European Society of Thoracic Surgeons expert consensus recommendations on technical standards of segmentectomy for primary lung cancer

The recent findings from the JCOG0802 and CALGB randomized control trials [1, 2] have corroborated previous observational reports series [3–8] showing favourable short-term and long-term results of segmentectomy in patients operated for peripheral (outer third of the lung), early-stage non-small-cell lung cancer (NSCLC) (2 cm or less). This has generated a growing interest in this procedure, which is however considered technically more challenging compared to lobectomy, especially when performed via closed-chest surgery. This renewed interest coupled with the implementation of lung screening programs with the increased detection of earlystage lung cancer [9] will likely lead to a progressive wider adoption of this procedure. During this phase, it is important to ensure that the oncologic principles will be respected and that practice variation will be minimized to guarantee patients’ safety and appropriate cancer treatment [10]. Recent publications have shown that the current adherence to pre-defined quality measures occurred in only <13% of all segmentectomies at a national level [11]. In addition, 20% of reported segmentectomies may actually not meet the criteria for true segmental resection [12]. Poor quality standards have been associated with poorer survival [11]. With the aim to provide guidance to safely implement the adoption of segmentectomy as a curative resection for earlystage lung cancer patients, the European Society of Thoracic Surgeons designed an expert consensus project aiming at defining quality technical criteria of segmentectomies, whose results are herein reported.