In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy a suitable alternative to thoracotomy and segmentectomy in terms of morbidity and equivalence of resection?: Table 1:

Abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy a suitable alternative to thoracotomy and segmentectomy in terms of morbidity and equivalence of resection?' Altogether 232 papers were found as a result of the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Only one study compared the survival rates of video-assisted thoracoscopic surgery (VATS) and open surgery and found no significant difference in overall (P = 0.605) and disease-free (P = 0.996) survival between these groups. The mean length of hospital stay was reported as shorter following VATS when compared with open surgery in all of the studies looking at this outcome. The greatest difference in length of hospital stay reported was 4.8 days (VATS 3.5 days and open 8.3 days). The duration of chest tube placement was also universally reported as shorter in patients having VATS procedures when compared with open procedures. Two studies compared the number of lymph nodes that could be sampled when completing this operation by VATS using an open approach and neither found there to be a significant difference between these numbers. Using the evidence collected, we conclude that anatomical segmentectomy performed by VATS is a safe and effective alternative to conventional techniques in the surgical management of non-small-cell lung cancer. We are aware that the current evidence is limited and existing studies all examine small numbers of patients. Unfortunately, at present there is no blinded randomized control trial comparing these two surgical methods. There is also no study comparing the utility of each method for differing anatomical locations of segments. This should be kept in mind when interpreting the results of the studies presented.

POINT: Should Segmentectomy Rather Than Lobectomy Be the Operation of Choice for Early-Stage Non-small Cell Lung Cancer? Yes

“…A systematic review considering either retrospective comparative studies or prospective observational studies has concluded that anatomic video thoracoscopic segmentectomy is a feasible operation with at least equivalent levels of morbidity, recurrence, and long-term survival compared with open segmentectomy. 11 Furthermore, several studies report significant differences in the length of hospital stay, postoperative complications, and duration of chest tube placement, suggesting that in selected cases, thoracoscopic segmentectomy may confer additional perioperative benefit compared with the thoracotomy procedure. 11 Moreover, a recent retrospective study comparing thoracoscopic segmentectomy with thoracoscopic lobectomy after propensity-score matching has shown equal short-term surgical results and long-term oncologic outcomes between the two procedures.…”

“…11 Furthermore, several studies report significant differences in the length of hospital stay, postoperative complications, and duration of chest tube placement, suggesting that in selected cases, thoracoscopic segmentectomy may confer additional perioperative benefit compared with the thoracotomy procedure. 11 Moreover, a recent retrospective study comparing thoracoscopic segmentectomy with thoracoscopic lobectomy after propensity-score matching has shown equal short-term surgical results and long-term oncologic outcomes between the two procedures. 12 In conclusion, it is now clear that although segmentectomy is still largely reserved for patients with compromised cardiopulmonary status, recent evidence supports the intentional use of such an operation even in low-risk patients with tumors < 2 cm.…”

Three-dimensional computed tomography reconstruction for operative planning in robotic segmentectomy: a pilot study

“…Sublobar resection (segmentectomy or wedge resection) is recommended for patients with stage I ground glass opacity ≤2 cm (3). The long-term oncologic efficiency of segmentectomy versus lobectomy for small NSCLC has yet to be demonstrated (4).…”

3D-CT anatomy for VATS segmentectomy

“…Although segmentectomy can preserve lung function, its non-inferiority regarding the oncological outcome is still a matter of debate (1)(2)(3)(4). Surgical approaches such as video-assisted thoracoscopic surgery (VATS) and robotic surgery have also been reported for segmentectomy (5)(6)(7)(8). In addition to primary lung cancer, segmentectomy is performed for metastatic lung lesions arising from other malignancies such as colon cancer (9,10).…”