VATS segmentectomy: an underused option?

Abstract

It is well known that the "gold standard" procedure for surgically resectable early-stage non-small cell lung cancer (NSCLC), is pulmonary lobectomy. Even though sublobar resections (SLR), particularly segmentectomy, seem attractive as an alternative to lobectomy in early stage lung cancers, they are still debated procedures. The aim of this study is to answer to the question: "Is VATS lung segmentectomy an underused option?" To obtain an answer to this query, the authors carried out a review of the "state of the art" as follows: (I) performing a non-systematic review of the literature; (II) analyzing the review articles published; (III) looking at the ongoing studies, the results of which have not yet published; (IV) scanning the technical aspect of lung segmentectomy. After completing the multi-step revision, we can conclude that there is a lack of evidence about the oncological value of segmentectomy in early stage NSCLC. Although VATS segmentectomy is feasible and performed by many thoracic surgeons, it's currently not yet world-wide adopted. Among the trials now being recruited in some countries and, aimed to clarify the role of SLR in the treatment of early stage lung cancer, a European prospective randomized study is advocated to implement the scientific knowledge on this issue.

The European experience

“…Because of these reasons, some anatomical sublobar resections are carried out more frequently than others (i.e., apical segment of the lower lobes, lingulectomy, left apical trisegmentectomy), and they are performed only by surgeons with a lot of experience, especially by VATS (39). Scientific Literature, however, shows an increasing spread of anatomical segmentectomies around Europe, which leads us to think that, as it happened before for other types of cancer, this most conservative approach is bound to become the procedure of choice in selected patients.…”

The Series on “How to Deal with Early Stage Lung Cancer: Sublobar Resections as A Possible Choice (Report of the 2019 Spring Meeting of Italian Society of Thoracic Surgery)?”

“…Nowadays anatomical sublobar resections are the elective choice in patients with early stage non-small-cell lung cancer even in the presence of a poor cardiopulmonary reserve. Up-to date evidences stemming both from monocentric and non-randomized multicentric analyses support this approach; results on the oncological non-inferiority of lung-sparing anatomical resections are nevertheless still missing (2).…”