in Book/Report/Conference proceedingChapter

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Title of host publicationDifficult Decisions in Thoracic Surgery (Second Edition)
Subtitle of host publicationAn Evidence-Based Approach
PublisherSpringer London
Pages125-133
Number of pages9
ISBN (Print)9781849963640
DOIs
StatePublished - 2011
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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