This series explores innovative approaches to thoracic procedures, highlighting the
evolving discussion around segmentectomy and its benefits. Our expert panel, featuring
five top specialists from the Asia Pacific region, shares their techniques and strategies for
segmentectomy.

In this part, Dr. Shun-Ichi Watanabe’s lecture  focused on surgical options for non-small
cell lung cancer, emphasizing that tumor size and CT ratio are crucial in determining the
appropriate surgical approach, particularly for GGO-dominant tumors. Segmentectomy is
effective, especially in elderly or high-risk patients, but requires careful consideration in
younger or female patients due to a higher risk of recurrence. Additionally, lymph node
dissection is recommended for solid tumors due to the risk of lymph node metastasis.

Dr. In Kyu Parks’ lecture focused the intricacies of segmentectomy, particularly for the left
upper lobe. He emphasized that precise patient selection and thorough preoperative
planning are critical for successful outcomes. Key considerations include understanding
arterial variations, achieving sufficient resection margins, and preventing postoperative
dysfunction of the remaining lung. Dr. Park highlighted the importance of lymph node
dissection in managing regional disease and noted that segmentectomy is distinct from
lobectomy, requiring careful technique to optimize patient outcomes.

Dr. Yin-Kai Chao’s lecture focused on the technical aspects of performing left upper lobe
segmentectomy using robotic surgery. He emphasized the importance of thorough
anatomical knowledge and preoperative planning, particularly in understanding segmental
arteries and bronchi. Dr. Chao also highlighted the necessity of extensive lymph node
dissection, which he believes simplifies segmentectomy and lobectomy. He discussed the
use of ICG for identifying intersegmental planes and stressed that effective coordination
with surgical assistants is key for successful robotic segmentectomy.

This series explores innovative approaches to thoracic procedures, highlighting the
evolving discussion around segmentectomy and its benefits. Our expert panel, featuring
five top specialists from the Asia Pacific region, shares their techniques and strategies for
segmentectomy.

In this part, Dr. Shun-Ichi Watanabe summarized the JCOG 0802 trial results, highlighting
that although segmentectomy showed only a slight 3% improvement in overall survival
(OS) compared to lobectomy, it also had a higher local recurrence rate (10% vs. 5%).
Interestingly, non-lung cancer deaths were more frequent in the lobectomy group, though
the cause remains unclear. Segmentectomy patients received more aggressive treatment
for relapses and secondary cancers, possibly contributing to better outcomes in this group.
The pulmonary function difference between the two groups was smaller than expected, at
only 3.5% one year post-surgery.

Dr. Mingyon Mun's presentation emphasizes the importance of detailed anatomical
knowledge when performing right upper lobe segmentectomy, highlighting critical
intersegmental veins (B1, B2, B3) that define surgical boundaries. He underscores the role
of 3D reconstruction and CT scans for preoperative planning to assess tumor size, location,
and anatomical variations. Intraoperatively, bronchoscopy, pulmonary artery exposure, and
techniques such as inflation-deflation lines and ICG fluorescence help confirm segmental
borders. Dr. Mun discusses surgical margin evaluation, particularly in complex resections,
where precise dissection is essential for successful outcomes.

Dr. Agasthian Thirugnanam discusses the management of multiple ground-glass
opacities (GGOs) and the importance of segmentectomy, particularly in patients with
compromised lung function or multiple primary lung cancers. He highlights that earlier lung
cancers often appeared biologically advanced, leading to higher recurrence rates after
segmentectomy. However, the advent of lung cancer screening has enabled earlier
detection of biologically less aggressive cancers, such as GGOs, which have better
outcomes. He emphasizes careful follow-up to differentiate benign GGOs from malignant
ones, advocating for tailored surgical approaches based on radiological and pathological
findings. He also introduce a couple of local treatment other than surgery for NSCLC.

This series explores innovative approaches to thoracic procedures, highlighting the
evolving discussion around segmentectomy and its benefits. Our expert panel, featuring
five top specialists from the Asia Pacific region, shares their techniques and strategies for
segmentectomy.

In this part, Dr. Shun-Ichi Watanabe presented the final results of the JCOG0802 trial
focusing on “Local Recurrence”. This study compared segmentectomy with lobectomy,
finding that while segmentectomy showed superior overall survival, it was associated with a
higher rate of local recurrence. Dr. Watanabe emphasized the need for caution when
performing segmentectomy, particularly in younger female patients, and concluded that
ensuring an adequate surgical margin is crucial.

Dr. Nan Wu presented on the use of an AI-based 3D virtual imaging system in S6
segmentectomy, emphasizing its role in precise surgical planning and navigation. The S6
segment is anatomically complex and requires special attention. The AI system aids in
identifying anatomical differences and ensuring adequate margins to prevent recurrence.
Recurrence rates vary depending on tumor location, with tumors near the mediastinum
leading to N2 lymph node metastasis. S3 tumors have a higher likelihood of causing N2
metastasis by bypassing other segments. If malignant findings are confirmed after surgery,
adjuvant therapy is recommended due to the challenges of reoperation.