Segmentectomy for lung cancer

Experience reported in the literature increasingly supports the notion that segmentectomy is comparable with lobectomy for small tumors (≤2 cm), provided that the lesion is located centrally and affords a 2-cm parenchymal surgical margin. In a recent retrospective study that compared video-assisted thoracic surgery (VATS) lobectomy to VATS segmentectomy, the authors concluded that segmentectomy yields excellent oncological results with comparable morbidity, mortality, locoregional recurrence, and 3-year survival. Moreover, patients in both surgical groups were discharged after similar length hospital stays although patients undergoing VATS segmentectomy had worse pulmonary function before surgery. Perceived difficulties with new applications of minimally invasive surgeries disappear as experience increases, permitting application to technically more challenging operations. A technical description of VATS segmentectomy is provided, including 2 new methods for ensuring the exact delineation of the fissure.