Stage IA (T1aN0M0) Lobectomy vs. Segmentectomy

The increased detection of early non-small cell lung cancers (NSCLCs) by a larger use of CT scan, associated to the increasing use of lung cancer screening, has allowed many surgeons to consider treatment of small peripheral lesions with intentional limited resection, which has gained much interest even in patients with low surgical risk. NLST had shown an advantage of screening in reducing lung cancer mortality. Recently, presentation of NELSON trial data confirmed the benefit of low-dose chest CT screening in terms of survival in lung cancer. The use of screening in clinical practice will shortly be able to diagnose small lung cancers. 

The radical treatment of lung cancer has always been considered lobectomy, however, the new evidence for small and indolent tumors has reopened the question on the extent of pulmonary resection. For some tumors segmentectomy could represent a radical treatment, but with an advantage in terms of post-operative respiratory function.

The minimally invasive approach to lung surgery has many benefits that have been widely reported. Robotic-assisted thoracoscopic surgery, similar to video-assisted thoracoscopic surgery (VATS), offers several advantages in lung cancer, including improved visualization and more precise instrument manipulation. Minimally invasive segmentectomy combines two beneficial aspects: first, the decreased surgical insult to the patient; second, the concept of “lung-sparing surgery”, especially for those patients with reduced lung function. A review of the literature about segmentectomies with related advantages and controversies related to this surgical practice is also reported.