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Learning Modern Laryngeal Surgery in a Dissection Laboratory

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Lung Segmentectomy in NSCLC Surgery.

Alberto Salvicchi¹, Simone Tombelli¹, Giovanni Mugnaini¹

¹Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy.

Life (Basel, Switzerland)

|June 28, 2023

Summary

Segmentectomy is now a standard surgical option for early-stage non-small cell lung cancer (NSCLC), showing superiority over lobectomy in recent trials for overall survival and lung function. This challenges previous guidelines for treating this specific lung cancer patient group.

Keywords:

NSCLC early-stage lobectomy lung cancer lung surgery segmentectomy sublobar

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Area of Science:

Thoracic Surgery
Surgical Oncology
Pulmonology

Background:

Current guidelines favor lobectomy for early-stage non-small cell lung cancer (NSCLC).
Sublobar resection was historically reserved for patients with poor cardiopulmonary reserve or elderly status.
The role of segmentectomy in NSCLC treatment has been debated for decades.

Purpose of the Study:

To review the current role of segmentectomy in lung cancer treatment.
To summarize key studies influencing the use of segmentectomy versus lobectomy.
To evaluate recent evidence supporting segmentectomy for specific NSCLC patient groups.

Main Methods:

Narrative review of relevant clinical trials and guidelines.
Analysis of randomized controlled trials comparing segmentectomy and lobectomy.
Summary of findings from studies like JCOG0802/WJOG4607L and CALGB 140503 (Alliance).

Main Results:

The JCOG0802/WJOG4607L trial showed segmentectomy superior to lobectomy in overall survival and post-operative lung function for stage IA NSCLC (<2 cm, CTR < 0.5).
The CALGB 140503 (Alliance) trial demonstrated non-inferiority of sublobar resection for clinical stage IA NSCLC (<2 cm).
These findings suggest a shift in standard surgical practice for select early-stage NSCLC patients.

Conclusions:

Segmentectomy should be considered a standard surgical procedure for specific early-stage NSCLC patients.
Recent evidence supports segmentectomy as an effective alternative to lobectomy, improving patient outcomes.
The review highlights the evolving landscape of surgical treatment for non-small cell lung cancer.