Segmentectomy for early-stage non-small cell lung cancer： current applications and ongoing controversies

doi:10.3969/j.issn.1009-976X.2026.01.010

Abstract

Abstract: Lung cancer remains a leading cause of cancer-related mortality worldwide, and non-small cell lung cancer （NSCLC） accounts for approximately 85% of all lung cancer cases. For early-stage （stage I） NSCLC, surgical resection is the mainstay of treatment, with anatomical lobectomy having long been regarded as the standard procedure. In recent years, advances in imaging technologies and the wider implementation of early screening have renewed interest in segmentectomy, an anatomical sublobar resection that preserves more functional lung parenchyma. This review summarizes the evolution of segmentectomy, expansion of its indications, oncologic outcomes and recurrence risk, advantages in postoperative pulmonary function preservation, technical challenges, the impact of spread through air spaces （STAS） on procedure selection, current controversies, and future research priorities, with the aim of informing clinical decision-making.

Key words: non-small cell lung cancer, segmentectomy, early-stage lung cancer, pulmonary function, surgical indications

摘要： 肺癌是全球癌症相关死亡的主要原因之一,非小细胞肺癌（NSCLC）约占肺癌的85%。早期（I期）NSCLC治疗以手术切除为主,解剖性肺叶切除术长期以来是标准术式。近年来,随着影像学技术的进步和早期筛查的普及,肺段切除术作为一种能保留更多正常肺组织的解剖性次肺叶切除方式,逐渐受到关注。本文综述了肺段切除术的发展历程、适应证拓展、疗效与复发风险、肺功能保留优势、手术技术难点、STAS对术式选择的影响、当前存在的争议以及未来研究方向,以期为临床实践提供参考依据。

关键词: 非小细胞肺癌, 肺段切除术, 早期肺癌, 肺功能, 手术适应证

CLC Number:

SHI Shangzhe, SAI Xiyalatu. Segmentectomy for early-stage non-small cell lung cancer： current applications and ongoing controversies[J]. Lingnan Modern Clinics In Surgery, 2026, 26(01): 68-74.

石尚哲, 赛喜雅拉图. 肺段切除术在早期非小细胞肺癌治疗中的应用现状与争议[J]. 岭南现代临床外科, 2026, 26(01): 68-74.

References

[1] Sung H, Ferlay J, Siegel RL, et al.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] Siegel RL, Miller KD, Wagle NS, et al.Cancer statistics, 2023[J]. CA Cancer J Clin, 2023, 73(1): 17-48.
[3] Ginsberg RJ, Rubinstein LV.Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group[J]. Ann Thorac Surg, 1995, 60(3): 615-623.
[4] Henschke CI,Yankelevitz DF.CT screening for lung cancer[J]. Radiol Clin North Am, 2000, 38(3):487-495.
[5] Blasberg JD, Pass HI, Donington JS.Sublobar resection: a movement from the Lung Cancer Study Group[J]. J Thorac Oncol, 2010, 5(10): 1583-1593.
[6] Saji H, Okada M, Tsuboi M, et al.Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial[J]. Lancet, 2022, 399(10335): 1607-1617.
[7] Altorki N, Wang X, Kozono D, et al.Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer[J]. N Engl J Med, 2023, 388(6): 489-498.
[8] Aokage K, Suzuki K, Saji H, et al.Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): a multicentre, single-arm, confirmatory, phase 3 trial[J]. Lancet Respir Med, 2023, 11(6): 540-549.
[9] Kane IJ.Segmental localization of pulmonary disease on the postero-anterior chest roentgenogram[J]. Radiology, 1952, 59(2): 229-237.
[10] Cahan WG.Radical lobectomy[J]. J Thorac Cardiovasc Surg, 1960, 39: 555-572.
[11] Smith CB, Swanson SJ, Mhango G, et al.Survival after segmentectomy and wedge resection in stage I non-small-cell lung cancer[J]. J Thorac Oncol, 2013, 8(1): 73-78.
[12] 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?[J]. Ann Thorac Surg, 2001,71(3):956-961.
[13] Veronesi G, Abbas AE, Muriana P, et al.Perioperative Outcome of Robotic Approach Versus Manual Videothoracoscopic Major Resection in Patients Affected by Early Lung Cancer: Results of a Randomized Multicentric Study (ROMAN Study)[J]. Front Oncol, 2021, 11: 726408.
[14] Zhang Y, Chen C, Hu J, et al.Early outcomes of robotic versus thoracoscopic segmentectomy for early-stage lung cancer: A multi-institutional propensity score-matched analysis[J]. J Thorac Cardiovasc Surg, 2020, 160(5): 1363-1372.
[15] Nomori H, Shiraishi A, Cong Y, et al.Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy[J]. Eur J Cardiothorac Surg, 2018, 53(3): 640-647.
[16] Landreneau RJ, Normolle DP, Christie NA, et al.Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis[J]. J Clin Oncol, 2014, 32(23): 2449-2455.
[17] Keenan RJ, Landreneau RJ, Jr RHM, et al.Segmental resection spares pulmonary function in patients with stage I lung cancer[J]. Ann Thorac Surg, 2004, 78(1): 228-233.
[18] Wang P, Wang S, Liu Z, et al.Segmentectomy and Wedge Resection for Elderly Patients with Stage I Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis[J]. J Clin Med, 2022, 11(2): 294.
[19] Lee BE, Altorki N.Sub-Lobar Resection: The New Standard of Care for Early-Stage Lung Cancer[J]. Cancers (Basel), 2023, 15(11): 2914.
[20] Lin R, Chen W, Zhu L, et al.Comparison of postoperative cough-related quality of life and recovery between sublobectomy and lobectomy for early-stage non-small cell lung cancer patients: a longitudinal study[J]. BMC Pulm Med, 2022, 22(1): 154.
[21] Seguin-Givelet A, Grigoroiu M, Brian E, et al.Planning and marking for thoracoscopic anatomical segmentectomies[J]. J Thorac Dis, 2018, 10(Suppl 10): S1187-S1194.
[22] Oizumi H, Kanauchi N, Kato H, et al.Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases[J]. J Thorac Cardiovasc Surg, 2011, 141(3): 678-682.
[23] Chan EG, Landreneau JR, Schuchert MJ, et al.Preoperative (3-dimensional) computed tomography lung reconstruction before anatomic segmentectomy or lobectomy for stage I non-small cell lung cancer[J]. J Thorac Cardiovasc Surg, 2015, 150(3): 523-528.
[24] Sato M, Omasa M, Chen F, et al.Use of virtual assisted lung mapping (VAL-MAP), a bronchoscopicmultispot dye-marking technique using virtual images, for precise navigation of thoracoscopic sublobar lung resection[J]. J Thorac Cardiovasc Surg, 2014, 147(6): 1813-1819.
[25] Oizumi H, Kanauchi N, Kato H, et al.Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases[J]. J Thorac Cardiovasc Surg, 2011, 141(3): 678-682.
[26] Pischik VG, Kovalenko A.The role of indocyanine green fluorescence for intersegmental plane identification during video-assisted thoracoscopic surgery segmentectomies[J]. J Thorac Dis, 2018, 10(Suppl 31): S3704-S3711.
[27] Sun Y, Zhuang Y, Wang Z, et al.Indocyanine green fluorescence identification of the intersegmental plane by the target segmental vein-first single-blocking during thoracoscopic segmentectomy[J]. BMC Surg, 2024, 24(1): 299.
[28] Sekine Y, Ko E, Oishi H, et al.A simple and effective technique for identification of intersegmental planes by infrared thoracoscopy after transbronchial injection of indocyanine green[J]. J Thorac Cardiovasc Surg, 2012, 143(6): 1330-1335.
[29] Nagano M, Sato M.Ten-Year Outcome and Development of Virtual-Assisted Lung Mapping in Thoracic Surgery[J]. Cancers (Basel), 2023, 15(7): 1971.
[30] Eguchi T, Miura K, Hamanaka K, et al.Adoption of Robotic Core Technology in Minimally Invasive Lung Segmentectomy: Review[J]. J Pers Med, 2022, 12(9): 1417.
[31] Kadota K, Nitadori JI, Sima CS, et al.Tumor spread through air spaces is an important pattern of invasion and impacts the frequency and location of recurrences after limited resection for small stage I lung adenocarcinomas[J]. J Thorac Oncol, 2015, 10(5):806-814.
[32] Chen Z, Wu X, Fang T, et al.Prognostic impact of tumor spread through air spaces for T2aN0 stage IB non-small cell lung cancer[J]. Cancer Med, 2023, 12(14): 15246-15255.
[33] Shiono S, Endo M, Suzuki K, et al.Spread through air spaces affects survival and recurrence of patients with clinical stage IA non-small cell lung cancer after wedge resection[J]. J Thorac Dis, 2020, 12(5): 2247-2260.
[34] Lambin P, Leijenaar RTH, Deist TM, et al.Radiomics: the bridge between medical imaging and personalized medicine[J]. Nat Rev Clin Oncol, 2017, 14(12): 749-762.
[35] Gu Y, Zheng B, Zhao T, et al.Computed Tomography Features and Tumor Spread Through Air Spaces in Lung Adenocarcinoma: A Meta-analysis[J]. J Thorac Imaging, 2023, 38(2): W19-W29.
[36] Riely GJ, Wood DE, Ettinger DS, et al.Non-Small Cell Lung Cancer, Version 4.2024, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr CancNetw, 2024, 22(4): 249-274.
[37] Forde PM, Spicer J, Lu S, et al.Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer[J]. N Engl J Med, 2022, 386(21): 1973-1985.
[38] Forde PM, Spicer J, Lu S, et al.Overall survival with neoadjuvant nivolumab plus chemotherapy in lung cancer[J]. N Engl J Med, 2025, 392:2381-2395.
[39] Zer A, Ahn M, Barlesi F, et al.Early and locally advanced non-small-cell lung cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up[J]. Ann Oncol, 2025, 36(11): 1245-1262.
[40] Cao J, Yuan P, Wang Y, et al.Survival Rates After Lobectomy, Segmentectomy, and Wedge Resection for Non-Small Cell Lung Cancer[J]. Ann Thorac Surg, 2018, 105(5): 1483-1491.
[41] Rizk NP, Ghanie A, Hsu M, et al.A prospective trial comparing pain and quality of life measures after anatomic lung resection using thoracoscopy or thoracotomy[J]. Ann Thorac Surg, 2014, 98(4): 1160-1166.
[42] Roman M, Labbouz S, Valtzoglou V, et al.Lobectomy vs. segmentectomy. A propensity score matched comparison of outcomes[J]. Eur J Surg Oncol, 2019, 45(5): 845-850.
[43] Zheng L, Song P, Jiang Y, et al.Outcomes and quality of life after Robot-assisted lobectomy/segmentectomy for lung cancer compared to video-assisted thoracoscopic surgery: both three-port procedures performed by a single surgeon[J]. J Thorac Dis, 2022, 14(3): 689-698.
[44] Bian C, Fu C, Xue W, et al.Three-dimensional reconstruction for determining positional indications of pulmonary segmentectomy/subsegmentectomy for ground glass opacity-dominant clinical T1a-bN0 non-small cell lung cancer[J]. Transl Lung Cancer Res, 2024, 13(11): 2947-2957.