Lung segmentectomy: does it offer a real functional benefit over lobectomy?

摘要

Anatomical segmentectomy has been developed to offer better pulmonary function preservation than lobectomy; in stage IA lung cancer. Despite the retrospective nature of most of the studies and the lack of randomised studies; a substantial body of literature today allows us to evaluate to what extent lung function decreases after segmentectomy and whether segmentectomy offers a real functional benefit over lobectomy. From the available series; it emerges that the mean decrease in forced expiratory volume in 1xe2x80x85s (FEV1) is low; ranging from xe2x88x929% to xe2x88x9224% of the initial value within 2xe2x80x85months and xe2x88x923 to xe2x88x9213% 12xe2x80x85months after segmentectomy. This reduction in lung function is significantly lower than that induced by lobectomy; but saves only a few per cent of pre-operative FEV1. Moreover; the published results do not firmly establish the functional benefit of segmentectomy over lobectomy in patients with poor lung function. Some issues remain to be addressed; including whether video-assisted thoracic surgery (VATS) segmentectomy may preserve lung function better than VATS lobectomy in patients with poor lung function; especially within the early days after surgery; and whether this may translate to lowering the functional limit for surgery. Eventually; trials comparing stereotactic ablative body radiotherapy; radiofrequency ablation and segmentectomy functional consequences are warranted.