Guest Editor Series: Segmentectomy for Lung Cancer

In the newest entry into the CTSNet Guest Editor Series, "Segmentectomy for Lung Cancer," CTSNet is happy to feature Alan D. L. Sihoe, MBBChir, FRCSEd, FCSHK, FHKAM. A world-renowned thoracic specialist, Dr. Sihoe has brought together a set of informative videos to share unique insights regarding segmentectomy procedures in the treatment of lung cancer cases to the cardiothoracic community. You can learn more about Dr. Sihoe in this Featured Profile Interview.

• This CTSNet Guest Editor Series features seven contributor videos from six thoracic surgery specialists across the world. The videos will be released from August 1 to August 5, 2022.
• For details regarding the content, the authors, and video lineup, please scroll to the bottom of this page.
• The series concluded with a webinar held on August 12, 2022. CTSNet hosted Dr. Sihoe and some of his series contributors for a live discussion regarding the primary topic of segmentectomy for lung cancer.

Webinar Recording

Greetings CTSNet members,

The most important disruptive innovation in thoracic surgery since the advent of video-assisted thoracic surgery (VATS) is arguably the emergence of segmentectomy as an accepted surgical strategy for the curative resection of non-small cell lung cancer.

Sublobar resection has long been considered the black sheep of the lung cancer surgery family. For decades, it was thought that resecting less than a lobe for lung cancer would result in poorer survival and increased local recurrence risk. However, clinical evidence accumulated over the past fifteen to twenty years has gradually demonstrated that sublobar resections may still yield good oncological outcomes in some patients. In patients who are unfit to undergo a lobectomy, sublobar resection may be tolerable and still provide better survival than nonsurgical management. In patients who can tolerate a lobectomy, sublobar resection may offer comparable survival with potentially better-preserved lung function if certain criteria are met. These criteria include lung cancers no larger than 2 cm; tumors with ground glass opacity (GGO) appearance on CT scan; segmentectomy performed instead of wedge resections; and adequate lymph node dissection.

However, the breakthrough that has put segmentectomy on the lips of thoracic surgeons around the world has unquestionably been the announcement of the JCOG0802 randomized trial results in 2021. This Japanese study is one of the largest randomized trials ever performed in this specialty, and it compared segmentectomy versus lobectomy for peripherally located, solid-predominant lung cancers smaller than 2 cm in diameter. The finding that segmentectomy offered slightly better overall survival than lobectomy was an astonishing result. Far from a black sheep, segmentectomy is now emerging as a genuine—possibly even preferable—alternative to lobectomy for selected patients with lung cancer.

With the spotlight now firmly cast on segmentectomy, interest in it has risen dramatically among thoracic surgeons worldwide. An explosion of surgical advances has followed. Sophisticated imaging and preoperative intervention technologies can help pinpoint those small, hard-to-palpate lesions that are most amenable to segmental resections. Operative techniques have also evolved, so that segmentectomies can now be safely and effectively performed using robotic-assistance or via even a single small VATS port. The technological and technical options available to the thoracic surgeon when undertaking a segmentectomy are now exceedingly abundant.

However, despite the plethora of choices available, surgeons considering segmentectomy are still faced with fundamental questions and challenges. Is the current evidence sufficiently robust to justify choosing segmentectomy over a lobectomy? How does one navigate the pitfalls, such as difficult-to-detect nodules or complex segmental anatomy? Is there an optimal surgical approach for segmentectomy, and if so which one? Crucially, what is the role of segmentectomy in this rapidly changing world of lung cancer management, where increased screening, nonsurgical options such as stereotactic body radiation therapy (SBRT) and ablative therapy, and many other medical developments are concurrently taking place?

This CTSNet Guest Editor Series is designed to address these questions. Each video in this series is presented by a world-renowned thoracic surgeon, each of whom have been specifically invited to summarize the topic for which they are widely recognized to have the greatest expertise. Through these concise, readily assimilated videos, CTSNet readers should gain a clear and up-to-date insight into the most pertinent aspects of segmentectomy today. It is my hope that these videos will provide thoracic surgeons with the core understanding that will help them when considering segmentectomy for their patients in the future.

Enjoy!

Alan Sihoe, MBBChir, FRCSEd, FCSHK, FHKAM

Cardiothoracic Surgery Specialist at HEAL Medical Group in Hong Kong SAR

Contributor Videos

1. Segmentectomy Versus Lobectomy for Non-Small Cell Lung Cancers: Clinical Evidence by Christopher Cao
2. Robotic-Assisted Bronchoscopic Dye Marking & VATS Left Lower Lobe Apical Segmentectomy by Calvin Ng, et al.
3. Anatomical Landmarks for Anatomical Segmentectomies by Dominique Gossot, et al.
4. Uniportal Pure Robotic-Assisted Thoracic Surgery—Left Bisegmentectomy S9-S10 by Diego Gonzalez-Rivas, et al.
5. Uniportal Video-Assisted Thoracic Surgery Left Lower Posterobasal Anatomic Segmentectomy S10 by Diego Gonzalez-Rivas, et al.
6. Robotic Left S10 Anatomic Resection with 3D Perioperative Planning by Ricardo Terra, et al.
7. Segmentectomy for Non-Small Lung Cancer by Jessica Donington