Anatomic segmental lung resections for malignant neoplasms of the lung

Dotdaev A.A.; Ryabov A.B.; Pikin O.V.; Kolbanov K.I.

doi:https://doi.org/10.17116/onkolog20241305169

Close metadata

Recommended articles:

Video-assisted mediastinal lymphadenectomy in the treatment strategy of patients with non-small cell lung cancer. P.A. Herzen Journal of Oncology. 2025;(5):13-18

Exosomal non-coding rnas as potential biomarkers in the diagnosis and prognosis of lung cancer. Review. Laboratory Service. 2024;(3):42-49

The first thousand of VATS anatomical lung resections at the Herzen Moscow Oncology Research Institute. Pirogov Russian Journal of Surgery. 2025;(6):7-18

Prognostic model and calculator for assessing the risk of prolonged pleural effusion after lobectomy. Pirogov Russian Journal of Surgery. 2025;(6):26-34

Fibrosing interstitial lung disease as a risk factor for lung cancer: a review of the literature and clinical case report. Journal of Respiratory Medicine. 2025;(2):51-59

Survival of patients with malignant lung neoplasms in the Tomsk region (2013—2022). Russian Journal of Preventive Medicine. 2025;(7):43-49

Morphological examination of surgical material of primary lung cancer after neoadjuvant therapy: recommendations and literature review. Russian Journal of Archive of Pathology. 2025;(4):40-46

Features of lung cancer carcinogenesis involving cancer stem cells in COVID-19. Effects of photodynamic therapy in the treatment of cancer and COVID-19. Russian Journal of Archive of Pathology. 2025;(5):65-73

Pulmonary artery surgery in thoracic oncology. Pirogov Russian Journal of Surgery. 2025;(10):24-30

Prediction of mediastinal nodal metastases based on multivariate analysis of VAMLA results in non-small cell lung cancer patients. Pirogov Russian Journal of Surgery. 2025;(10):38-46

Abstract:

Lung cancer is one of the leading causes of cancer-related mortality worldwide. For a long period of time, lobectomy was considered the minimum surgical treatment for patients with non-small cell lung cancer (NSCLC). Minimising the surgical volume for primary lung tumour has been debated for over 25 years. Anatomic segmental lung resection preserves more lung tissue volume than lobectomy. The effect of anatomic segmental lung resection on long-term survival remains controversial.

Keywords:

segmentectomy

segmental resection

lung cancer

lung metastases

three-dimensional reconstruction

Authors:

Dotdaev A.A.

P.A. Herzen Moscow Oncology Research Institute — Branch of the National Medical Radiology Research Center

ORCID: 0009-0000-6337-0955

Ryabov A.B.

P.A. Herzen Moscow Oncology Research Institute — Branch of the National Medical Radiology Research Center

ORCID: 0000-0002-1037-2364

Pikin O.V.

P.A. Herzen Moscow Oncology Research Institute — Branch of the National Medical Radiology Research Center

ORCID: 0000-0001-6871-6804

Kolbanov K.I.

P.A. Herzen Moscow Oncology Research Institute — Branch of the National Medical Radiology Research Center

ORCID: 0000-0003-0536-7613

Received:

19.09.2023

Accepted:

24.01.2024

Close metadata

References:

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. https://doi.org/10.3322/caac.21492
Whitson BA, Groth SS, Andrade RS, Maddaus MA, Habermann EB, D’Cunha J. Survival after lobectomy versus segmentectomy for stage I non-small cell lung cancer: a population-based analysis. Ann Thorac Surg. 2011;92(6):1943-1950. https://doi.org/10.1016/j.athoracsur.2011.05.091
Churchill ED, Belsey R. Segmental pneumonectomy in bronchiectasis: the lingula segment of the left upper lobe. Ann Surg. 1939;109(4):481-499. https://doi.org/10.1097/00000658-193904000-00001
Ramsay H. Whither tuberculosis? BMJ. 1949;1:152. https://doi.org/10.1136/bmj.1.4594.152-b
Overholt R, Atwell S. Cancer of the lung. New York: American Cancer Society; 1950.
Jensik RJ, Faber LP, Milloy FJ, Monson DO. Segmental resection for lung cancer. A fifteen-year experience. J Thorac Cardiovasc Surg. 1973;66(4):563-572.
Weissberg D, Straehley CJ, Scully NM, Margulies DR. Less than lobar resections for bronchogenic carcinoma. Scand J Thorac Cardiovasc Surg. 1993;27(3-4):121-126. https://doi.org/10.3109/14017439309099098
Pastorino U, Valente M, Bedini V, Infante M, Tavecchio L, Ravasi G. Limited resection for Stage I lung cancer. Eur J Surg Oncol. 1991;17(1):42-46.
Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60(3):615-622; discussion 622-623. https://doi.org/10.1016/0003-4975(95)00537-u
Okada M, Nishio W, Sakamoto T, Uchino K, Yuki T, Nakagawa A, Tsubota N. Effect of tumor size on prognosis in patients with non-small cell lung cancer: the role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg. 2005;129(1):87-93. https://doi.org/10.1016/j.jtcvs.2004.04.030
Sienel W, Dango S, Kirschbaum A, Cucuruz B, Hörth W, Stremmel C, Passlick B. Sublobar resections in stage IA non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections. Eur J Cardiothorac Surg. 2008;33(4):728-734. https://doi.org/10.1016/j.ejcts.2007.12.048
Hwang Y, Kang CH, Kim HS, Jeon JH, Park IK, Kim YT. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy on the patients with non-small cell lung cancer: a propensity score matching study. Eur J Cardiothorac Surg. 2015;48(2):273-278. https://doi.org/10.1093/ejcts/ezu422
Landreneau RJ, Normolle DP, Christie NA, et al. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis. J Clin Oncol. 2014;32(23):2449-2455. https://doi.org/10.1200/JCO.2013.50.8762
El-Sherif A, Gooding WE, Santos R, Pettiford B, Ferson PF, Fernando HC, Urda SJ, Luketich JD, Landreneau RJ. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis. Ann Thorac Surg. 2006;82(2):408-415; discussion 415-416. https://doi.org/10.1016/j.athoracsur.2006.02.029
Mediratta N, Shackcloth M, Page R, Woolley S, Asante-Siaw J, Poullis M. Should males ever undergo wedge resection for stage 1 non-small-cell lung cancer? A propensity analysis. Eur J Cardiothorac Surg. 2014;46(2):267-273; discussion 273. https://doi.org/10.1093/ejcts/ezt603
Zhong C, Fang W, Mao T, Yao F, Chen W, Hu D. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stage IA lung cancer. Ann Thorac Surg. 2012;94(2):362-367. https://doi.org/10.1016/j.athoracsur.2012.04.047
Dai C, Shen J, Ren Y, et al. Choice of surgical procedure for patients with non-small-cell lung cancer ≤1 cm or >1 to 2 cm among lobectomy, segmentectomy, and wedge resection: a population-based study. J Clin Oncol. 2016;34(26):3175-3182. https://doi.org/10.1200/JCO.2015.64.6729
Saji H, Okada M, Tsuboi M, et al.; West Japan Oncology Group and Japan Clinical Oncology Group. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022;399(10335):1607-1617. https://doi.org/10.1016/S0140-6736(21)02333-3
Suzuki K, Saji H, Aokage K, et al.; West Japan Oncology Group; Japan Clinical Oncology Group. Comparison of pulmonary segmentectomy and lobectomy: safety results of a randomized trial. J Thorac Cardiovasc Surg. 2019;158(3):895-907. https://doi.org/10.1016/j.jtcvs.2019.03.090
Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med. 2018;6(12):915-924. https://doi.org/10.1016/S2213-2600(18)30411-9
Stamatis G, Leschber G, Schwarz B, et al. Survival outcomes in a prospective randomized multicenter Phase III trial comparing patients undergoing anatomical segmentectomy versus standard lobectomy for non-small cell lung cancer up to 2 cm. Lung Cancer. 2022;172:108-116. https://doi.org/10.1016/j.lungcan.2022.08.013
Liu Q, Wang H, Zhou D, Deng X, Min J, Dai J. Comparison of clinical outcomes after thoracoscopic sublobectomy versus lobectomy for Stage I nonsmall cell lung cancer: a meta-analysis. J Cancer Res Ther. 2016;12(2):926-931. https://doi.org/10.4103/0973-1482.174181
Winckelmans T, Decaluwé H, De Leyn P, Van Raemdonck D. Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2020;57(6):1051-1060. https://doi.org/10.1093/ejcts/ezz339
Zeng W, Zhang W, Zhang J, You G, Mao Y, Xu J, Yu D, Peng J, Wei Y. Systematic review and meta-analysis of video-assisted thoracoscopic surgery segmentectomy versus lobectomy for stage I non-small cell lung cancer. World J Surg Oncol. 2020;18(1):44. https://doi.org/10.1186/s12957-020-01814-x
Martin-Ucar AE, Delgado Roel M. Indication for VATS sublobar resections in early lung cancer. J Thorac Dis. 2013;5 Suppl. 3(Suppl. 3):S194-S199. https://doi.org/10.3978/j.issn.2072-1439.2013.08.41
Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT. The eighth edition lung cancer stage classification. Chest. 2017;151(1):193-203. https://doi.org/10.1016/j.chest.2016.10.010
Yang CF, Sun Z, Speicher PJ, et al. Use and outcomes of minimally invasive lobectomy for stage I non-small cell lung cancer in the National Cancer Data Base. Ann Thorac Surg. 2016;101(3):1037-1042. https://doi.org/10.1016/j.athoracsur.2015.11.018
Shimizu K, Nakazawa S, Nagashima T, Kuwano H, Mogi A. 3D-CT anatomy for VATS segmentectomy. J Vis Surg. 2017;3:88. https://doi.org/10.21037/jovs.2017.05.10
Watanabe A, Ohori S, Nakashima S, Mawatari T, Inoue N, Kurimoto Y, Higami T. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg. 2009;35(5):775-780; discussion 780. https://doi.org/10.1016/j.ejcts.2009.01.013
Watanabe S, Arai K, Watanabe T, Koda W, Urayama H. Use of three-dimensional computed tomographic angiography of pulmonary vessels for lung resections. Ann Thorac Surg. 2003:75(2):388-392; discussion 392. https://doi.org/10.1016/s0003-4975(02)04375-8
Oizumi H, Endoh M, Takeda S, Suzuki J, Fukaya K, Sadahiro M. Anatomical lung segmentectomy simulated by computed tomographic angiography. Ann Thorac Surg. 2010;90(4):1382-1383. https://doi.org/10.1016/j.athoracsur.2009.11.062
Sato M, Murayama T, Nakajima J. Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP). J Thorac Dis. 2016;8(Suppl. 9):S716-S730. https://doi.org/10.21037/jtd.2016.09.56
Miyasaka Y, Oh S, Takahashi N, Takamochi K, Suzuki K. Postoperative complications and respiratory function following segmentectomy of the lung — comparison of the methods of making an inter-segmental plane. Interact Cardiovasc Thorac Surg. 2011;12(3):426-429. https://doi.org/10.1510/icvts.2010.253989
Tsubota N. An improved method for distinguishing the intersegmental plane of the lung. Surg Today. 2000;30(10):963-964. https://doi.org/10.1007/s005950070056
Iwata H, Shirahashi K, Mizuno Y, Matsui M, Takemura H. Surgical technique of lung segmental resection with two intersegmental planes. Interact Cardiovasc Thorac Surg. 2013;16(4):423-425. https://doi.org/10.1093/icvts/ivs560
Roman MA, Nakas A. Comparing outcomes of segmentectomy and lobectomy for non-small cell lung cancer: is less truly more? Chest. 2021;159(1):21-22. https://doi.org/10.1016/j.chest.2020.07.063
Nomori H, Mori T, Ikeda K, Yoshimoto K, Iyama K, Suzuki M. Segmentectomy for selected cT1N0M0 non-small cell lung cancer: a prospective study at a single institute. J Thorac Cardiovasc Surg. 2012;144(1):87-93. https://doi.org/10.1016/j.jtcvs.2012.03.034
Nomori H, Okada M. Sleeve segmentectomy. Illustrated anatomical segmentectomy for lung cancer. Springer; 2012: 237-242. https://doi.org/10.1007/978-4-431-54144-8_7
Tsubota N, Ayabe K, Doi O, Mori T, Namikawa S, Taki T, Watanabe Y. Ongoing prospective study of segmentectomy for small lung tumors. Study Group of Extended Segmentectomy for Small Lung Tumor. Ann Thorac Surg. 1998;66(5):1787-1790. https://doi.org/10.1016/s0003-4975(98)00819-4
Okada M, Yoshikawa K, Hatta T, Tsubota N. Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller? Ann Thorac Surg. 2001;71(3):956-960; discussion 961. https://doi.org/10.1016/s0003-4975(00)02223-2
Fan W, Yang H, Ma J, Wang Z, Zhao H, Yao F. Indocyanine green fluorescence-navigated thoracoscopy versus traditional inflation-deflation approach in precise uniportal segmentectomy: a short-term outcome comparative study. J Thorac Dis. 2022;14(3):741-748. https://doi.org/10.21037/jtd-22-292
Sekine Y, Ko E, Oishi H, Miwa M. A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green. J Thorac Cardiovasc Surg. 2012;143(6):1330-1335. https://doi.org/10.1016/j.jtcvs.2012.01.079
Misaki N, Chang SS, Igai H, Tarumi S, Gotoh M, Yokomise H. New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system. J Thorac Cardiovasc Surg. 2010;140(4):752-756. https://doi.org/10.1016/j.jtcvs.2010.07.020
Sun Y, Zhang Q, Wang Z, Shao F, Yang R. Feasibility investigation of near-infrared fluorescence imaging with intravenous indocyanine green method in uniport video-assisted thoracoscopic anatomical segmentectomy for identifying the intersegmental boundary line. Thorac Cancer. 2021;12(9):1407-1414. https://doi.org/10.1111/1759-7714.13923
Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006;132(4):769-775. https://doi.org/10.1016/j.jtcvs.2006.02.063
Altorki NK, Yip R, Hanaoka T, Bauer T, Aye R, Kohman L, Sheppard B, Thurer R, Andaz S, Smith M, et al.; I-ELCAP Investigators. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg. 2014;147(2):754-762; Discussion 762-764. https://doi.org/10.1016/j.jtcvs.2013.09.065
Koike T, Koike T, Yoshiya K, Tsuchida M, Toyabe S. Risk factor analysis of locoregional recurrence after sublobar resection in patients with clinical stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg. 2013;146(2):372-378. https://doi.org/10.1016/j.jtcvs.2013.02.057
Lee PC, Kamel M, Nasar A, Ghaly G, Port JL, Paul S, Stiles BM, Andrews WG, Altorki NK. Lobectomy for non-small cell lung cancer by ideo-assisted thoracic surgery: effects of cumulative institutional experience on adequacy of lymphadenectomy. Ann Thorac Surg. 2016;101(3):1116-1122. https://doi.org/10.1016/j.athoracsur.2015.09.073
Watanabe S, Asamura H, Suzuki K, Tsuchiya R. Problems in diagnosis and surgical management of clinical N1 non-small cell lung cancer. Ann Thorac Surg. 2005;79(5):1682-1685. https://doi.org/10.1016/j.athoracsur.2004.11.025