Segmentectomy, or segment resection, is a surgical treatment that can be an option to treat non-small cell lung cancer (NSCLC).
What is segmentectomy?
The lungs are divided into multiple lobes (two in the left lung and three in the right lung). A segmentectomy involves the removal of part of one of the lobes of the lung to entirely remove a cancerous tumor.
Why is segmentectomy recommended?
Segmentectomy may be recommended over lobectomy (where one entire lobe of the lung is removed) if the patient already has a highly reduced lung reserve. Lobectomy is the most common and preferred type of procedure for NSCLC. However, due to the increasingly earlier detection of lung cancer, research suggests that it may not always have a significant benefit over segmentectomy.
In general, segmentectomy is only recommended for patients with early-stage NSCLC. If the cancer is advanced or metastatic (the cancer cells have detached from the main tumor and moved to form tumors in other areas in the body), then segmentectomy is unlikely to cure the cancer and is probably not worth the risk associated with it.
Lung surgery is generally not recommended for patients with small cell lung cancer (SCLC), as this type of aggressive cancer normally spreads beyond the lungs starting at an early disease stage.
Before the surgery
Prior to segmentectomy, the patient will be thoroughly assessed to ensure they are well enough to proceed with the surgery, to reduce the risk of complications during the surgery, and to improve the recovery time after the surgery. This could include blood tests, chest X-rays, and lung and heart function tests.
During the surgery
The surgery will be carried out while the patient is under general anesthesia. A segmentectomy is generally performed in one of two ways: as a thoracotomy or through video-assisted thoracoscopy (VATS).
Thoracotomy (or open surgery) involves making an incision around the side of the chest so the surgeon can access the lung. This incision could be as small as a few centimeters or could run from the nipple around the back, depending on the size and location of the section to be removed.
VATS (or keyhole surgery) is used to remove very small tumors and involves making a few (generally three or four) small cuts. The surgeon inserts a “thoracoscope” (a thin tube with a fiberoptic camera at the end) to view the inside of the chest. This is used to direct the insertion or surgical instruments to remove the tumor. Because smaller incisions are made, VATS may have a shorter recovery time compared to thoracotomy.
After the surgery
Immediately following surgery, the patient usually feels drowsy and is generally given an intravenous (IV) drip to provide fluid and nutrients. They may also be fitted with a temporary tube to drain excess fluid from the site of the surgery.
The surgical wound is usually sealed with stitches, which may have to be removed once the wound has healed (unless they are the type of stitches that dissolve).
The patient may experience some level of pain or discomfort after the surgery, which can be treated with painkillers. It is normal for some patients to experience pain weeks or months after surgery because of the time it takes the pain receptors at the site of the surgery to grow back.
The patient needs regular check-ups after the surgery to ensure that the lung is functioning properly and that the cancer has been successfully removed.
Risks associated with segmentectomy
There are several risks associated with any surgery and these are also valid for segmentectomy.
Segmentectomy is carried out under general anesthesia, which can be a risk factor in itself for some patients. There is also the risk of excessive bleeding, blood clot formation, pneumonia, and infection of the surgical wound. It is essential that the wound is kept clean and is monitored closely for signs of infection (such as increased heat, redness or swelling, or an abnormal discharge).
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