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Pulmonary resection is the first line of treatment of stage I and II non-small cell lung cancer (NSCLC). It is also important as part of the management of stage IIIA. In early stages of NSCLC, the surgery focuses on diagnosis, staging and resection of the entire tumor. Pneumonectomy and lobectomy carry a mortality rate in hospital of up to 4% and 8% percent respectively.
Types of Pulmonary Resection
Different portions of the lung are removed during the diverse procedures that make up pulmonary resection, including:
Pneumonectomy refers to removal of the lung affected with cancer.
Lobectomy refers to the removal of the diseased lobe, ligation of the bronchovascular structures and removal of the lymph nodes in the hilum and mediastinum on the same side. It is the gold standard for pulmonary resection in lung cancer.
Sublobar resection refers to the removal of less than an entire lobe of a lung, within anatomical or non-anatomical boundaries. Their advantages include lower mortality rates and comparable complication rates or lung function when set against a lobectomy. Currently, these are advised when a patient is too ill or whose lung reserve is too low to tolerate lobectomy.
Wedge resections, also known as non-anatomical sublobar resections are performed in patients too ill for lobectomy, for small tumors which are peripherally located and cross anatomical boundaries, or those with multiple primary NSCLC tumors. Wide margins of excision should be provided to ensure tumor-negative margins and lymph node removal is mandatory.
Segmentectomy refers to the removal of a lung segment beginning with bronchovascular ligation and anatomical dissection, followed by a mediastinal lymph node sampling as for lobectomy. Anatomical segmentectomy has comparable survival and recurrence rates to lobectomy, when performed for tumors smaller than 3 cm. For larger tumors, it is associated with higher recurrence rates.
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