My second talk was on surgery for early stage lung cancer and in the past three years two very important studies came out addressing the issue of small-sized tumours located in the periphery – do they always require a complete lobectomy or can they be resected by a segmentectomy? The tumour size was limited to 2cm and the first study from the Japanese group showed that the overall survival was similar, in fact 3% better for segmentectomy compared to lobectomy, which was a surprise. We thought it was the other way around and we cannot really explain why segmentectomy is slightly better. The local recurrence rate is higher and the functional difference between segmentectomy and lobectomy is relatively small, it was 3%. 

These data were confirmed by a multicentre study coming from the United States showing no difference in overall survival and disease free survival comparing sublobar resection to lobectomy.  This influences the decision-making process for these small tumours in the future, that in general sublobar resection and segmentectomy is enough and we don’t have to perform a lobectomy. However, certain tumours are not ideally located for a segmentectomy and lobectomy is still possible to be performed.