Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer.

Abstract

OBJECTIVE:

As thoracoscopic lobectomy becomes widely applied for treatment of non-small cell lung cancer, thoracoscopic segmentectomy remains controversial for patients with small stage I lung cancers. Questions remain regarding safety, morbidity, mortality, and recurrence rate. This study compared outcomes between thoracoscopic segmentectomy and lobectomy.

METHODS:

Retrospective review was undertaken of patients who underwent thoracoscopic segmentectomy or lobectomy for clinical stage I non-small cell lung cancer between January 2002 and February 2008. Indications for segmentectomy were tumor smaller than 3 cm, limited pulmonary reserve, comorbidities, and peripheral tumor location.

RESULTS:

Thirty-one patients underwent segmentectomy and 113 underwent lobectomy. Patients after segmentectomy had worse mean forced expiratory volume in 1 second than after lobectomy (83% vs 92%, P = .04). There were no differences in mean number of nodes (10) and nodal stations (5) resected. Segmentectomy and lobectomy groups had similar median chest tube durations (2 vs 3 days, P = .18), stays (both 4 days), total complications, recurrence rates, and survivals at mean follow-ups of 22 and 21 months, respectively. Lobectomy group had 1 30-day death; segmentectomy group had none. There were 5 (17.2%) recurrences after segmentectomy and 23 (20.4%) after lobectomy (P = .71), with locoregional recurrence rates of 3.5% and 3.6%, respectively.

CONCLUSION:

Thoracoscopic segmentectomy is a safe option for experienced thoracoscopic surgeons treating patients with small stage I lung cancers. No significant difference in oncologic outcome was seen between thoracoscopic segmentectomy and thoracoscopic lobectomy. Lymph node dissection could be performed as effectively during segmentectomy as lobectomy.

• Authors: Mark Shapiro, Todd S Weiser, Juan P Wisnivesky, Cynthia Chin, Michael Arustamyan, Scott J Swanson
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 137 Issue 6 Pg. 1388-93 (Jun 2009) ISSN: 1097-685X [Electronic] United States
• PMID: 19464454 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Carcinoma, Non-Small-Cell Lung (pathology, surgery)
• Disease-Free Survival
• Female
• Humans
• Lung Neoplasms (pathology, surgery)
• Male
• Neoplasm Recurrence, Local
• Pneumonectomy
• Postoperative Complications
• Thoracic Surgery, Video-Assisted