In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy an appropriate alternative to video-assisted thoracoscopic lobectomy?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy an appropriate alternative to video-assisted thoracoscopic lobectomy?' Two hundred papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. In one meta-analysis identified, there was no significant difference observed between groups in overall survival (HR = 0.808, 95% CI 0.556-1.174). All other studies identified also found no significant difference in overall survival. As well, local and distant recurrence rates and disease-free survival were similar in all studies. Two studies identified a significantly greater number of lymph nodes dissected with the video-assisted thoracosopic surgery (VATS) lobectomy procedure; however, all other studies noted no significant difference. There was evidence from two studies that VATS segmentectomy is associated with a shorter length of hospital stay than lobectomy. Between both groups, there was an overall low number of postoperative complications and 30-day mortality (highest n = 2), highlighting the safety of both procedures. Three studies compared patient groups with similar tumour sizes; the average tumour size was 17 ± 1 mm. However, in the four other observational studies, the tumour size in the VATS lobectomy group was significantly larger. From the limited evidence currently available, VATS segmentectomy appears to be a valid alternative to VATS lobectomy. The included studies were mainly retrospective observational studies, with one meta-analysis; however, there are currently two large randomized trials ongoing with results expected to be reported in 2021.