What Are Lung Segmentectomy and Limited Pulmonary Resection?

A lung segmentectomy is the removal of diseased lung, often due to lung cancer.

A lung segmentectomy is a procedure to remove the diseased lung without removing excess normal lung.

Certain diseases, such as lung cancer, may require removal of the part of the lungs to limit the spread of cancer in the body. The surgery that removes a lung or part of the lungs is called a pulmonary resection. In some forms of pulmonary resection, most of the lung tissue is salvaged and only a wedge or segment (lung segmentectomy) of the lungs is removed. Such a surgery is called a limited pulmonary resection.

The lungs are divided into segments based upon certain anatomical criteria such as different blood supply. In a segmentectomy, these anatomic criteria are considered for resection in a lung segment. In a wedge resection, however, a non-anatomic lung resection is done to remove a wedge of the lung. 

Removing a small diseased portion of the lungs is effective because it preserves most of the functional lungs. However, it is only possible when the disease is confined to a small part of the lungs. Because the technique is technically demanding, some surgeons may prefer to wedge out the lung lesion (wedge resection) using a stapler. The recurrence rate of cancer after a wedge resection, however, is higher than that after a segmentectomy.

Although a lung segmentectomy has been popular for the resection of infected lesions and non-cancerous masses, some experts have also recommended it for very early lung cancer.

The choice for patients with lung cancer is usually a lobectomy (surgical removal of a lobe of the lung), but in some patients with diseased lungs having a minimal lung reserve, a lung segmentectomy is a good option. Limited pulmonary resection and segmentectomy are also used to treat various lung infections and birth defects (congenital lung malformations).

Both segmentectomy and lesser lung resection can be performed via open surgery (thoracotomy) or a small incision surgery (video-assisted thoracoscopic surgery or VATS) that yields better outcomes, less pain, and shorter recovery than the traditional techniques.

Lung segmentectomy and limited pulmonary resection are performed in the following cases:

• Bronchiectasis (abnormal widening of the airways causing an increased risk of infections)
• Early-stage lung cancer (usually in patients who have significantly reduced heart and lung functions)
• Lung nodules
• Tuberculosis
• Suppurative lesions (lesions filled with and producing pus)

Three major complications that can occur during the surgery are massive bleeding due to an injury to the pulmonary artery (the blood vessel that supplies the lungs) or its branches, abnormal heart rhythm, and pneumothorax in the contralateral lung (the presence of air or gas in the cavity between the contralateral lung and chest wall, causing the collapse of the lung).

The most common complications of lung segmentectomy and limited pulmonary resection include the following:

• Air leakage: Most leaks seal within a few days, but large leaks may persist for weeks
• Bleeding
• Residual airspace can occur when a large amount of lung is resected
• Infection of the pleural space (the space between the lung and its covering or pleura) can occur when residual airspace persists; in some cases, the patient may require another surgery to close off the residual space and eliminate the infection.
• Respiratory failure is not a direct complication of surgery; patients who have borderline lung function are more likely to develop respiratory distress in the postoperative period.
• Cardiac complications may include heart attack (myocardial infarction) and arrhythmias (abnormal heart rhythm)