Feedback

Role of Sublobar Resection (Segmentectomy and Wedge Resection) in the Surgical Management of Non-Small Cell Lung Cancer

Simon R. Turner, Rodney J. Landreneau, Brian Pettiford
Role of Sublobar Resection (Segmentectomy and Wedge Resection) in the Surgical Management of Non-Small Cell Lung Cancer is a topic covered in the Pearson's General Thoracic.

To view the entire topic, please or .

STS Cardiothoracic Surgery E-Book from The Society of Thoracic Surgeons provides expert guidance for Cardiac and Thoracic Surgery. Sections include Pearson’s General Thoracic, Esphageal, Adult Cardiac, and Pediatric and Congenital Cardiac Surgery. Explore these free sample topics:

-- The first section of this topic is shown below --

Key Points

  • The increased application of high-resolution CT scanning, including in the context of lung cancer screening, is identifying a greater number of small peripheral lung nodules.
  • Sublobar resection with margins at least equal to the diameter of the tumour can be effective in the primary management of peripheral adenocarcinomas measuring less than 2 cm and without endobronchial involvement.
  • Tumour biology and incomplete staging may account for survival differences between patients undergoing lobectomy and those undergoing sublobar resection.
  • The recently completed JCOG and CALGB/Alliance randomized trials comparing sublobar resection to lobectomy for small peripheral lung cancers may help to further define the role of sublobar resection alone in the management of stage I NSCLC.

The use of sublobar resection as definitive management of resectable non-small cell lung cancer (NSCLC) has been a controversial topic throughout the history of surgery for lung cancer. Based largely on a single randomized control trial published in 1995, lobectomy has long been considered the gold standard treatment for resectable lung cancer confined to a single lobe. Accordingly, sublobar resection is considered a so-called compromise operation by many surgeons, one that is employed only for the management of small peripheral lung cancers present in patients with significant impairment in cardiopulmonary reserve who cannot withstand the physiologic rigors of lobectomy.

The increasingly common finding of subcentimeter malignant lesions identified through computed tomographic (CT) chest scanning, whether found incidentally or as part of a formal screening program, has led many surgeons to reassess the need for total lobectomy for the management of smaller peripheral NSCLCs. In this setting, a question frequently asked today is, “Could anatomic segmentectomy or extended nonanatomic wedge resection be adequate for cure of the patient’s lung cancer?” We review the clinical information that is available today to the physician who is formulating an opinion regarding the appropriate use of sublobar resection for the small, peripherally located NSCLC. Segmentectomy demands a thorough knowledge of the three-dimensional bronchovascular anatomy of the lung. The anatomic detail makes segmentectomy significantly more challenging than lobectomy. The technical details of the most commonly performed segmental resections are described elsewhere in this text.

-- To view the remaining sections of this topic, please or --

Key Points

  • The increased application of high-resolution CT scanning, including in the context of lung cancer screening, is identifying a greater number of small peripheral lung nodules.
  • Sublobar resection with margins at least equal to the diameter of the tumour can be effective in the primary management of peripheral adenocarcinomas measuring less than 2 cm and without endobronchial involvement.
  • Tumour biology and incomplete staging may account for survival differences between patients undergoing lobectomy and those undergoing sublobar resection.
  • The recently completed JCOG and CALGB/Alliance randomized trials comparing sublobar resection to lobectomy for small peripheral lung cancers may help to further define the role of sublobar resection alone in the management of stage I NSCLC.

The use of sublobar resection as definitive management of resectable non-small cell lung cancer (NSCLC) has been a controversial topic throughout the history of surgery for lung cancer. Based largely on a single randomized control trial published in 1995, lobectomy has long been considered the gold standard treatment for resectable lung cancer confined to a single lobe. Accordingly, sublobar resection is considered a so-called compromise operation by many surgeons, one that is employed only for the management of small peripheral lung cancers present in patients with significant impairment in cardiopulmonary reserve who cannot withstand the physiologic rigors of lobectomy.

The increasingly common finding of subcentimeter malignant lesions identified through computed tomographic (CT) chest scanning, whether found incidentally or as part of a formal screening program, has led many surgeons to reassess the need for total lobectomy for the management of smaller peripheral NSCLCs. In this setting, a question frequently asked today is, “Could anatomic segmentectomy or extended nonanatomic wedge resection be adequate for cure of the patient’s lung cancer?” We review the clinical information that is available today to the physician who is formulating an opinion regarding the appropriate use of sublobar resection for the small, peripherally located NSCLC. Segmentectomy demands a thorough knowledge of the three-dimensional bronchovascular anatomy of the lung. The anatomic detail makes segmentectomy significantly more challenging than lobectomy. The technical details of the most commonly performed segmental resections are described elsewhere in this text.

There's more to see -- the rest of this entry is available only to subscribers.

Last updated: July 29, 2021