Lung Segmentectomy

January 24, 2025

This page was reviewed under our medical and editorial policy by Jyoti Malhotra, M.D., M.P.H., associate professor, Department of Medical Oncology & Therapeutics Research, City of Hope^® Orange County Lennar Foundation Cancer Center; and Jae Y. Kim, M.D., associate professor, Division of Thoracic Surgery, Department of Surgery, City of Hope Cancer Center Duarte

When a patient is diagnosed with lung cancer, doctors may recommend several types of treatments to fight the disease. Lung segmentectomy is a type of surgery that may be a recommended treatment.

To determine if a patient is a candidate for a lung segmentectomy procedure, doctors examine the tumor’s location, the stage or extent of the cancer spread, the amount of healthy lung tissue that is present and the patient’s health and preferences.

Other types of lung cancer surgeries include:

• Pnemonectomy to remove the entire lung
• Lobectomy to remove one of the five lobes of the lungs where a tumor is located
• Wedge resection to remove a piece of lung (smaller than a segment)
• Sleeve resection to remove part of a lobe and large airway (bronchus) that contains the tumor, and reattach the remaining sections together

What Is a Lung Segmentectomy?

A lung segmentectomy, or segmental lung resection, is surgery to take out a section or sections of the lobe where the cancer tumor is located. Each lung is made up of lobes, with three lobes in the right lung and two lobes in the left lung. Each lobe consists of several segments (anywhere from two to five). Because only a segment or segments of a lobe are removed, it may help to preserve some lung function.

Segmentectomy may be recommended in patients with small, early-stage cancer or for people who are not candidates for removal of the entire lobe. This includes patients with other health problems that affect their lungs and those with limited pulmonary reserve, which is limited reserves of air in the lungs.

During the procedure, doctors may also take tissue samples of certain lymph nodes and test them in the laboratory to help determine how far the lung cancer has spread.

Lung Segmentectomy Surgery

Patients undergoing a lung segmentectomy receive anesthesia medications to put them to sleep before the procedure begins so they will not feel any pain. A few different techniques may be used by the thoracic surgeon who performs the operation.

Video-assisted thoracic surgery (VATS): For VATS surgery, three to four smaller cuts are made, and surgical tools and a videoscope with an attached camera are passed through these openings to perform the surgery. Robot-assisted VATS may also be performed, during which a robot holds the surgical instruments and the surgeon directs this robot’s movements from a computer station.

Thoracotomy surgery: In a thoracotomy, a large cut is made between the ribs to access the lungs. Rib-spreaders are used for improved viewing inside the chest cavity. However, in most cases, segmentectomies are performed using VATS.

For a lung segmentectomy procedure:

• The patient is positioned on his or her side
• A large cut is made between the ribs (thoracotomy) or smaller cuts are made in a triangular fashion (VATS)
• The lungs are deflated
• The surgeon confirms how much of the lung tissue needs to be removed, sometimes with the help of intraoperative imaging
• The appropriate arteries, veins and the main airway (bronchus) are stapled off and the surgeon performs a leak test to make sure there are not any leaks
• The surgeon uses tools to remove the segment of the lung that contains the tumor, and sometimes area lymph nodes as well
• The lungs are reinflated, and blood and airflow are reinstated
• A chest drain may be put in before the surgeon closes the incisions

Thoracotomy surgery typically takes between two to six hours to complete, and VATS may take about 2.5 to four hours. Patients often stay in the hospital for an additional day or more after the segmentectomy procedure so the care team can manage and monitor their recovery.

Minimally invasive surgical techniques like VATS have been shown to reduce the patient’s recovery time, length of hospital stay and complications after surgery.

Procedure Recovery

Lung segmentectomy recovery begins in the hospital, where doctors and nurses may provide patients with pain and blood clot management medications. Patients may also receive instructions on breathing exercises to perform that aim to reduce their risk of developing pneumonia or other infections.

Tubes initially drain fluid and air from the lungs. Patients are encouraged to sit up and begin walking around as soon as possible after the surgery.

After leaving the hospital, it may take several weeks to fully return to a normal schedule of activities.

Sometimes people experience pain during this time, especially when they twist their upper body or move their arms. Those with other lung conditions like emphysema may have shortness of breath when doing certain activities after the surgery. The doctor may prescribe pain medications and breathing and mobility exercises to help accelerate postsurgery healing and recovery.

Lung Segmentectomy Complications

People undergoing segmental resection of the lungs may have complications that include:

• Pneumonia
• A buildup of fluid in the air spaces of the lungs (pulmonary edema)
• Blood collecting between the lungs and chest wall (hemothorax)
• A buildup of a bodily fluid called chyle in the lung tissue (chylothorax)
• Narrowing of the bronchi or airways (bronchial stenosis)
• Adult respiratory distress syndrome
• A buildup of pus between the lungs and the inner chest wall (empyema)
• Development of a channel between a bronchus (airway) and the pleural space (bronchopleural fistula)
• Rotation of a lobe or the entire lung that causes the airway to be blocked (lung torsion)
• Reactions to anesthesia medications
• Infections
• Excess bleeding
• Lung or leg blood clots
• Pain at the site of the incision
• Air leaks
• Respiratory failure