Lung segmentectomy: does it offer a real functional benefit over lobectomy?

Abstract

@ERSpublicationsLung segmentectomy offers mild post-operative to small long-term functional benefits over lobectomy http://ow.ly/dcPQ30fuCU9Cite this article as: Charloux A, Quoix E. Lung segmentectomy: does it offer a real functional benefit over lobectomy ? Eur Respir Rev 2017; 26: 170079 [https://doi.org/10.1183/16000617.0079-2017.ABSTRACT Anatomical segmentectomy has been developed to offer better pulmonary function preservation than lobectomy, in stage IA lung cancer. Despite the retrospective nature of most of the studies and the lack of randomised studies, a substantial body of literature today allows us to evaluate to what extent lung function decreases after segmentectomy and whether segmentectomy offers a real functional benefit over lobectomy. From the available series, it emerges that the mean decrease in forced expiratory volume in 1 s (FEV1) is low, ranging from −9% to −24% of the initial value within 2 months and −3 to −13% 12 months after segmentectomy. This reduction in lung function is significantly lower than that induced by lobectomy, but saves only a few per cent of pre-operative FEV1. Moreover, the published results do not firmly establish the functional benefit of segmentectomy over lobectomy in patients with poor lung function. Some issues remain to be addressed, including whether video-assisted thoracic surgery (VATS) segmentectomy may preserve lung function better than VATS lobectomy in patients with poor lung function, especially within the early days after surgery, and whether this may translate to lowering the functional limit for surgery. Eventually, trials comparing stereotactic ablative body radiotherapy, radiofrequency ablation and segmentectomy functional consequences are warranted.

Uniportal video-assisted thoracoscopic surgery lobectomy and segmentectomy for pulmonary sequestration

“…We do not routinely have patients undergoing pulmonary function test after operation; actual difference in recovery of pulmonary function between different extents of pulmonary resections was unknown in our series. It is believed that segmentectomy provided mild postoperative and small long-term benefits over lobectomy in pulmonary function (24). Although we demonstrated that uniportal surgical lung resection is a feasible method for the treatment of lung sequestration, we considered a relatively small number of cases.…”

Single-direction thoracoscopic basal segmentectomy

“…It is widely believed that pulmonary function can be preserved to a greater degree by combining sublobar resection with less invasive thoracoscopic surgery. 22 Reports with encouraging outcomes from sublobar resection for the treatment of small-sized, noninvasive or minimally invasive lung cancer have been increasing. 3,4,6,[23][24][25] Although wedge resection is also increasingly considered to be sufficiently effective in patients with radiologically noninvasive tumors, [26][27][28] we considered segmentectomy as the preferred option before the final results of the randomized clinical studies published.…”

Systematic review and meta-analysis of video-assisted thoracoscopic surgery segmentectomy versus lobectomy for stage I non–small cell lung cancer

“…Most studies show that segmentectomy preserves more lung tissue and therefore promotes lung function recovery [33,37,38], but some reports suggest that the retained lung tissue provides little functional advantage [10,39]. There could be several explanations.…”