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Segmentectomy Versus Lobectomy for Stage I Lung Cancer in Patients with Good Pulmonary Function

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Difficult Decisions in Thoracic Surgery

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Abstract

The initial surgical operation of choice for lung cancer was pneumonectomy.1 However, since the 1960’s lobectomy with lymph node dissection has been the standard resection technique used by most surgeons for patients with good pulmonary function.2,3 Anatomical segmentectomy may offer a lung-preserving alternative to lobectomy, much as lobectomy did to pneumonectomy. Anatomical segmentectomy was first described by Churchill and Belsey in 1939 for resection of bronchiectasis and tuberculosis.4 Segmentectomy for resection of lung cancer was subsequently performed by some surgeons; however, concerns were raised over the perceived higher risk of local recurrence.5–9 In order to better define the role of lesser resection, in 1995 the Lung Cancer Study Group (LCSG) reported a randomized trial of 247 low-risk patients with clinical T1N0 peripheral NSCLC assigned to either limited resection (anatomical segmentectomy or wedge resection) or lobectomy.10 The study showed that locoregional recurrence was significantly higher in patients treated by sublobar resections. Although patients treated by lobectomy had a higher 5-year survival compared to those treated by limited resection, the difference in survival did not achieve statistical significance (73% vs. 56%, p = 0.06). This trial arguably established lobectomy as the surgical standard of care for early stage disease.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Weill Cornell Medical College New York Presbyterian Hospital, New York, NY, USA

    Brendon M. Stiles

  2. Department of Cardiothoratic Surgery, Weill-Medical College of Cornell University, New York, NY, USA

    Nasser K. Altorki

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  1. Brendon M. Stiles
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  2. Nasser K. Altorki
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Editors and Affiliations

  1. Dept. Surgery, Mail Code 5035, University of Chicago, S. Maryland Avenue 5841, Chicago, 60637, Illinois, USA

    Mark K. Ferguson

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Stiles, B.M., Altorki, N.K. (2011). Segmentectomy Versus Lobectomy for Stage I Lung Cancer in Patients with Good Pulmonary Function. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Springer, London. https://doi.org/10.1007/978-1-84996-492-0_13

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  • DOI: https://doi.org/10.1007/978-1-84996-492-0_13

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