Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer?

  • Takahiro Mimae
  • Morihito OkadaEmail author
Special Edition Diagnosis and Treatment for Early Stage Non-small Cell Lung Cancer


In 1995, Ginsberg et al. compared lobectomy with limited resection including segmentectomy and wide-wedge resection for stage I lung cancer in a randomized controlled trial and found that limited resection should not be applied to otherwise healthy patients with clinical stage IA lung cancer who can tolerate lobectomy. However, recent advances in diagnostic technology have improved the precision of detecting early-stage and small lung cancers. Therefore, whether radical segmentectomy, anatomical segmentectomy with hilar and mediastinal lymph node dissection (that is more valuable than wedge resection in terms of oncological aspects) and lobectomy are comparable in terms of curative intent for patients with early-stage non-small cell lung cancer (NSCLC) remains controversial. The role of segmentectomy differs according to tumor or patient characteristics. High resolution computed tomography findings of tumor size, location, and the presence or ratio of a ground glass opacity (GGO) component and the maximum of standardized uptake value on fluorine-18-2-deoxy-d-glucose positron emission tomography are important for selecting surgical procedures because the malignant potential of even early-stage NSCLC is variable. The ongoing JCOG0802/WJOG4607L, JCOG1211, and CALGB140503 trials will disclose the influence of segmentectomy for patients with early-staged NSCLCs that are small peripheral tumors based on preoperative high-resolution computed tomography findings about preserved pulmonary function and long-term prognosis. Segmentectomy is a key surgical procedure that general thoracic surgeons will need to master considering that it can be converted to lobectomy if the surgical margin is insufficient or lymph node metastasis is intraoperatively confirmed.


Small size Peripheral Surgical indication Pulmonary function 





Ground glass opacity


High resolution computed tomography


Hounsfield units


Positron emission tomography


Overall survival



This study was supported by grants from the Japan Society for the Promotion of Science (JSPS) KAKENHI (18H06242, 19K21338).



Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.


  1. 1.
    Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60:615–22 (discussion 22–3).CrossRefGoogle Scholar
  2. 2.
    Darling GE, Allen MS, Decker PA, Ballman K, Malthaner RA, Inculet RI, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg. 2011;141:662–70.CrossRefGoogle Scholar
  3. 3.
    Okada M, Yoshikawa K, Hatta T, Tsubota N. Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller? Ann Thorac Surg. 2001;71:956–60; (discussion 61).CrossRefGoogle Scholar
  4. 4.
    Schuchert MJ, Pettiford BL, Keeley S, D'Amato TA, Kilic A, Close J, et al. Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer. Ann Thorac Surg. 2007;84:926–32 (discussion 32–3).CrossRefGoogle Scholar
  5. 5.
    Aokage K, Saji H, Suzuki K, Mizutani T, Katayama H, Shibata T, et al. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211). Gen Thorac Cardiovasc Surg. 2017;65:267–72.CrossRefGoogle Scholar
  6. 6.
    Nakamura K, Saji H, Nakajima R, Okada M, Asamura H, Shibata T, et al. A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol. 2010;40:271–4.CrossRefGoogle Scholar
  7. 7.
    Kohman LJ, Gu L, Altorki N, Scalzetti E, Veit LJ, Wallen JM, et al. Biopsy first: lessons learned from cancer and leukemia Group B (CALGB) 140503. J Thorac Cardiovasc Surg. 2017;153:1592–7.CrossRefGoogle Scholar
  8. 8.
    Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Prognostic significance of using solid versus whole tumor size on high-resolution computed tomography for predicting pathologic malignant grade of tumors in clinical stage IA lung adenocarcinoma: a multicenter study. J Thorac Cardiovasc Surg. 2012;143:607–12.CrossRefGoogle Scholar
  9. 9.
    Aoki T, Tomoda Y, Watanabe H, Nakata H, Kasai T, Hashimoto H, et al. Peripheral lung adenocarcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival. Radiology. 2001;220:803–9.CrossRefGoogle Scholar
  10. 10.
    Asamura H, Hishida T, Suzuki K, Koike T, Nakamura K, Kusumoto M, et al. Radiographically determined noninvasive adenocarcinoma of the lung: survival outcomes of Japan Clinical Oncology Group 0201. J Thorac Cardiovasc Surg. 2013;146:24–30.CrossRefGoogle Scholar
  11. 11.
    Kodama K, Doi O, Higashiyama M, Yokouchi H Intentional limited resection for selected patients with T1 N0 M0 non-small-cell lung cancer: a single-institution study. J Thorac Cardiovasc Surg. 1997;114:347-53.CrossRefGoogle Scholar
  12. 12.
    Ohde Y, Nagai K, Yoshida J, Nishimura M, Takahashi K, Suzuki K, et al. The proportion of consolidation to ground-glass opacity on high resolution CT is a good predictor for distinguishing the population of non-invasive peripheral adenocarcinoma. Lung Cancer. 2003;42:303–10.CrossRefGoogle Scholar
  13. 13.
    Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006;132:769–75.CrossRefGoogle Scholar
  14. 14.
    Tsubota N, Ayabe K, Doi O, Mori T, Namikawa S, Taki T, et al. Ongoing prospective study of segmentectomy for small lung tumors. Study Group of Extended Segmentectomy for Small Lung Tumor. Ann Thorac Surg. 1998;66:1787-90.CrossRefGoogle Scholar
  15. 15.
    Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. The IASLC lung cancer staging project: proposals for revision of the TNM Stage groupings in the forthcoming (Eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11:39–51.CrossRefGoogle Scholar
  16. 16.
    Handa Y, Tsutani Y, Mimae T, Tasaki T, Miyata Y, Okada M. Surgical outcomes of complex versus simple segmentectomy for stage I non-small cell lung cancer. Ann Thorac Surg. 2019;107:1032–9.CrossRefGoogle Scholar
  17. 17.
    Mimae T, Miyata Y, Mimura T, Ito H, Nakayama H, Okumura S, et al. Radiologic findings to predict low-grade malignant tumour among clinical T1bN0 lung adenocarcinomas: lessons from histological subtypes. Jpn J Clin Oncol. 2015;45:767–73.CrossRefGoogle Scholar
  18. 18.
    Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Prediction of pathologic node-negative clinical stage IA lung adenocarcinoma for optimal candidates undergoing sublobar resection. J Thorac Cardiovasc Surg. 2012;144:1365–71.CrossRefGoogle Scholar
  19. 19.
    Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Segmentectomy for clinical stage IA lung adenocarcinoma showing solid dominance on radiology. Eur J Cardiothorac Surg. 2014;46:637–42.CrossRefGoogle Scholar
  20. 20.
    Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy. Chest. 2014;145:66–71.CrossRefGoogle Scholar
  21. 21.
    Suzuki K, Watanabe S, Mizusawa J, Moriya Y, Yoshino I, Tsuboi M, et al. Predictors of non-neoplastic lesions in lung tumours showing ground-glass opacity on thin-section computed tomography based on a multi-institutional prospective studydagger. Interact Cardiovasc Thorac Surg. 2015;21:218–23.CrossRefGoogle Scholar
  22. 22.
    Harada H, Okada M, Sakamoto T, Matsuoka H, Tsubota N. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg. 2005;80:2041–5.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Department of Surgical OncologyHiroshima UniversityHiroshimaJapan

Personalised recommendations