I am a 63-year-old, healthy, non-smoking male who was diagnosed with lung cancer in June. I saw a highly recommended (including by other physicians) Thoracic Surgeon in my area who in July performed a VAT procedure to remove a 2.5cm, Non-Small Cell tumor from the superior segment of my lower right lobe.
The tumor was wedged in the upper corner of the superior segment, against the upper right lobe and visceral pleura of the superior segment. Because of the invasion of the visceral pleura, it was staged T2aN0MX (aka 1B). It was well differentiated and eleven combined subcarinal and Hilar lymph biopsied nodes were negative.
The surgical report called it a Segmentectomy, but it appears to be more of wedge resection of most of the superior segment. There was no margin information available in the path report between the tumor and the staple line but was told it was at least one cm.
I went to a regional cancer center to a get a second opinion on post-operative treatment like adjuvant chemotherapy. The Oncologist there had me meet with a Thoracic surgeon who was critical of the treatment from my “local” Thoracic surgeon. Amongst other things, I was told by this Thoracis surgeon that the standard of care for my diagnosis is a lobectomy. That is now what is being recommended to me by the Thoracic surgeon at the regional cancer center I was also told that based upon some studies done in the 1990s, the expected recurrence rate of Wedge Resection or Segmentectomy is triple that of a Lobectomy.
I am trying to make a go/no-go decision on whether to have the lobectomy. I certainly would prefer not to have another surgery on the heels of the first. Nor to lose my entire lower right lobe which I have read can result in as much as a 30% plus reduction in lung function. Especially since as we age, we rely on the lower lobes even more. At the same time, I want to do what I can to lower the reoccurrence risk and extend my survival rate.
I am willing to make some tradeoff on the recurrence rate and survivability being higher if I do not have the lobectomy. The question is what really is that difference. I have read through many studies/meta-analysis comparing the reoccurrence rate and survival outcomes of wedge resection vs. segmentectomy vs. lobectomy until my head is spinning. While most, if not all, still have a bias towards lobectomy, the reoccurrence rate and survival outcomes vary greatly.
So my question to this community is this. Has anyone faced this segmentectomy vs lobectomy dilemma what did you decide and why? Also, what studies would you r