Segmentectomy of early stage lung cancer: From technology to clinical research_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Jiahao , ZHANG Yajie ,  LI Hecheng

Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R.China;

Corresponding author：

LI Hecheng, Email: lihecheng2000@hotmail.com

Keywords：

Early stage lung cancer; lung segmentectomy; clinical research; lung lobectomy; video-assisted thoracoscopic surgery

DOI：

10.7507/1007-4848.201912016

Video：

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Segmentectomy is the removal of certain segments of the lung with lesions and retaining the normal lung tissue of the lobe. Lung segmentectomy is considered difficult due to the lack of clear anatomical boundaries between lung segments. Segmentectomy has a variety of indications, such as lung cancer, metastatic lung tumors, and many non-malignant diseases. In the treatment of early stage lung cancer, segmentectomy was initially considered only as a treatment option for patients not suitable for conventional lobectomy. As more evidence emerged, the indications for segmentectomy have continued to change over time, and segmentectomy has been widely performed in patients with early stage lung cancer. Theoretically, segmentectomy leads to better preservation of lung function than lobectomy, but the risk of incomplete tumor resection is higher, so the indication of segmentectomy has become a focus of debate. This article will introduce the surgical techniques of segmentectomy and summarize the published and unpublished clinical studies on segmentectomy for the treatment of early stage lung cancer.

Citation： ZHANG Jiahao, ZHANG Yajie, LI Hecheng. Segmentectomy of early stage lung cancer: From technology to clinical research. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(10): 1127-1133. doi: 10.7507/1007-4848.201912016 Copy

1.	Ettinger DS, Wood DE, Aggarwal C, <italic>et al</italic>. NCCN guidelines insights: non-small cell lung vancer, version 1.2020. J Natl Compr Canc Netw, 2019, 17(12): 1464-1472.
2.	Shimizu K, Nagashima T, Ohtaki Y, <italic>et al</italic>. Analysis of the variation pattern in right upper pulmonary veins and establishment of simplified vein models for anatomical segmentectomy. Gen Thorac Cardiovasc Surg, 2016, 64(10): 604-611.
3.	Sato M, Murayama T, Nakajima J. Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP). J Thorac Dis, 2016, 8(Suppl 9): S716-S730.
4.	Okada M, Mimura T, Ikegaki J, <italic>et al</italic>. A novel video-assisted anatomic segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
5.	Andolfi M, Potenza R, Seguin-Givelet A, <italic>et al</italic>. Identification of the intersegmental plane during thoracoscopic segmentectomy: state of the art. Interact Cardiovasc Thorac Surg, 2020, 30(3): 329-336.
6.	Misaki N, Chang SS, Gotoh M, <italic>et al</italic>. A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg, 2009, 138(3): 613-618.
7.	Iizuka S, Kuroda H, Yoshimura K, <italic>et al</italic>. Predictors of indocyanine green visualization during fluorescence imaging for segmental plane formation in thoracoscopic anatomical segmentectomy. J Thorac Dis, 2016, 8(5): 985-991.
8.	Oh S, Suzuki K, Miyasaka Y, <italic>et al</italic>. New technique for lung segmentectomy using indocyanine green injection. Ann Thorac Surg, 2013, 95(6): 2188-2190.
9.	Wu WB, Xia Y, Pan XL, <italic>et al</italic>. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
10.	Sato M, Kuwata T, Yamanashi K, <italic>et al</italic>. Safety and reproducibility of virtual-assisted lung mapping: a multicentre study in Japan. Eur J Cardiothorac Surg, 2017, 51(5): 861-868.
11.	Ueda K, Uemura Y, Sato M. Protocol for the VAL-MAP 2.0 trial: a multicentre, single-arm, phase Ⅲ trial to evaluate the effectiveness of virtual-assisted lung mapping by bronchoscopic dye injection and microcoil implementation in patients with small pulmonary nodules in Japan. BMJ Open, 2019, 9(9): e028018.
12.	Nakazawa S, Shimizu K, Mogi A, <italic>et al</italic>. VATS segmentectomy: past, present, and future. Gen Thorac Cardiovasc Surg, 2018, 66(2): 81-90.
13.	Shimizu K, Nakazawa S, Nagashima T, <italic>et al</italic>. 3D-CT anatomy for VATS segmentectomy. J Vis Surg, 2017, 3: 88.
14.	Asakura K, Izumi Y, Kohno M, <italic>et al</italic>. Effect of cutting technique at the intersegmental plane during segmentectomy on expansion of the preserved segment: comparison between staplers and scissors in ex vivo pig lung. Eur J Cardiothorac Surg, 2011, 40(1): e34-e38.
15.	Liu H, Lin G, Zhang S, <italic>et al</italic>. Electrocautery versus stapler for intersegmental plane dissection in complete thoracoscopic segmentectomy. Zhongguo Fei Ai Za Zhi, 2017, 20(1): 41-46.
16.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
17.	Wolf AS, Richards WG, Jaklitsch MT, <italic>et al</italic>. Lobectomy versus sublobar resection for small (2 cm or less) non-small cell lung cancers. Ann Thorac Surg, 2011, 92(5): 1819-1823.
18.	Martin-Ucar AE, Nakas A, Pilling JE, <italic>et al</italic>. A case-matched study of anatomical segmentectomy versus lobectomy for stage Ⅰ lung cancer in high-risk patients. Eur J Cardiothorac Surg, 2005, 27(4): 675-679.
19.	Detterbeck FC, Boffa DJ, Kim AW, <italic>et al</italic>. The eighth edition lung cancer stage classification. Chest, 2017, 151(1): 193-203.
20.	Yamashita S, Tokuishi K, Anami K, <italic>et al</italic>. Thoracoscopic segmentectomy for T1 classification of non-small cell lung cancer: a single center experience. Eur J Cardiothorac Surg, 2012, 42(1): 83-88.
21.	Zhong C, Fang W, Mao T, <italic>et al</italic>. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stage ⅠA lung cancer. Ann Thorac Surg, 2012, 94(2): 362-367.
22.	Sugi K, Kobayashi S, Sudou M, <italic>et al</italic>. Long-term prognosis of video-assisted limited surgery for early lung cancer. Eur J Cardiothorac Surg, 2010, 37(2): 456-460.
23.	Cao C, Chandrakumar D, Gupta S, <italic>et al</italic>. Could less be more?-A systematic review and meta-analysis of sublobar resections versus lobectomy for non-small cell lung cancer according to patient selection. Lung Cancer, 2015, 89(2): 121-132.
24.	Mun M, Kohno T. Efficacy of thoracoscopic resection for multifocal bronchioloalveolar carcinoma showing pure ground-glass opacities of 20 mm or less in diameter. J Thorac Cardiovasc Surg, 2007, 134(4): 877-882.
25.	Tsutani Y, Miyata Y, Nakayama H, <italic>et al</italic>. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage ⅠA lung adenocarcinoma: wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
26.	Sagawa M, Oizumi H, Suzuki H, <italic>et al</italic>. A prospective 5-year follow-up study after limited resection for lung cancer with ground-glass opacity. Eur J Cardiothorac Surg, 2018, 53(4): 849-856.
27.	Watanabe A, Ohori S, Nakashima S, <italic>et al</italic>. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg, 2009, 35(5): 775-780.
28.	Gu Z, Wang H, Mao T, <italic>et al</italic>. Pulmonary function changes after different extent of pulmonary resection under video-assisted thoracic surgery. J Thorac Dis, 2018, 10(4): 2331-2337.
29.	Harada H, Okada M, Sakamoto T, <italic>et al</italic>. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg, 2005, 80(6): 2041-2045.
30.	Shao C, Zheng C, Yan W, <italic>et al</italic>. Evaluation of efficacy and safety of minimally invasive segmentectomy in the treatment of lung cancer. Oncol Lett, 2018, 15(6): 9516-9522.
31.	Echavarria MF, Cheng AM, Velez-Cubian FO, <italic>et al</italic>. Comparison of pulmonary function tests and perioperative outcomes after robotic-assisted pulmonary lobectomy vs segmentectomy. Am J Surg, 2016, 212(6): 1175-1182.
32.	Bédat B, Abdelnour-Berchtold E, Perneger T, <italic>et al</italic>. Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study. J Cardiothorac Surg, 2019, 14(1): 189.
33.	Smith CB, Kale M, Mhango G, <italic>et al</italic>. Comparative outcomes of elderly stage Ⅰ lung cancer patients treated with segmentectomy via video-assisted thoracoscopic surgery versus open resection. J Thorac Oncol, 2014, 9(3): 383-389.
34.	Ghaly G, Kamel M, Nasar A, <italic>et al</italic>. Video-assisted thoracoscopic surgery is a safe and effective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stageⅠ non-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 465-472.
35.	Schuchert MJ, Pettiford BL, Pennathur A, <italic>et al</italic>. Anatomic segmentectomy for stageⅠ non-small-cell lung cancer: comparison of video-assisted thoracic surgery versus open approach. J Thorac Cardiovasc Surg, 2009, 138(6): 1318-1325.
36.	Witte B, Stenz C, Vahl CF, <italic>et al</italic>. Comparative intention-to-treat analysis of the video-assisted thoracoscopic surgery approach to pulmonary segmentectomy for lung carcinoma. Interact Cardiovasc Thorac Surg, 2015, 21(3): 276-283.
37.	Le Gac C, Gondé H, Gillibert A, <italic>et al</italic>. Medico-economic impact of robot-assisted lung segmentectomy: what is the cost of the learning curve? Interact Cardiovasc Thorac Surg, 2020, 30(2): 255-262.
38.	Kent M, Wang T, Whyte R, <italic>et al</italic>. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg, 2014, 97(1): 236-242.
39.	She XW, Gu YB, Xu C, <italic>et al</italic>. Three-dimensional (3D)-computed tomography bronchography and angiography combined with 3D-video-assisted thoracic surgery (VATS) versus conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of non-small cell lung cancer. Thorac Cancer, 2018, 9(2): 305-309.
40.	Kuroda H, Yoshida T, Arimura T, <italic>et al</italic>. Novel development of Spectra-A using indocyanine green for segmental boundary visibility in thoracoscopic segmentectomy. J Surg Res, 2018, 227: 228-233.
41.	Kuwata T, Shinohara S, Matsumiya H, <italic>et al</italic>. Virtual-assisted lung mapping (VAL-MAP) shortened surgical time of wedge resection. J Thorac Dis, 2018, 10(3): 1842-1849.
42.	Aokage K, Saji H, Suzuki K, <italic>et al</italic>. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211). Gen Thorac Cardiovasc Surg, 2017, 65(5): 267-272.

1. Ettinger DS, Wood DE, Aggarwal C, <italic>et al</italic>. NCCN guidelines insights: non-small cell lung vancer, version 1.2020. J Natl Compr Canc Netw, 2019, 17(12): 1464-1472.
2. Shimizu K, Nagashima T, Ohtaki Y, <italic>et al</italic>. Analysis of the variation pattern in right upper pulmonary veins and establishment of simplified vein models for anatomical segmentectomy. Gen Thorac Cardiovasc Surg, 2016, 64(10): 604-611.
3. Sato M, Murayama T, Nakajima J. Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP). J Thorac Dis, 2016, 8(Suppl 9): S716-S730.
4. Okada M, Mimura T, Ikegaki J, <italic>et al</italic>. A novel video-assisted anatomic segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
5. Andolfi M, Potenza R, Seguin-Givelet A, <italic>et al</italic>. Identification of the intersegmental plane during thoracoscopic segmentectomy: state of the art. Interact Cardiovasc Thorac Surg, 2020, 30(3): 329-336.
6. Misaki N, Chang SS, Gotoh M, <italic>et al</italic>. A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg, 2009, 138(3): 613-618.
7. Iizuka S, Kuroda H, Yoshimura K, <italic>et al</italic>. Predictors of indocyanine green visualization during fluorescence imaging for segmental plane formation in thoracoscopic anatomical segmentectomy. J Thorac Dis, 2016, 8(5): 985-991.
8. Oh S, Suzuki K, Miyasaka Y, <italic>et al</italic>. New technique for lung segmentectomy using indocyanine green injection. Ann Thorac Surg, 2013, 95(6): 2188-2190.
9. Wu WB, Xia Y, Pan XL, <italic>et al</italic>. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
10. Sato M, Kuwata T, Yamanashi K, <italic>et al</italic>. Safety and reproducibility of virtual-assisted lung mapping: a multicentre study in Japan. Eur J Cardiothorac Surg, 2017, 51(5): 861-868.
11. Ueda K, Uemura Y, Sato M. Protocol for the VAL-MAP 2.0 trial: a multicentre, single-arm, phase Ⅲ trial to evaluate the effectiveness of virtual-assisted lung mapping by bronchoscopic dye injection and microcoil implementation in patients with small pulmonary nodules in Japan. BMJ Open, 2019, 9(9): e028018.
12. Nakazawa S, Shimizu K, Mogi A, <italic>et al</italic>. VATS segmentectomy: past, present, and future. Gen Thorac Cardiovasc Surg, 2018, 66(2): 81-90.
13. Shimizu K, Nakazawa S, Nagashima T, <italic>et al</italic>. 3D-CT anatomy for VATS segmentectomy. J Vis Surg, 2017, 3: 88.
14. Asakura K, Izumi Y, Kohno M, <italic>et al</italic>. Effect of cutting technique at the intersegmental plane during segmentectomy on expansion of the preserved segment: comparison between staplers and scissors in ex vivo pig lung. Eur J Cardiothorac Surg, 2011, 40(1): e34-e38.
15. Liu H, Lin G, Zhang S, <italic>et al</italic>. Electrocautery versus stapler for intersegmental plane dissection in complete thoracoscopic segmentectomy. Zhongguo Fei Ai Za Zhi, 2017, 20(1): 41-46.
16. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
17. Wolf AS, Richards WG, Jaklitsch MT, <italic>et al</italic>. Lobectomy versus sublobar resection for small (2 cm or less) non-small cell lung cancers. Ann Thorac Surg, 2011, 92(5): 1819-1823.
18. Martin-Ucar AE, Nakas A, Pilling JE, <italic>et al</italic>. A case-matched study of anatomical segmentectomy versus lobectomy for stage Ⅰ lung cancer in high-risk patients. Eur J Cardiothorac Surg, 2005, 27(4): 675-679.
19. Detterbeck FC, Boffa DJ, Kim AW, <italic>et al</italic>. The eighth edition lung cancer stage classification. Chest, 2017, 151(1): 193-203.
20. Yamashita S, Tokuishi K, Anami K, <italic>et al</italic>. Thoracoscopic segmentectomy for T1 classification of non-small cell lung cancer: a single center experience. Eur J Cardiothorac Surg, 2012, 42(1): 83-88.
21. Zhong C, Fang W, Mao T, <italic>et al</italic>. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stage ⅠA lung cancer. Ann Thorac Surg, 2012, 94(2): 362-367.
22. Sugi K, Kobayashi S, Sudou M, <italic>et al</italic>. Long-term prognosis of video-assisted limited surgery for early lung cancer. Eur J Cardiothorac Surg, 2010, 37(2): 456-460.
23. Cao C, Chandrakumar D, Gupta S, <italic>et al</italic>. Could less be more?-A systematic review and meta-analysis of sublobar resections versus lobectomy for non-small cell lung cancer according to patient selection. Lung Cancer, 2015, 89(2): 121-132.
24. Mun M, Kohno T. Efficacy of thoracoscopic resection for multifocal bronchioloalveolar carcinoma showing pure ground-glass opacities of 20 mm or less in diameter. J Thorac Cardiovasc Surg, 2007, 134(4): 877-882.
25. Tsutani Y, Miyata Y, Nakayama H, <italic>et al</italic>. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage ⅠA lung adenocarcinoma: wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
26. Sagawa M, Oizumi H, Suzuki H, <italic>et al</italic>. A prospective 5-year follow-up study after limited resection for lung cancer with ground-glass opacity. Eur J Cardiothorac Surg, 2018, 53(4): 849-856.
27. Watanabe A, Ohori S, Nakashima S, <italic>et al</italic>. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg, 2009, 35(5): 775-780.
28. Gu Z, Wang H, Mao T, <italic>et al</italic>. Pulmonary function changes after different extent of pulmonary resection under video-assisted thoracic surgery. J Thorac Dis, 2018, 10(4): 2331-2337.
29. Harada H, Okada M, Sakamoto T, <italic>et al</italic>. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg, 2005, 80(6): 2041-2045.
30. Shao C, Zheng C, Yan W, <italic>et al</italic>. Evaluation of efficacy and safety of minimally invasive segmentectomy in the treatment of lung cancer. Oncol Lett, 2018, 15(6): 9516-9522.
31. Echavarria MF, Cheng AM, Velez-Cubian FO, <italic>et al</italic>. Comparison of pulmonary function tests and perioperative outcomes after robotic-assisted pulmonary lobectomy vs segmentectomy. Am J Surg, 2016, 212(6): 1175-1182.
32. Bédat B, Abdelnour-Berchtold E, Perneger T, <italic>et al</italic>. Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study. J Cardiothorac Surg, 2019, 14(1): 189.
33. Smith CB, Kale M, Mhango G, <italic>et al</italic>. Comparative outcomes of elderly stage Ⅰ lung cancer patients treated with segmentectomy via video-assisted thoracoscopic surgery versus open resection. J Thorac Oncol, 2014, 9(3): 383-389.
34. Ghaly G, Kamel M, Nasar A, <italic>et al</italic>. Video-assisted thoracoscopic surgery is a safe and effective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stageⅠ non-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 465-472.
35. Schuchert MJ, Pettiford BL, Pennathur A, <italic>et al</italic>. Anatomic segmentectomy for stageⅠ non-small-cell lung cancer: comparison of video-assisted thoracic surgery versus open approach. J Thorac Cardiovasc Surg, 2009, 138(6): 1318-1325.
36. Witte B, Stenz C, Vahl CF, <italic>et al</italic>. Comparative intention-to-treat analysis of the video-assisted thoracoscopic surgery approach to pulmonary segmentectomy for lung carcinoma. Interact Cardiovasc Thorac Surg, 2015, 21(3): 276-283.
37. Le Gac C, Gondé H, Gillibert A, <italic>et al</italic>. Medico-economic impact of robot-assisted lung segmentectomy: what is the cost of the learning curve? Interact Cardiovasc Thorac Surg, 2020, 30(2): 255-262.
38. Kent M, Wang T, Whyte R, <italic>et al</italic>. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg, 2014, 97(1): 236-242.
39. She XW, Gu YB, Xu C, <italic>et al</italic>. Three-dimensional (3D)-computed tomography bronchography and angiography combined with 3D-video-assisted thoracic surgery (VATS) versus conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of non-small cell lung cancer. Thorac Cancer, 2018, 9(2): 305-309.
40. Kuroda H, Yoshida T, Arimura T, <italic>et al</italic>. Novel development of Spectra-A using indocyanine green for segmental boundary visibility in thoracoscopic segmentectomy. J Surg Res, 2018, 227: 228-233.
41. Kuwata T, Shinohara S, Matsumiya H, <italic>et al</italic>. Virtual-assisted lung mapping (VAL-MAP) shortened surgical time of wedge resection. J Thorac Dis, 2018, 10(3): 1842-1849.
42. Aokage K, Saji H, Suzuki K, <italic>et al</italic>. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211). Gen Thorac Cardiovasc Surg, 2017, 65(5): 267-272.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Segmentectomy of early stage lung cancer: From technology to clinical research

Abstract Full text Figures/Tables Video References Cited by

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