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[Extended segmentectomy for small-sized peripheral CN0 non-small cell lung cancer].

With advances in diagnostic imaging techniques, small-sized lung cancers are now diagnosed much more often. Lobectomy has been the standard surgical procedure even for small lung for decades. Is it necessary to remove uniformly such a large amount of lung tissue for all tiny cancers? Extended segmentectomy as an intentional lesser resection for a peripheral clinical N0 lung cancer tumor 2 cm or less in diameter in patients able to tolerate a lobectomy, in which the resection line of the lung is placed beyond the burdened segment if required for sufficient margins, requires confirmation of surgical N0 disease by intraoperative examination of lymph node frozen sections. The procedure should be converted to standard lobectomy if the sections are positive. Recently, several reports have suggested that the prognosis after lesser resection in such highly selected patients is no worse than that following standard lobectomy. In addition to preservation of pulmonary function, this lung-saving surgery provides a second chance to patients who have a higher risk of metachronous disease after surviving the first disease. Extended segmentectomy might be an alternative standard surgery for patients with small peripheral lung cancers. However, patient selection with intraoperative pathologic examination and accurate technique with wide lesion margins must be strictly adhered to.