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Kato et al. Mini-invasive Surg 2021;5:5 I http://dx.doi.org/10.20517/2574-1225.2020.98 Page 3 of 11

Figure 1. Procedure types for lung cancer. Although lobectomy is a standard procedure, sublobar resections such as segmentectomy,
subsegmentectomy, and partial resections have also been performed in the treatment of small-sized lung cancer.

On the other hand, if sublobar resection is acceptable for small-sized lung nodules, a thoracoscopic
approach is highly desirable as a minimally invasive surgery. The thoracoscopic approach has better
outcomes than thoracotomy in maintaining patients’ quality of life and preventing complications. It is
preferred over thoracotomy because of its advantages of decreased postoperative pain, shortened chest
tube duration, shortened length of hospital stay, faster return to preoperative activity levels, and preserved
pulmonary function [20,21] . Therefore, thoracoscopic sublobar resection is in great demand as a minimally
invasive surgical procedure.

TYPES OF SUBLOBAR RESECTIONS AND THE TECHNICAL ASPECTS OF EACH PROCEDURE
Although lobectomy has been traditionally performed as a standard procedure in many patients with
lung cancer, sublobar resections have also been performed according to each patient’s preoperative
condition [Figure 1]. Among sublobar resections, wedge resection and segmentectomy have generally
been performed for small-sized lung cancer treatments. Wedge resection has been widely performed to
diagnose indeterminate lung nodules or to cure small-sized GGO-dominant lung tumors, as the procedure
[22]
is not complicated . Although segmentectomy is generally thought to be more complicated than wedge
resection, the oncological outcomes of segmentectomy in a propensity-matched study were comparable to
[11]
those of lobectomy for patients with early-stage NSCLC . Therefore, segmentectomy has been advocated
[10]
as an alternative procedure for lobectomy in recent years .
In addition to wedge resection and segmentectomy, other procedures such as subsegmentectomy have also
been performed, although not as commonly as wedge resection and segmentectomy.

Subsegmentectomy is a more minute anatomical procedure than segmentectomy, and it is indicated
for smaller GGO-dominant lung cancers in which a sufficient surgical margin can be secured. In this
procedure, it is necessary to understand more peripheral anatomical structures . If the tumor size is small
[23]
and the GGO component ratio large, and if a sufficient surgical margin can be secured, subsegmentectomy
can be accepted as a procedure among sublobar resections because the number of reports on the procedure
has increased recently [24,25] . Another characteristic of subsegmentectomy is that it has the advantage