Lung Segmentectomy

Remove the segment, keep the lobe. For small tumors at the edge of the lung.

In JCOG0802, five-year survival reached 94.3 percent after segmentectomy against 91.1 percent after lobectomy for tumors of 2 centimeters or less.

How the lung is divided

Lobes and segments

Each lobe is made of smaller segments, each supplied by its own branch of the airway, artery and vein, and that arrangement lets the surgeon remove a segment along its natural borders. Because the segment comes out with its own vessels, its airway and the lymph nodes at its root, a segmentectomy gives a cleaner cancer operation than a wedge while keeping most of the lobe working, which matters for people with limited breathing reserve and for anyone who may need another lung operation in the future, since a second lung cancer develops in a few percent of patients each year after a first one, and a lobe saved now leaves room for that later operation.

Three ways to remove lung tissue

Side by side

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Which tumors suit a segmentectomy

Size, position and appearance on CT decide. Segmentectomy is considered for

• tumors 2 centimeters or smaller in the outer third of the lung,
• ground-glass nodules, hazy spots that are often slow-growing early cancers, up to 3 centimeters,
• patients whose breathing tests limit how much lung can be removed,
• and people who have had lung surgery before.

What the trials found

For decades, lobectomy was preferred, because a 1995 American trial of 247 patients found that limited resections, segments or wedges, tripled the local recurrence rate. Better scans and techniques led three new trials to test the question again.

In Japan, JCOG0802 randomized 1,106 patients with tumors of 2 centimeters or less to segmentectomy or lobectomy. Five-year survival was 94.3 percent after segmentectomy and 91.1 percent after lobectomy, a difference large enough to show segmentectomy was better. Relapse-free survival was the same at 88.0 and 87.9 percent, but local recurrence occurred in 10.5 percent against 5.4 percent, and lung function at one year was 3.5 percent better after segmentectomy. Part of the survival gap came from deaths unrelated to the cancer, since other diseases caused 63 percent of deaths after lobectomy and 47 percent after segmentectomy, and the investigators linked this to the extra lung kept, which leaves more reserve for pneumonia, heart disease and a later second cancer. In North America, CALGB 140503 randomized 697 patients with tumors of 2 centimeters or less and clear lymph nodes to sublobar resection or lobectomy. Five-year disease-free survival was 63.6 and 64.1 percent and overall survival 80.3 and 78.9 percent.

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Less lung removed, the same chance of cure, for the right tumor.

How the operation is done

Planning starts on the CT, days before the operating room. Before surgery we complete

1. a three-dimensional reconstruction of the segment's vessels and airway from the CT,
2. breathing tests to measure how much lung function you can spare,
3. a PET-CT or lymph node sampling when the scan raises a question,
4. and, for a tiny or faint nodule, a small marker placed nearby so it can be found during surgery.

Risks and how they are managed

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The recovery

Most patients walk on the first day and go home after three to five days once the drain is out. Breathing exercises with a small device continue at home, and stamina builds week by week with walking. Pain along the ribs fades over weeks. Desk work returns in two to three weeks and heavy lifting after six. Lung function after a segmentectomy is closer to normal than after a lobectomy, which many patients notice on stairs and hills.

How long to stay in Istanbul

Plan for ten to fourteen days.

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A published Istanbul package for keyhole lung resection with node removal shows five nights on the ward, surgery and airport transfers included and the hotel paid separately. Expect a few days of tests first. Final pathology arrives within a week, and the surgeon clears you for the flight once an X-ray shows the operated lung has re-expanded, around the end of the second week.

What decides the cost

Keyhole or robotic surgery, three-dimensional planning, nodule marking, nights in hospital and pathology set most of the figure.

A quote you can compare names the approach, the planning and the stay. That figure comes only after our surgical oncology team reviews your CT, PET-CT and breathing tests, and the review costs nothing.

Arranging the trip

Our review starts the moment your thin-slice CT, breathing tests and any biopsy or PET-CT report reach us on WhatsApp, and the same coordinator follows your case from that first message to the scans you have at home a year later. Interpreters join for any language outside English, Arabic, French, Russian, Serbian, Romanian and Spanish, which the team speaks. Your room has a companion bed for one relative. For the rest of the trip, the international office handles the hotel booking, the visa invitation letter ten days ahead and the airport transfers. Halal, vegetarian or diabetic meals, a prayer room and a female physician can be requested.

Once you are back home

CT scans every six months for two years and then yearly watch the staple line and the rest of the lungs, and the images can be sent through the coordinator for review.

See a doctor the same day for any of these.

• Fever or chills
• Breathlessness that gets worse instead of better
• Chest pain or coughing up blood
• Redness, swelling or fluid at the drain site

Lung segmentectomy FAQ