Which extent of surgical resection thoracic surgeons would choose if they were diagnosed with an early-stage lung cancer: a European survey

The recent publication of 3 randomized trials has established segmentectomy as a valuable alternative to lobectomy in peripheral lymph node-negative stage IA1 and IA2 non-small-cell lung cancer. There are still unmet knowledge gaps including the level of functional benefit provided by sublobar resections compared to lobectomy, the most adequate lymph node dissection, the relative merits of video-assisted thoracic surgery (VATS) versus robotic approach, the prognostic role of spread through air spaces (STAS) and the appropriate distance of the tumour from the resection margin among others. In addition, segmentectomies are often perceived as technically complex procedures and a longer learning curve is needed to ensure adequate technical standards and respect for oncologic principles for a lung cancer operation. Despite recent evidence that has generated some enthusiasm among the thoracic surgical community, the general adoption of this procedure remains unexplored. In particular, the risk perception of surgeons playing the role of patients and undergoing segmentectomy in different hypothetical scenarios appears an interesting point of view which may help to identify knowledge and evidence gaps for future investigations or educational activities. Therefore, the ESTS approved a survey to disseminate to thoracic surgeons to capture the individual preferences of undergoing segmentectomy as opposed to lobectomy in case the surgeon was diagnosed with early-stage lung cancer with different hypothetical scenarios. The rationale is to provide a more personalized representation of the current acceptance of this procedure among the thoracic surgical community based on a subjective standpoint.