New research is completely changing the way surgeons operate on patients with lung cancer. Removal of the entire lobe where the cancer is located (lobectomy) is the standard of care, but researchers in Japan have found that patients with early lung cancer who underwent a segmentectomy, or removal of just the cancer-infected area, had a better survival rate than those who had a larger resection or lobectomy. In fact, the study found the less traumatic surgery saved important tissue that provides more lung function for a better quality of life. If the patient happens to have a recurrence, there may be more room for another local resection or another definitive therapy like radiation.
“This new research is changing the paradigm of lung surgery,” says Dr. Ramiro Fernandez, assistant professor in the Michael E. DeBakey Department of Surgery – Division of Thoracic Surgery at Baylor College of Medicine. “Before, segmentectomy was reserved for patients who were too frail or had poor lung condition to tolerate a lobectomy. But now we know, thanks to this study, that in patients with early lung cancer, a segmentectomy could lead to the same if not better survival rate as a lobectomy.”
Lung cancer is primarily caused by using tobacco products. Some of the earliest cases were treated with removing the whole lung, but as screening became more advanced and smaller spots were detected in early stages, the treatment was reduced to just removing the infected lobe (lobectomy).
A study in 1995 compared the survival rates of a lobectomy to a more limited resection and found that those who had a lobectomy lived longer. So, the standard of care since 1995 was to do a lobectomy, which leaves patients with reduced lung function. But the new Japanese study looked at many years of data of patients with early lung cancers (less than 2 centimeters in size) and found that patients who had a segmentectomy had better outcomes.
“Finding lung cancer early is paramount for these patients to have limited lung resections,” says Fernandez. “Unfortunately, less than 10% of those who are candidates for lung cancer screening undergo it. But we know from studies that low-dose screening CT scans increase cancer specific survival rate by 20%.”
Oftentimes, lung cancer does not have symptoms until it is too developed. So, the U.S. Preventive Task Force suggests yearly lung cancer screenings for at-risk people over 50 years old. At risk criteria includes smokers, those who have quit smoking in the past 15 years and had a 20 pack-year smoking history.
Dr. Fernandez encourages all patients at risk for lung cancer get yearly low-dose lung cancer screenings. These screenings show detailed pictures of the lungs to find any lung cancer early.
Lung cancer is the most common cause of cancer death in the United States and worldwide. In fact, lung cancer causes more deaths than the next three most common causes of cancer death combined—colorectal cancer, breast cancer and pancreatic cancer.
By Tiffany Harston, communications associate in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine