Definition & Overview
Segmentectomy is the surgical procedure of removing a part of an organ as treatment of several types of tumour and cancer. During this process, the cancer tissue and part of the normal tissue surrounding it are removed to stop the spread of disease. This procedure is also called segmental resection, tumourectomy, wide excision, or quandrantectomy. In some instances, a segmentectomy is also performed on a gland.
This procedure is typically performed when the growth of cancer tumours or cells is localized in certain areas and there are no indications of metastasis. The excision of healthy cells surrounding the tumour typically provides higher chances of preventing the recurrence of cancer.
Who Should Undergo and Expected Results
Segmentectomy can benefit patients with the following conditions:
Lung cancer - The procedure can be recommended for those who are unsuitable to undergo a procedure that removes the entire lung lobe and are deemed to be more appropriate candidate for wide excision of the said organ to preserve adequate pulmonary functions. Segmentectomy is most effective if performed during the initial stages of the disease and in cases wherein the cancer cells have not yet spread to other lung tissues. Patients with benign lung lesions and masses can also undergo this procedure to prevent the progression of their conditions.
Breast cancer - Women diagnosed with breast cancer may also consider segmentectomy as a breast-conserving surgical option. In some cases, the term segmentectomy is used if only a small segment of the breast is removed; removing a bigger part of it is called quadrantectomy. However, both procedures remove the identified tumour cells and its surrounding tissue.
Liver cancer - Patients diagnosed with liver cancer, especially those with hepatocellular carcinoma, are also advised to undergo segmentectomy to preserve as much liver function as possible.
A segmentectomy is a major surgical procedure that requires several days of hospitalisation. Postoperative physical therapy is also advised to encourage healing.
As for the expected results, the procedure has a good success rate for removing localised tumours and cancers. Several studies report higher survival rate with retention of organ functions, up to a certain degree. Prognosis following this procedure is heavily dependent on the severity of the disease, the location of the tumour cells, general health of the patient, and metastasis of cancer to nearby body parts.
How is the Procedure Performed?
Prior to surgery, the location of the tumour cells is identified with the use of advanced imaging techniques such as CT scanning and MRI.
At the start of the procedure, the patient is placed under general anaesthesia.
For segmentectomy of the lungs, the surgeon makes several incisions in the thoracic area for the insertion of the thoracoscope and other surgical instruments. After locating the tumour, the surgeon proceeds to remove the diseased tissue with surrounding healthy cells. Affected blood vessels and bronchia structures are also cut and closed off. Most surgeons also remove any nearby lymph nodes to reduce the chances of recurrence. After all diseased tissues have been taken out, the chest cavity is cleansed with aseptic distilled water. The incisions are then closed with sutures and the specimens collected are sent to a pathology laboratory.
The same concept applies to segmentectomy of the liver. The tumour cells are excised along with a margin of healthy cells around it. The nearby lymph nodes are removed, as well. Some surgeon often used laparoscopy for this procedure, reporting reduced blood loss and shortened hospital stay compared to the open or traditional approach.
In removing cancer cells from the breast, a surgeon often marks the location of tumour cells and proceeds to make an incision. There are several detailed techniques on how to remove the affected cell and the resection margin is decided based on the exact location and depth of the tumour. Removal of tumour cells located close to the skin surface would sometimes require adjacent tissue transfer to fill any cavity left by the surgical procedure.
Possible Risks and Complications
As in any major surgical procedure, segmentectomy comes with a number of possible risks and complications. These include:
- Adverse reactions to anesthesia
- Significant bleeding
- Bacterial infection in the surgical site
- Pneumonia (for patients who underwent segmentectomy of the lungs are also at risk of developing
- Gas emboli
- Necrosis of the skin and fat cells (particularly for patients who had the procedure as treatment of breast cancer)
- Tumour recurrence, especially if the tumour cells were not completely removed.
Leshnower BG, Miller DL, Fernandez FG, Pickens A, Force SD. Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure. Ann Thorac Surg. 2010 May. 89(5):1571-6.
Swanson SJ. Video-assisted thoracic surgery segmentectomy: the future of surgery for lung cancer?. Ann Thorac Surg. 2010 Jun. 89(6):S2096-7.