Comprehensive narrative review of segmentectomy for lung cancer

Abstract

Pulmonary lobectomy has been historically the gold standard oncologic resection for early stage non-small cell lung cancer (NSCLC). Pulmonary segmentectomy has gained popularity as technological advances and improved understanding of segmental anatomy have allowed the use of minimally invasive surgery for parenchymal sparing resections. Oncologic equivalency between segmentectomy and lobectomy remains under investigation. In this manuscript, we aim to review existing literature with regards to oncologic and functional outcomes comparing lobectomy vs. segmentectomy, and comparisons among different surgical approaches: open, traditional video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery. When compared with lobectomy, segmentectomy appears to provide equivalent oncologic outcomes in appropriately selected patients, as long as adequate lymphadenectomy and negative margins are achieved. The robotic platform, with its improved visualization and use of wristed instruments may allow for a more complete lymphadenectomy during a segmental resection. The following manuscript serves as a guide for clinicians on recent literature for open, video-assisted and robotic thoracoscopic pulmonary segmentectomy.