Marcus Alvarez, MD, and Thomas Ng, MD, FRCSC, FACS
Central Message.
A recent randomized trial suggests that segmentectomy may be the new standard for small-sized lung cancers, thus it becomes important for thoracic surgeons to be proficient at complex segmentectomies.
See Article page 200.
Similar to surgery for breast cancer, a paradigm shift to less-radical resections for lung cancer has also occurred. Thoracic surgeons have evolved from pneumonectomy (performed in single-stage first by Evarts Graham in 1933) to lobectomy (solidified as the standard in 1995 by the Lung Cancer Study Group1), and now, likely to segmentectomy.
At the American Association for Thoracic Surgery 2021 Annual Meeting, the results of JCOG 0802 were presented, and although not yet published at the time of this commentary, the findings of this trial will likely be practice-changing. JCOG 0802 randomized peripheral ≤2 cm clinical stage IA lung cancers to receive lobectomy versus segmentectomy.2 The investigators found no difference in relapse-free survival but superior overall survival and postoperative pulmonary function in favor of segmentectomy.
In light of these results from JCOG 0802, thoracic surgeons must be proficient at performing segmentectomies, both simple and complex (complex being defined as requiring separation of 2 intersegmental planes). In this issue of JTCVS Techniques, Salfity and colleagues3 present a video atlas describing the complex segmentectomy of S3, the anterior segment of the right upper lobe. The authors provide a detailed description of the procedure, including a complete list of instruments used and a comprehensive step-by-step breakdown of the technique, which is accompanied by individual videos for each step.
Led by Dr D'Amico, the authors from Duke University are internationally known for their expertise and excellence in thoracoscopic procedures. They now provide us with an outstanding, and timely, video atlas that thoracic surgeons at all levels should read/view. For thoracic surgical trainees, this publication will be of great educational value; for thoracic surgeons not comfortable with complex segmentectomies, this video atlas will be an important first step toward becoming proficient; and for surgeons already familiar with the procedure, this video atlas will be a valuable reference for technical improvement.
Arguably segmentectomy, especially complex, is a more difficult procedure to perform than standard lobectomy. However, we must avoid the temptation of performing the less-difficult procedure if doing so is not what is best for our patients. With the emerging results of JCOG 0802, thoracic surgeons must be prepared to make every effort to perform segmentectomy, rather than lobectomy, for lung cancers that qualify. For these reasons, this video atlas by Salfity and colleagues3 is an important publication.
Footnotes
Disclosures: The authors reported no conflicts of interest.
The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
References
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