What is Segmentectomy and Why is It a Viable Option for Some Lung Cancers?

As surgical treatments have become more refined, segmentectomy has become an increasingly viable option for some patients with early-stage, non-small cell lung cancer, as Dr. Nabil Rizk, chief of thoracic surgery at Hackensack University Medical Center in Hackensack, New Jersey, explained to CURE®.

“Segmentectomies are just a little bit more of a refined way of treating cancers within a lobe without taking as much (healthy) lung tissue,” Rizk noted.

A study of more than 1,100 patients with clinical stage 1A non-small cell lung cancer treated with either segmentectomy or lobectomy (a surgical removal of an entire section of a patient’s lung), showed that at a median follow-up of 7.3 years, the five-year overall survival (the time a patient lives following treatment) was 94.3% for patients treated with segmentectomy and 91.1% for patients treated with lobectomy, according to findings published in The Lancet, researchers wrote “suggest that segmentectomy should be the standard surgical procedure for this population of patients.”

Rizk spoke with CURE® about segmentectomy and how opinions on the procedure have evolved alongside the developments of robotics in surgery.

Transcript:

Q: Let's talk a bit about this procedure for any folks out there who are not familiar with (segmentectomy) and why it is such a viable treatment option for some patients with lung cancer.

A: Sure. So, the lung is separated into lobes — we have two lungs, and each lung has lobes. The right side has three lobes, the left side has two. And then within each lobe, there are segments. And each has its own blood supply, its own airway. And so, segmentectomies are just a little bit more of a refined way of treating cancers within a lobe without taking as much lung tissue, yet (while) still being able to identify the structures going into that segment and removing all the lymph nodes within that segment, which sometimes is important for cancer.

Q: And as technology has developed and advanced, has this procedure become more refined and even more precise over time?

A: Yeah, I think the most recent impetus has been robotics. So, we’ve been doing minimally invasive surgery for over 20 years, but the tools have been relatively rudimentary. So, for video-assisted (surgery) the instruments were not particularly well-adapted to doing these types of operations.

Robotics, on the other hand, is much more refined, and the visualization is much better. So, it allows us to be more precise in how we dissect out the structures. And so, for segmentectomy, that turns out to be a lot more important.

Q: Got it. And are there certain patient populations, stages and disease types, for whom this is a more viable option?

A: I mean, historically, people have thought so for earlier stages, patients without lymph nodes, but the data has never really been strong one way or the other. More recently, there was a trial that compared lobectomy, which has been the traditional treatment for lung cancer, removing a whole lobe, to segmentectomy and something even less than a segmentectomy called a wedge, and they found no difference between these approaches.

And so, what we tend to do is choose the appropriate operation based on the location of the tumor. If we can take it out with less lung tissue we do, if we have to do a lobectomy, we do that as well, it’s whatever is appropriate for the tumor.

Transcript has been edited for conciseness and clarity.

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