The role of minimally invasive sublobar resection in pulmonary metastasectomy: a narrative review

Background and Objective: Pulmonary metastases are one of the main causes of pulmonary nodules, especially if they are multiple. Treatment of lung metastases as part of a multidisciplinary approach can sometimes be surgical when certain medical criteria are met, assuming resectability. Currently, the most commonly performed resection to treat metastasis, when indicated, is atypical segmentectomy. However, with technical improvements, other types of lung resections have begun to be performed, such as anatomical segmentectomies, which offer some advantages when patients are correctly selected. The objective of this narrative review is to understand the role of minimally invasive anatomical segmentectomies in the surgical treatment of lung metastases and discuss further future directions.Methods: A narrative review was conducted using terms including "VATS" OR "thoracoscopy", "RATS" OR "robotic thoracic surgery", "segmentectomy" OR "sublobar lung resection", "outcomes", "pulmonary metascasectomy" and "minimally invasive thoracic surgery". Included studies were published after 1927 to 2022 and were available in English and Spanish.Key Content and Findings: A growing number of studies indicate us that anatomic sublobar resections are indicated in selected patients taking into account tumor localization and the characteristics of the patients, besides minimally invasive surgery also contributes to this type of surgery an early and intensified recovery with acceptable oncological results and morbidity and mortality comparable to open surgery. We summarize these indications and the role of minimally invasive surgery.Conclusions: Anatomical segmentectomies play an important role in lung metastasis resection, especially in patients with centrally located nodules and poor respiratory lung function. Minimally invasive surgery combined with early and intensified recovery protocols have shown to reduce hospital stay, pleural drainage time, and postoperative pain. These revisions show that minimally invasive segmentectomies can be carried out with the same security as wedge resections. Although the evidence is weak and the results currently available, mainly obtained in retrospective studies, show that segmentectomies are equally valid and useful procedures than wedge resections. However, randomized studies are needed to generalize these conclusions.