Segmentectomy is the excision (removal) of a portion of any organ or gland. The procedure has several variations and many names, including wide excision, lumpectomy, tumorectomy, quadrantectomy, and partial mastectomy.
Purpose
The purpose of this procedure is to surgically remove a portion (in this case, with a cancerous tumor) of an organ or gland as a treatment.
Precautions
Because of the need for radiotherapy after segmentectomy, some patients, such as pregnant women and those with syndromes not compatible with radiation treatment, may not be candidates for this procedure. As with any surgery, patients should alert their physician about all allergies and any medications they are taking.
Description
Common organs that have segments are the breasts, lungs, and liver. When cancer is confined to a segment, removal of that portion may offer cancer-control results equivalent to larger operations. This is especially true for breast and liver cancers. In cases of lung cancer, lobectomy (surgical removal of all or part of the lung) is preferable, but if the patient does not have sufficient pulmonary function to tolerate this larger operation, then a segmentectomy may be necessary. For breast and lung cancers, this procedure is often combined with removal of some or all regional lymph nodes.
Preparation
Routine preoperative preparations, such as having nothing to eat or drink the night before surgery, are typically ordered for a segmentectomy. Information about expected outcomes and potential complications is also part of the preparation for this surgery.
Aftercare
After a segmentectomy, patients are usually cautioned against any moderate lifting for several days. Other activities may be restricted (especially if lymph nodes were removed) according to individual needs. Pain is often enough to limit inappropriate motion. Women who undergo segmentectomy of the breast are often instructed to wear a well-fitting support bra both day and night for approximately one week after surgery. Pain is usually well-controlled with prescribed medication. If it is not, the patient should contact the surgeon, as severe pain may be a sign of a complication, which needs medical attention.
Radiation therapy is usually started four to six weeks after surgery and will continue for four to five weeks. The timing of additional therapy is specific to each individual patient.
Risks
Risk of infection in the area affecting a segmentectomy only occurs in 3% to 4% of patients.
Normal results
Successful removal of the tumor.
Abnormal results
Major bleeding and/or infection at the wound after surgery.
Clinical Trials
Using a segmentectomy to remove breast cancers (as a technique that conserves the aesthetics of a breast) is being investigated for large tumors after several cycles of preoperative chemotherapy. Segmentectomy is also being investigated for treating small cell lung cancers. Information about clinical trial options is available from the National Cancer Institute at <http://www.nci.nih.gov>.
Resources
BOOKS
Zurrida, S. and Giovanna Gatti. "Breast Conservation: Quan drantectomy: Its Current Role and Technical Aspects." In
Breast Cancer Diagnosis and Management Elsevier Sci ence, 2000.
PERIODICALS
Okada, M., et al. "Is Segmentectomy With Lymph Node Assessment an Alternative to Lobectomy for Non-Small Cell Lung Cancer of 2 cm or Smaller?" Annual Thoracic Surgery (March 2001): 956-61.
Sagawa, M., et al. "Segmentectomy for Roentgenographically Occult Bronchogenic Squamous Cell Carcinoma." Annual Thoracic Surgery (April 2001):1100-4
Korst, R.J., et al. "Appropriate Surgical Treatment of Resectable Non-small-cell Lung Cancer." World Journal of Surgery (February 2001):184-8.
Veronesi, U., and S. Zurrida. "Quandrantectomy for Malignant Disease." Operative Techniques in General Surgery (June 2000):132-6.
Veronesi, U., and S. Zurrida. ldquo;Treatment of Breast Can cer." Annales Chirurgiae et Gynaecologiae (2000):187-90.
Zurrida, S. et al. "The Veronesi Quadrantectomy: An Estab lished Procedure for the Conservative Treatment of Early Breast Cancer." International Journal of Surgical Investi gation (2000):1-9.
ORGANIZATION
American Cancer Society 1599 Clifton Rd. NE, Atlanta, GA 30329. (800) 227-2345. <http://www.cancer.org>.
ENCORE YWCA of the USA, Office of Women's Health
Advocacy, Suite 700, 1015 18th St. NW, Washington, DC 20036. (800) 953-7587. <http://www.ywca.org>. Discus sion and exercise program for women who have had breast cancer surgery to restore physical strength and emotional well-being.
National Alliance of Breast Cancer Organizations (NABCO) 10th Floor, Nine E. 37th St., New York, NY 10016. (888) 80-NABCO. <http://www.nabco.org>. Provides informa tion about breast cancer and is involved with legislative concerns of breast cancer patients and survivors.
Y-ME National Breast Cancer Organization 212 West Van Buren St., Chicago, IL 60607-3908. (800) 986-9505. <http://www.y-me.org>. Information and support to breast cancer patients, families, and friends.
Laura Ruth, Ph.D.
Conservation surgery
—Surgery that preserves the aesthetics of the area to be worked on.
Excision
—To surgically remove.
Lymph nodes
—Small, bean-shaped organs located throughout the lymphatic system. Lymph nodes store special cells that can trap cancer cells and bacteria that are traveling through the body.
Radiotherapy
—The treatment of disease with high-energy radiation, such as x or gamma rays.
QUESTIONS TO ASK THE DOCTOR
Is segmentectomy an option for treatment?
How will I know that all the cancer has been removed?
What is the risk of tumor recurrence if I undergo this procedure?
