PURPOSE: The use of parenchymal-sparing operations, such as segmentectomy, in the management of non-small cell lung carcinoma (NSCLC) remains controversial due to the increased rate of locoregional recurrence rates seen in the only randomized trial evaluating sublobar resections. Several recent studies have come to question the findings of this randomized trial. Interest in video-assisted thoracic surgery (VATS) segmentectomy has increased in the surgical management for bronchogenic carcinoma. We reviewed our experience with VATS segmentectomy in patients with NSCLC.
METHODS: A retrospective review was undertaken of all patients who underwent thoracoscopic segmentectomy for NSCLC between 2002 and 2007. Patient selection for VATS segmentectomy was based on the location of the tumor and patient co-morbidities.
RESULTS: Twenty four consecutive patients underwent VATS segmentectomy during the selected period. In two of these patients the lesions resected were benign lesions. The remaining 22 patients underwent resection of NSCLC: 18 patients had pathological stage I disease, 1 had stage II disease, and 3 patients had pathological stage III lung cancer. Mean follow-up was 27.2 months (range 4 –70). All margins were tumor free. The median length of stay (LOS) was 4 days (range 1–98). Seven patients developed perioperative complications (29.2%), with pneumonia being the most common complication (n=3). There was no perioperative mortality. Four patients developed recurrence (18.2%); 1 was locoregional and 3 developed distant disease. Three patients died during the follow-up period, all due to distant metastatic disease. Overall, patients had a satisfactory recovery, with Karnofsky scale scrore being 90–100% at the time of follow up or prior to undergoing additional surgical interventions.
CONCLUSION: Anatomic segmentectomy can be performed safely via a thoracoscopic approach in the surgical management of NSCLC. The incidence of postoperative morbidity and the recurrence rate in this study compare favorably to those seen in other studies analyzing outcomes after lobectomy.
CLINICAL IMPLICATIONS: VATS segmentectomy treatment of NSCLC provides another treatment option that may be particularly valuable in patients whose co-morbidities would preclude lobectomy.
DISCLOSURE: Mark Shapiro, No Financial Disclosure Information; No Product/Research Disclosure Information