Abstract
Objective
The advent of lung cancer screening and detection of smaller nodules amplifies the
need to clarify the oncological quality of sublobar resections. Furthermore, studies
comparing sublobar resections to lobectomies offer conflicting conclusions. We hypothesize
that this is driven, in part, by inconsistency in reporting; that is, variable interpretation
of what constitutes an operative segment. Without an established standard, 2 very
different operations may be reported as segmental resections, leaving the data on
sublobar approaches subject to interpretative variability.
Methods
A retrospective audit was performed on all segmental resections from May 2016 to December
2019 at Brigham and Women's Hospital. Pathology and operative reports were reviewed,
with particular attention to the dissection of the component artery, vein, and bronchus.
Resections with dissection and division of at least 1 major vascular structure (the
segmental artery or vein), as well as the segmental bronchus, met operative criteria
for anatomic segmentectomy. Surgical quality metrics were compared between the 2 groups.
Results
There were 271 segmental resections: 219 (80.8%) were anatomic segmentectomies and
52 (19.2%) were nonanatomic segmentectomies. For the entire cohort, nonanatomic segmentectomies
had smaller margins (1.0 vs 1.5 cm; P = .02), fewer lymph nodes (2.0 vs 6.0; P < .001), and fewer mediastinal lymph node stations sampled (1.0 vs 2.0; P < .001). Similarly, there were smaller margins (1.5 vs 1.8 cm; P = .03), fewer lymph nodes (2.0 vs 6.0; P < .001), and fewer mediastinal lymph node stations sampled (1.0 vs 2.0; P < .001) in nonanatomic segmentectomies for non–small cell lung cancer.
Conclusions
Nearly 20% of reported segmentectomies may not meet criteria for true segmental resection.
Therefore, prior studies may need further scrutiny to clarify outcomes and results.
Establishing a professional standard may help mitigate ambiguity in published data
on this subject.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
NSCLC (non–small cell lung cancer)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 13, 2022
Accepted:
August 23,
2022
Received in revised form:
August 4,
2022
Received:
May 14,
2022
Footnotes
Drs Weiss and Deeb were funded through the Jack Mitchell Surgical Education and Thoracic Oncology Fellowships, respectively.
Identification
Copyright
© 2022 by The American Association for Thoracic Surgery
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- Commentary: Calling a spade a spade? What constitutes a segmentectomyThe Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 6
- PreviewThe Nederlands–Leuvens Longkanker Screenings Onderzoek (NELSON) trial proved that a national program for lung cancer screening improves lung cancer–related mortality largely in part to detecting smaller tumors and earlier stage of disease.1 Over the course of the NELSON trial, surgical resection, specifically lobectomy, was the gold standard for treatment of early-stage lung cancer.2 Lobectomy has been challenged by limited resection over the years through retrospective studies showing conflicting results.
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