Parenchymal-sparing resections: why, when, and how

Although lobectomy should continue to be regarded as the procedure of choice for NSCLC, certain subsets of patients who have favorable characteristics may be treated appropriately with segmentectomy without adversely affecting oncologic outcome as long as an adequate assessment of intraoperative nodal status and surgical margin is performed. The use of anatomic segmentectomy may be particularly useful for small, peripheral tumors less than 2 cm in diameter located within anatomic segmental boundaries, as well as for elderly patients who have impaired cardiopulmonary function. Ground-glass opacities and lesions displaying bronchoalveolar histology also may be appropriate target lesions for segmentectomy because of their low metastatic potential. Prospective, randomized studies (such as the CALGB/Altorki trial and the brachytherapy mesh trial) will be necessary to delineate fully the utility of segmentectomy in patients who have NSCLC.