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Subcostal Specimen Removal in Completely Portal Robotic Lobectomy

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Published on: April 19, 2024

Comparison of segmentectomy and lobectomy for non-small cell lung cancer with visceral pleural invasion.

Masaya Tamura^1,2, Takashi Sakai³, Naoki Furukawa³

¹Department of Thoracic Surgery, Kochi Medical School, Nankoku, Kochi, Japan. masatamu@kochi-u.ac.jp.

Journal of Cardiothoracic Surgery

|December 24, 2025

Summary

This summary is machine-generated.

For non-small cell lung cancer (NSCLC) with visceral pleural invasion (VPI), segmentectomy may be suitable for smaller tumors (<2 cm). Lobectomy is recommended for larger tumors (>2 cm) due to higher recurrence rates with segmentectomy.

Keywords:

Non-small cell lung cancer (NSCLC)Prognosis Segmentectomy Visceral pleural invasion (VPI)

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Area of Science:

Thoracic Surgery
Surgical Oncology
Pulmonary Medicine

Background:

Visceral pleural invasion (VPI) significantly impacts Non-Small Cell Lung Cancer (NSCLC) staging, prognosis, and surgical strategy.
Comparing segmentectomy and lobectomy outcomes in VPI-positive NSCLC is crucial for optimizing treatment decisions.

Purpose of the Study:

To compare the surgical outcomes of segmentectomy versus lobectomy in patients with VPI-positive NSCLC.
To analyze the impact of tumor size on the efficacy of different surgical procedures in VPI-positive NSCLC patients.

Main Methods:

Retrospective analysis of 218 VPI-positive NSCLC patients.
Stratification into segmentectomy (n=42) and lobectomy (n=150) groups.
Subgroup analysis based on tumor size (<2 cm and >2 cm).

Main Results:

No significant difference in overall survival (OS), disease-specific survival (DSS), or recurrence-free survival (RFS) between segmentectomy and lobectomy after propensity matching.
In tumors >2 cm, lobectomy showed a trend towards higher RFS (p=0.08) and significantly lower pleural dissemination recurrence (p=0.03) compared to segmentectomy.
No significant differences in OS or RFS were observed in the <2 cm tumor group.

Conclusions:

Segmentectomy may offer a better prognosis for VPI-positive NSCLC patients with tumors <2 cm.
Lobectomy should be considered for VPI-positive NSCLC patients with tumors >2 cm, given the observed recurrence patterns and potential for better local control.
Stratifying outcomes by tumor size provides valuable insights for individualized surgical decision-making in VPI-positive NSCLC.