Segmentectomy Versus Lobectomy

The standard lung cancer operation for a tumor confined to a lobe of the lung is a lobectomy rather than a segmental resection. However, there is evidence that in some situations a segmentectomy may result in similar long-term survival as a lobectomy. This is important in a patient with limited pulmonary function in whom a lobectomy will result in a poor predicted postoperative FEV-1. In these segments a segmentectomy may permit resection of the lesion in an anatomical way but limit the amount of pulmonary compromise. In patients with squamous cell carcinoma, it appears that there is about equal initial benefit from a segmen-tectomy compared to a lobectomy; however, it appears that there is an overall 20% survival benefit in patients who undergo resection of the tumor as a lobectomy rather than a segmental resection. In particular, adenocarcinomas do poorly with limited resections, but more information is needed before any final conclusions are drawn about the overall applicability of segmentectomy.

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