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Lung segmentectomy

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was reviewed on August 30, 2022.

A lung segmentectomy, or segmental lung resection, is surgery that removes a piece of the lung that includes a lung cancer tumor and some surrounding tissue.

A segmentectomy is similar in scope to pulmonary wedge resection. It’s less extensive than other lung cancer surgeries, such as a sleeve lobectomy or a pneumonectomy.

Why it may be performed

A lung segmentectomy surgery removes just part of one lobe of the lung. Surgical oncologists may prefer a segmental lung resection if the patient’s lungs aren’t functioning well enough for more extensive surgery.

A lung segmentectomy may be recommended to treat early-stage lung cancer and other lung tumors. It may be an option for:

  • Stage 0 NSCLC, depending on the tumor’s location
  • Stage 1 NSCLC, if the tumor is very small
  • Lung carcinoid tumors
  • Stage 1/limited stage SCLC, if doctors found only one small tumor and no evidence cancer has spread
  • Lung metastases from other cancers
  • Noncancerous growths

A lung segmentectomy is similar in scope to another surgery called a wedge resection, and they’re both called a sublobar resection. The operations are similar, but the segmentectomy usually removes more lung tissue. A wedge resection removes a pie slice-shaped piece of the lobe that includes the tumor. Sublobar resections offer better outcomes for respiratory function, but could leave cancer cells behind.

Often, a lobectomy, which removes an entire lobe of the lung, is preferred for those with non-small cell lung cancers because it usually leads to better outcomes. Still, a segmentectomy may be recommended if the patient has other lung conditions compromising his or her ability to breathe without the entire lobe.

To determine whether a lung segmentectomy is an appropriate option depends on many factors, including:

  • The type of cancer 
  • The location of the cancer
  • The size of the tumor
  • If cancer has spread to the lymph nodes or other organs
  • The health of the patient's heart and other organs
  • If the patient has other heart and lung conditions
  • The patient’s lung function

How to prepare

The patient will be asked to take a number of steps to prepare for a segmental lung resection.

First, the patient will be encouraged to quit smoking—tobacco use increases the risk of surgical complications and slows the body’s ability to heal. The risk of complications is lower when lung segmentectomy patients quit smoking four to six weeks before surgery and abstain from smoking several weeks after surgery.

Leading up to surgery, the care team will review the patient’s medications to make sure they’re safe to keep taking. They’ll also provide instructions about eating and drinking before surgery.

Patients undergoing lung segmentectomy surgery will undergo respiratory testing to make sure they’ll be able to tolerate the surgery. They’ll likely undergo:

  • Pulmonary function testing
  • V/Q scan
  • Cardiac stress testing

The care team may suggest deep breathing and aerobic exercises to strengthen the lungs and improve recovery. An incentive spirometer may be prescribed to measure and increase lung capacity.

What to expect

The patient will be given general anesthesia through an intravenous (IV) line on the day of surgery and will be deeply asleep during the operation.

There are two ways surgeons may access the lungs to perform a segmentectomy or segmental lung resection:

A traditional open surgery begins with a thoracotomy, an incision in the chest. Lung cancer surgeries, including a conventional segmental resection, may take up to six hours to complete. Where the surgeon makes the incision and how large it will be depend on the location of the tumor. The incision usually ranges from 3 to 8 inches and may be anywhere from the armpit to the back. From this incision, the surgeon cuts through the skin, severing some muscle and separating the ribs.

A video-assisted thoracoscopic surgery (VATS) is less common and less invasive. The VATS procedure is done with a tube containing a video camera. The surgeon inserts the tube and other tools through smaller incisions in the chest. Because the incisions are smaller, recovery from a VATS procedure is quicker and has a lower risk of complications. But it may only be used when the tumor is small and the cancer is in its early stages. During surgery, the surgeon places tubes in the chest to help prevent fluid and air from building up in the chest cavity while the body heals. The tubes draining into a special container during healing may stay in for up to five days.

After lung surgery, patients typically stay in the hospital for five to seven days. The incision site and surrounding area will likely be painful after surgery.

Benefits, risks and recovery

During recovery from a lung segmentectomy, the patient may experience enduring pain when moving the arm, twisting the upper body and breathing deeply. Other than pain and reduced lung function, of additional potential complications include:

  • Reaction to anesthesia
  • Excess bleeding and blood loss
  • Blood clots in the legs or lungs
  • Infections at the incision—swelling or increased drainage
  • Symptoms of pneumonia—trouble breathing, coughing, fever, chills, nausea or vomiting
  • Pain that doesn’t get better with medication
  • Four or more days of constipation
  • Painful urination or other symptoms of UTI

Recovery from lung surgery may take weeks to months. It may take at least a couple of months before the patient may return to normal activity levels. After surgery, shortness of breath during regular activity is normal.

After surgery, the care team will likely recommend:

  • No lifting or carrying anything heavier than 10 pounds for two weeks after VATS (up to eight weeks for open surgery)
  • No light housework for two weeks after surgery
  • No yard work for four to eight weeks after surgery
  • Extra care when using the arms and upper body for the first six weeks

The patient should plan to:

  • Take four to eight weeks off work
  • Get up and walk two or three times a day—slowly increasing the distance
  • Adjust the home environment so he or she doesn’t have to climb stairs too often, and when taking stairs, take them one step at a time
  • Press a pillow over the incision when coughing or sneezing
  • When returning to work, adjust work activities or work only part time
  • Use a breathing device four to six times daily for the first two weeks after surgery to build up respiratory strength in the lungs

The benefits of a lung segmentectomy include removal of the primary lung cancer tumor and analysis of its tissues, resection of the area near the tumor to determine how far it’s spread and removal and testing of nearby lymph nodes.

A segmental resection may preserve more of the patient's lung function than more extensive lung cancer surgeries. It may be a good option for smaller, non-small cell lung tumors and some small cell or neuroendocrine lung tumors. But sublobar resection may sometimes leave cancer cells in the lungs, which may mean a higher rate of recurrence (cancer coming back) than more extensive operations like a lobectomy or pneumonectomy.

Life after surgery

Even after a few months, getting back to normal may be tough after lung surgery. However, because a segmentectomy is less extensive than other lung cancer surgeries, recovery may be less difficult than for patients with a lobectomy or pneumonectomy.

Many patients who have had surgery for lung cancer struggle with their breathing during physical activities even years later, according to the Cochrane Database of Systematic Reviews. The review found that up to 70 percent of lung cancer surgery patients can’t meet the physical activity guidelines several years later. These changes may also have a marked effect on mental health, since surgery and other treatments may decrease the quality of life in lung cancer patients.

Researchers found that eventually returning to an exercise routine of even mild exercise may improve lung function and quality of life.

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