title: Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer.
abstract: OBJECTIVE
  As thoracoscopic lobectomy becomes widely applied for treatment of non-small cell lung cancer, thoracoscopic segmentectomy remains controversial for patients with small stage I lung cancers. Questions remain regarding safety, morbidity, mortality, and recurrence rate. This study compared outcomes between thoracoscopic segmentectomy and lobectomy.
  
  
  METHODS
  Retrospective review was undertaken of patients who underwent thoracoscopic segmentectomy or lobectomy for clinical stage I non-small cell lung cancer between January 2002 and February 2008. Indications for segmentectomy were tumor smaller than 3 cm, limited pulmonary reserve, comorbidities, and peripheral tumor location.
  
  
  RESULTS
  Thirty-one patients underwent segmentectomy and 113 underwent lobectomy. Patients after segmentectomy had worse mean forced expiratory volume in 1 second than after lobectomy (83% vs 92%, P = .04). There were no differences in mean number of nodes (10) and nodal stations (5) resected. Segmentectomy and lobectomy groups had similar median chest tube durations (2 vs 3 days, P = .18), stays (both 4 days), total complications, recurrence rates, and survivals at mean follow-ups of 22 and 21 months, respectively. Lobectomy group had 1 30-day death; segmentectomy group had none. There were 5 (17.2%) recurrences after segmentectomy and 23 (20.4%) after lobectomy (P = .71), with locoregional recurrence rates of 3.5% and 3.6%, respectively.
  
  
  CONCLUSIONS
  Thoracoscopic segmentectomy is a safe option for experienced thoracoscopic surgeons treating patients with small stage I lung cancers. No significant difference in oncologic outcome was seen between thoracoscopic segmentectomy and thoracoscopic lobectomy. Lymph node dissection could be performed as effectively during segmentectomy as lobectomy.
authors.affiliation: Department of Surgery, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Shapiro
authors.forename: Todd S
authors.initials: TS
authors.lastname: Weiser
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chin
authors.forename: Michael
authors.initials: M
authors.lastname: Arustamyan
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Swanson
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local; D011013:Pneumonectomy; D011183:Postoperative Complications; D020775:Thoracic Surgery, Video-Assisted