Introduction

Segmentectomy, commonly referred to as segmental resection, is a surgical procedure which involves the removal of a segment of an organ. This procedure is most common in the lungs, removing the tumour and any dead tissues surrounding it. The surgery is frequently performed on patients who are diagnosed with early-stage cancer.  During lung resection, a portion of the lung lobe is removed, making it less invasive compared to a lobectomy, which involves removing the entire lobe of the lung. Segmental resections can also be performed on other organs such as the liver or kidneys.²

Types of segmentectomy 

Anatomical segmentectomy 

An anatomical segmentectomy removes the specific lung segment, sparing the healthy tissue. This kind of surgery is often used to treat benign lung diseases or early-stage lung cancer.³ To minimise the risk of more damage to the remaining healthy lung tissue, surgeons would need to dissect the targeted segment. Compared to other extensive surgical procedures like lobectomies, the accuracy of this procedure helps preserve maximum lung function whilst reducing the chances of any postoperative complications, giving the patient a better quality of life.^3,4

Non-anatomical segmentectomy

A non-anatomical segmentectomy, known as wedge resection,⁵ removes a portion of the lung that contains the dead tissue. This type of resection is used to remove the tumour altogether. It is less precise because it does not consider the anatomical boundaries of the organ such as the vessels and bronchi. The aim is to create clear margins around the affected tissue, allowing the target tumour to differ from the rest of the tissues and organs in the body.⁶

Indications of needing a segmentectomy

• Early-stage lung cancer - patients with stage 1 NSCLC have tumours that are less than 2cm in size^8,9
• Poor pulmonary reserve - patients who have reduced lung function or other health conditions would be suggested a segmentectomy instead of a complex surgery²
• Metastatic lung tumours - the resection of pulmonary metastases increases the survival rate, removing multiple lesions to reduce the impact on pulmonary function^2,10
• Benign tumours - segmentectomy would be considered if the tumour is located near a blood vessel or bronchi¹²
• Congenital lung malformations (CLM) - also known as congenital pulmonary airway malformations, poor lung development occurring during fetal development causing respiratory distress in newborns.^13,14

Surgical procedures

Open segmentectomy

A procedure involving a thoracotomy, an incision made in the chest wall or between the ribs to provide access to the lungs.¹⁵  

Video-assisted thoracoscopic surgery (VATS) 

This procedure involves making a small incision and inserting a thoracoscope, a thin, flexible tube with a camera to access the thoracic cavity.¹⁶     

Robotic-assisted segmentectomy

Robotic surgery is a procedure similar to VATS and is used to improve the accuracy of the surgeon’s movements. Compared to VATS, the surgeon can have better control by precisely controlling the robotic arms through any small incisions.⁸     

Benefits of a segmentectomy

• Preserving lung function¹⁷
• Shorter recovery

Risks of a segmentectomy

• Infection 
• Bleeding 
• Air leaks 

These are common risk factors that can occur after the surgery but can be controlled by using the correct approach. 

FAQs

Is a segmental resection a major surgery?

A segmentectomy is a less invasive surgery compared to other surgeries like a lobectomy and pneumonectomy. 

What are the effects of a lung resection?

The effects of a lung resection can include infections, bleeding and/or air leaks. 

What is the survival rate of a segmentectomy?

The survival rate of undergoing a segmentectomy is greater than 87.7%.¹⁸

Summary 

Segmentectomy is a surgery with significant benefits for preserving lung function and lowering the chance of any further surgical complications. There are two types of segmentectomies; anatomical and non-anatomical segmentectomy. Anatomical segmental resection involves removing a specific lung segment whereas non-anatomical or wedge resection involves removing more tissue. Indications of segmentectomy can include the following; early-stage lung cancer, metastatic tumours, benign tumours and CLM. Different surgical approaches such as VATS, open segmental resection and robotic surgery are available. Patient outcomes are continuously improved by advancements in surgical techniques using less invasive methods. Sustained clinical trials and research are crucial for improving and expanding its usage.