Video-assisted thoracoscopic trisegmentectomy and left upper lobectomy provide equivalent survivals for stage IA and IB lung cancer

Abstract

Despite a trend toward sublobar resections for lung cancers, some question the adequacy of limited resections in the treatment of lung cancer and questions remain about performing these procedures by video-assisted thoracoscopic surgery (VATS). We compared the survival for lung cancers treated with VATS segmentectomy versus VATS lobectomy. VATS segmentectomy and lobectomy for both malignant and benign lung pathology are reviewed from a single institution. Between 1998 and 2010, 73 VATS trisegmentectomies were performed in 49 women and 24 men (mean age, 72 years). Diagnoses included primary lung cancer (91%), benign disease (4%), and metastatic disease (5%). Primary lung cancers were 68% for stage IA, 17% for stage IB, and 15% for stage II-IV. Seventy-three left upper lobe (LUL) trisegmentectomies were performed. Mean hospital stay after VATS trisegmentectomy was 3.8 days, versus 5.5 days after VATS LUL lobectomy (P = .0736). Complication rates for trisegmentectomy group (37%) and lobectomy (17%; P > .05) were not statistically different. Survival after VATS trisegmentectomy and LUL lobectomy for either stage IA lung cancer or stage IB lung cancer was not statistically significant. Segmentectomy can be performed by VATS with no greater morbidity and mortality than with VATS lobectomy. LUL trisegmentectomy provides the same survival as lobectomy for stage IA and IB tumors. Our experience supports the use of lingular-sparing trisegmentectomy in the treatment of stage IA and IB lung cancer.