Open, thoracoscopic and robotic segmentectomy for lung cancer

Lobectomy is currently the standard procedure for early stage lung cancer and the role of sublobar resection is under investigation for selected patients with small tumors. In this review, studies reporting outcomes on open, thoracoscopic and robotic segmentectomy were analyzed. In patients with stage I lung cancer, with tumors <2 cm in diameter and within segmental anatomic boundaries, segmentectomy appears to have equivalent rates of morbidity, recurrence and survival when compared to lobectomy. Segmentectomy also appears to result in greater preservation of lung function and exercise capacity than lobectomy. It appears reasonable to consider segmentectomy for patients with stage I lung cancer (particularly in air-containing tumors with ground glass opacities) where tumors are <2 cm in diameter and an acceptable segmental margin is obtainable, especially in patients with advanced age, poor performance status, or poor cardiopulmonary reserve. The results of two ongoing randomized controlled trials (CALGB 140503 and JCOG0802/ WJOG4607L) and additional well-designed studies on open, thoracoscopic, and robotic segmentectomy will be important for clarifying the role of segmentectomy for lung cancer.