Anatomic segmentectomy for non-small cell lung cancer: can we believe the hype?

Since first being intentionally used for treatment of small peripheral lung cancers by Jensik et al., anatomic segmentectomy has garnered much attention when being considered as treatment for stage I non-small cell lung cancer (NSCLC) (1). Lobectomy has long been considered the standard of care. Support for this notion can be traced back to the findings of the Lung Cancer Study Group (LCSG) published in 1995 which revealed a 3-fold increase in local recurrence rates and decreased survival in patients who had undergone sublobar resection rather than lobectomy (2). However, controversy over these conclusions stemmed from the study’s incorporation of wedge resections in the sublobar group leading many to question whether the same results would hold true when comparing lobectomy to true anatomic segmentectomy. The LCSG study results were further supported by analysis done with the Surveillance Epidemiology and End Results (SEER) database [1998-2007] by our group which showed statistically significant better survival outcomes in patients undergoing lobectomy compared to segmentectomy (3). Nonetheless, anatomic segmentectomy still has gained enthusiasm by many surgical groups. Many investigators have reported equivalent outcomes for anatomic segmentectomy and lobectomy with stage I NSCLC. It is clear that additional studies are needed to define the merits of anatomic segmentectomy for early stage NSCLC. Definitive answers in this area can’t come fast enough when one considers the recent recommendations of CT screening from the National Lung Screening Trial where detection of more early stage peripheral tumors are on the horizon (4).