segmentectomy

Segmentectomy is a lung-sparing surgical procedure in which a single anatomic segment of the lung is removed. It is a type of sublobar resection that preserves surrounding lung tissue and is distinct from wedge resection (a non-anatomic removal) and from lobectomy (removal of an entire lobe). By following the natural segmental boundaries, segmentectomy aims to remove the lesion with an adequate margin while preserving maximal functional lung.

Indications for segmentectomy center on select patients with localized disease or nodules in whom preserving lung function is important. It is commonly considered for early-stage lung cancer when tumors are small and peripherally located, or in patients with limited pulmonary reserve or substantial comorbidities. The procedure may also be employed for benign nodules or localized infections in certain cases, where a precise, segmental resection is advantageous.

Technique and approach involve identifying the segmental bronchus and its accompanying segmental arteries and veins, then dividing these structures and removing the segment along its anatomical planes. Lymph node sampling or dissection is typically performed for staging. Segmentectomy can be done via open thoracotomy, video-assisted thoracoscopic surgery (VATS), or robotic-assisted thoracic surgery, with preoperative imaging and planning guiding the resection.

Outcomes and considerations include preservation of more lung function compared with lobectomy, which can benefit patients with limited reserve. In carefully selected patients with small, localized tumors, segmentectomy may offer comparable overall survival to lobectomy, though some data suggest a higher risk of local recurrence. Postoperative complications can include air leaks and pneumonia.