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Segmentectomy vs. Lobectomy for Non-Small Cell Diagnosis

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

  1. Hi Dane,

    Every case is different, oftentimes a wedge or segment resection is appropriate. May I ask if either of your doctors are from a comprehensive cancer center or are both from different local regional hospitals? Also, did the doctor who performed your surgery send a tissue sample sample out for biomarker testing? Please feel free to share more, I am possibly facing a second surgery myself and would be happy to discuss when I know a little more from you. My situation is going in front of the tumor board. I had a lobectomy 20 years ago and had my middle right lung removed, Stage 3 (not by VATS as it was not done back in my day). I've had nodules being watched all these years and if the tumor board said enough of a change was made, I will also be facing whether to get a segment of full lobectomy. Looking forward to hearing back from you and having others who might have experience with this decision to join in the discussion. All the best, Alisa, LungCancer.net Team

    1. Thanks so much Alisa for replying. My VAT segmentectomy was done by the head of Thoracic Surgery at a hospital that is part of a large, regional/state hospital network. The surgeon who is now recommending the lobectomy is part of a “comprehensive cancer center” as you called it.

      Yes, it was sent out for biomarking and the results were all not detected, no expression, etc. The only exception was the TPS 5% which had High Expression.

      Good luck with your tumor board review!!

  2. Hi Dane,
    When I was initially diagnosed I was considered stage 2b, at which point my local thoracic surgeon planned a pneumonectomy. I went for a second opinion prior to surgery at a comprehensive cancer center. Their opinion was a lobectomy. They however could not get me in for several months. I went back to my local surgeon and opted for the pneumonectomy, as I wanted this cancer out of my body, however, it was explained to me that once he was in there this may changed based on lymph node involvement. So, I was looking at the full lung, a lobectomy, a wedge resection or possibly nothing at all. It was a VAT surgery. When I came to after surgery I was told I received a wedge resection. I was told 2 of the 17-20 nodes tested had cells which restaged me to a 3a. He said at that point, he had to decide whether he should do anything and opted to at least remove the tumor with clear margins. My tumor cells were poorly differentiated. Upon returning to the comprehensive cancer center for another second opinion on chemotherapy, the thoracic oncologist questioned why the local surgeon only did a wedge and not a lobectomy as the lobectomy would be the standard of care regardless as to lymph node involvement. To which I really don't have the answers. I have to trust he made the best decision for me, but it is very uncomfortable when their own question why another did something. Yes the standard of care per the NCCN website would be a lobectomy. Followed by other standards that were not applied even by the comprehensive cancer center in my case. As patience, and the fear we experience with this diagnosis, I do believe any care team whether local or at a comprehensive cancer center should do better. This is ever changing, the treatments, the protocol, and each doctor that deals with any cancer is aware of the ever changing guidelines.
    Another thing about my situation, I was not offered concurrent chemo/radiation as is the standard of care on the NCCN website. Not even suggested by the cancer center in second opinions. So, once again I was asked by my current oncologist why I wasn't given this care. It is important for us as patients to know, but we have to be able to trust our care team to make the best medical decisions and not be questioned. The NCCN website is something I now reference. Wish Id known 15 months ago when this all began. www.nccn.org

    1. Lyn, thanks for sharing your experience which seems completely frustrating and upsetting. Sorry you have had to go through that.

      Your right, to have two Thoracic Surgeons, (In my case the one that did the surgery is the Head of Thoracic Surgery at a hospital that is part of a large, regional/state hospital network and the second opinion Thoracic Surgeon at a comprehensive cancer center) have very different treatment opinions does not engender confidence and trust and leaves you wondering who to believe. In my case, both also engaged in some bashing of each other’s recommendations to me in my discussions with them.

      Like you, I want to trust what my “local” surgeon did was appropriate and balanced loss of lung function with limiting the recurrence rate. But after the second opinion I am left to wonder.

      We can only hope that as time goes on our scans are clean but who wants to live on pins and needles.

      Thanks for the NCCN link, I will check it out. Best of wishes and health.

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