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J Thorac Cardiovasc Surg 2009;137:1388-1393
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer

^a Department of Surgery, The Mount Sinai Medical Center, New York, NY
^b Division of Thoracic Surgery, The Mount Sinai Medical Center, New York, NY
^c Department of Medicine, The Mount Sinai Medical Center, New York, NY
^d Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass

Received for publication October 25, 2008; revisions received December 18, 2008; accepted for publication February 1, 2009.

^_* Address for reprints: Scott J. Swanson, MD, Division of Thoracic Surgery, Brigham and Women's Hospital, Peter Bent Brigham Building 239, 75 Francis St, Boston, MA 02115. (Email: sjswanson{at}partners.org).

Objective: As thoracoscopic lobectomy becomes widely applied for treatment of non–small cell lung cancer, thoracoscopic segmentectomy remains controversial for patients with small stage I lung cancers. Questions remain regarding safety, morbidity, mortality, and recurrence rate. This study compared outcomes between thoracoscopic segmentectomy and lobectomy.

Methods: Retrospective review was undertaken of patients who underwent thoracoscopic segmentectomy or lobectomy for clinical stage I non–small cell lung cancer between January 2002 and February 2008. Indications for segmentectomy were tumor smaller than 3 cm, limited pulmonary reserve, comorbidities, and peripheral tumor location.

Results: Thirty-one patients underwent segmentectomy and 113 underwent lobectomy. Patients after segmentectomy had worse mean forced expiratory volume in 1 second than after lobectomy (83% vs 92%, P = .04). There were no differences in mean number of nodes (10) and nodal stations (5) resected. Segmentectomy and lobectomy groups had similar median chest tube durations (2 vs 3 days, P = .18), stays (both 4 days), total complications, recurrence rates, and survivals at mean follow-ups of 22 and 21 months, respectively. Lobectomy group had 1 30-day death; segmentectomy group had none. There were 5 (17.2%) recurrences after segmentectomy and 23 (20.4%) after lobectomy (P = .71), with locoregional recurrence rates of 3.5% and 3.6%, respectively.

Conclusion: Thoracoscopic segmentectomy is a safe option for experienced thoracoscopic surgeons treating patients with small stage I lung cancers. No significant difference in oncologic outcome was seen between thoracoscopic segmentectomy and thoracoscopic lobectomy. Lymph node dissection could be performed as effectively during segmentectomy as lobectomy.

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