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Matthew J. Schuchert
Brian L. Pettiford
Samuel Keeley
Arjun Pennathur
Ricardo Santos
Hiran C. Fernando
James D. Luketich
Rodney J. Landreneau
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Right arrow Lung - cancer

Ann Thorac Surg 2007;84:926-933
© 2007 The Society of Thoracic Surgeons

Original Articles: General Thoracic

Anatomic Segmentectomy in the Treatment of Stage I Non-Small Cell Lung Cancer

Matthew J. Schuchert, MDa, Brian L. Pettiford, MDa, Samuel Keeley, MDa, Thomas A. D’Amato, MD, PhDb, Arman Kilic, BSa, John Close, MAc, Arjun Pennathur, MDa, Ricardo Santos, MDa, Hiran C. Fernando, MDd, James R. Landreneaua, James D. Luketich, MDa, Rodney J. Landreneau, MDa,*

a Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery Institute, UPMC Health System, Pittsburgh
b Division of Thoracic Surgery, Jefferson Medical College, Philadelphia
c Department of Dental Public Health and Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
d Department of Cardiothoracic Surgery, Boston Medical Center, Boston, Massachusetts

Accepted for publication May 3, 2007.

* Address correspondence to Dr Landreneau, Heart, Lung and Esophageal Surgery Institute, Shadyside Medical Building, Suite 715, 5200 Centre Ave, Pittsburgh PA 15232 (Email: landreneaurj{at}upmc.edu).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: Segmentectomy for early-stage non-small cell lung cancer (NSCLC) remains controversial and has been previously associated with high local recurrence rates. We compared the outcomes of anatomic segmentectomy with lobectomy for stage I NSCLC and investigated the impact of surgical resection margins on recurrence.

Methods: From 2002 to 2006, 182 anatomic segmentectomies (114 open, 68 video-assisted thoracic surgery [VATS]), were performed for stage 1A (n = 109) or IB (n = 73) NSCLC. These were compared with 246 lobectomies (1A, 114; 1B, 132). Variables analyzed included hospital course, mortality, and patterns of recurrence and survival.

Results: All segmentectomy surgical margins were free of tumor (average margin, 18.2 mm). Operative time (147 versus 216 minutes; p < 0.0001) and estimated blood loss (185 versus 291 mL; p = 0.0003) were significantly reduced after segmentectomy compared with lobectomy. Thirty-day mortality (1.1% versus 3.3%), total complications, disease-free recurrence, and survival were similar between segmentectomy and lobectomy at a mean follow-up of 18.1 and 28.5 months, respectively. There were 32 recurrences after segmentectomy (17.6%) at a mean of 14.3 months (14 locoregional [7.7%], 18 distant [9.9%]), and 89% of recurrences were seen when tumor margins were 2 cm or less. Margin/tumor diameter ratios exceeding 1 were associated with a significant reduction in recurrence rates compared with ratios of less than 1 (25.0% versus 6.2%; p = 0.0014).

Conclusions: Anatomic segmentectomy can be performed safely by an open or VATS approach. Segmentectomy outcomes compare favorably with standard lobectomy for stage I NSCLC. Margin/tumor ratios of less than 1 are associated with a higher rate of recurrence. Lobectomy should be considered as primary therapy when such margins are not obtainable with segmentectomy in the good-risk patient.




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