segmentectomies

Segmentectomy, or pulmonary segmentectomy, is a lung resection that removes one or more anatomic bronchopulmonary segments while preserving the remaining segments of the lobe. It is an anatomical resection that follows segmental bronchi and vessels, in contrast to non-anatomic wedge resections.

Indications for segmentectomy include small, early-stage peripheral non-small cell lung cancer and patients with limited pulmonary reserve or significant comorbidities where removing an entire lobe would pose excessive risk. It may also be used for benign lesions or selected metastases when sparing lung tissue is advantageous. Careful preoperative assessment is essential to ensure adequate margins and nodal staging.

Technique and approaches often involve video-assisted thoracoscopic surgery (VATS) or robotic-assisted methods, though open thoracotomy remains an option. Planning relies on detailed imaging, including CT with three-dimensional reconstruction, to map segmental bronchi, arteries, and veins and to identify the intersegmental plane. The procedure typically involves isolating and dividing the segmental bronchus and accompanying vessels, followed by dissection along the intersegmental plane and division with staplers or sutures. The goal is to achieve complete tumor clearance with adequate margins while preserving adjacent segments. A chest drain is placed postoperatively.

Variants include single-segment or multi-segment (bi-segment) resections within a lobe. Segmentectomy is contrasted with lobectomy and with non-anatomic wedge resections, the latter not following the lung’s segmental anatomy.

Outcomes in selected patients show comparable short- to intermediate-term survival to lobectomy for small tumors, with the benefit of greater preserved lung function, but potentially higher risk of local recurrence if margins are inadequate or anatomy is complex.