Clinical outcomes of thoracoscopic pulmonary segmentectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Kunliang ,  CHEN Jian , ZHAN Bicheng , LIU Yongzhi , WANG Xiao , LIU Jian

Department of Cardiothoracic Surgery, Anqing Municipal Hospital, Anhui Medical University, Anqing, 246003, Anhui, P.R.China;

Corresponding author：

CHEN Jian, Email: 423287497@qq.com

Keywords：

Thoracoscopic surgery; segmentectomy; lung cancer; pulmonary nodule

DOI：

10.7507/1007-4848.202007088

Video：

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Objective To explore the clinical issues associated with video-assisted pulmonary segmentectomy and to provide reference for better implementation of thoracoscopic pulmonary segmentectomy and reduction of perioperative complications through analyzing the clinical results of thoracoscopic segmentectomy.Methods The clinical data of 90 patients who planned to undergo thoracoscopic segmentectomy in our department from October 2017 to December 2019 were retrospectively analyzed, including 35 males with an average age of 60.34±9.40 years and 55 females with an average age of 56.09±12.11 years. The data including lung nodule number, benign or malignant, preoperative location by Hookwire, preoperative planning and actual implementation, operation time, intraoperative blood loss, postoperative drainage volume and time of drainage tube removal, postoperative hospital stay and complications were collected and analyzed.Results Among the 90 patients, 38 were preoperatively positioned by Hook-wire, 52 were directly operated on; 87 were completed under thoracoscopic surgery among whom 3 underwent passive lobectomy after segmentectomy under thoracoscopic surgery, and 3 were converted to thoracotomy among whom 1 underwent lobectomy. Operation time was 198.58±56.42 min, intraoperative blood loss was 129.78±67.51 mL, lymph node samples were 6.43±1.41, drainage time was 2.98±1.25 d, the amount of postoperation drainage was 480.00±262.00 mL, hospital stay was 7.60±2.38 d. In all patients, 73 had single nodules and 17 had multiple nodules. Totally 113 pulmonary nodules were resected, 14 (12.39%) were benign nodules and 99 (87.61%) were malignant nodules. There was no perioperative death or serious complications.Conclusion For those pulmonary parenchymal nodules which meet the indications, it is feasible to perform thoracoscopic anatomic pulmonary segmentectomy according to preoperative thin-slice CT and three-dimensional computed tomography-bronchography and angiography (3D-CTBA) reconstruction results. Preoperative Hookwire localization can ensure effective edge resection and reduce unplanned lobotomy for intersegmental nodules and non-palpable peripheral pure ground-glass nodules.

Citation： GUO Kunliang, CHEN Jian, ZHAN Bicheng, LIU Yongzhi, WANG Xiao, LIU Jian. Clinical outcomes of thoracoscopic pulmonary segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(3): 319-324. doi: 10.7507/1007-4848.202007088 Copy

1.	金亮. 胸腔镜下肺段切除术在肺癌治疗中的现状. 中国微创外科杂志, 2018, 18(8): 749-752.
2.	陈亮, 王俊, 吴卫兵, 等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 21-28.
3.	王宁, 刘硕, 杨雷, 等. 2018全球癌症统计报告解读. 肿瘤综合治疗电子杂志, 2019, 5(1): 87-97.
4.	Bedetti B, Bertolaccini L, Rocco R, et al. Segmentectomy versus lobectomy for stage Ⅰ non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2017, 9(6): 1615-1623.
5.	Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage ⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
6.	Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
7.	Nomori H, Shiraishi A, Cong Y, et al. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy. Eur J Cardiothorac Surg, 2018, 53(3): 640-647.
8.	Mohiuddin K, Haneuse S, Sofer T, et al. Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non-small cell lung cance. J Thorac Cardiovasc Surg, 2014, 147(4): 1169-1175.
9.	Schuchert MJ, Pettiford BL, Keeley S, et al. Anatomic segmentectomy in the treatment of stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2007, 84(3): 926-932.
10.	Drevet G, Ugalde Figueroa P. Uniportal video-assisted thoracoscopic surgery: Safety, efficacy and learning curve during the first 250 cases in Quebec, Canada. Ann Cardiothorac Surg, 2016, 5(2): 100-106.
11.	Horinouchi H, Nomori H, Nakayama T, et al. How many pathological T1N0M0 non-small cell lung cancers can be completely resected in one segment? Special reference to high-resolution computed tomography findings. Surg Today, 2011, 41(8): 1062-1066.
12.	邱斌, 冀瑛, 白广宇, 等. 解剖性部分肺叶切除术治疗早期肺癌: 实践与发展. 中华胸部外科电子杂志, 2020, 7(4): 240-246.
13.	吴卫兵, 夏阳, 许晶, 等. 3D导航胸腔镜联合肺亚段切除术治疗肺段间结节的对比研究. 南京医科大学学报 (自然科学版), 2018, 38(10): 1424-1427.
14.	刘广杰, 贾宇轩, 徐文华, 等. 肺部同时性多发磨玻璃结节胸腔镜诊治流程研究. 中国全科医学, 2020, 23(15): 1956-1960.
15.	王礼同, 汤晓明, 黄华, 等. 电视胸腔镜手术前CT引导下亚甲蓝和/或Hookwire定位肺磨玻璃结节. 中国医学影像技术, 2019, 35(8): 1220-1223.
16.	徐灿, 陈宝俊, 史敏科, 等. CT引导微弹簧圈定位在胸腔镜切除孤立肺结节的临床研究. 中华腔镜外科杂志(电子版), 2017, 10(2): 102-104.
17.	王柏霖, 林吉兴, 申磊磊, 等. 硬化剂定位联合单操作孔胸腔镜切除肺部微小结节的临床应用价值. 解放军医学院学报, 2018, 39(5): 419-421.
18.	刘晓明, 胡燕, 朱萍. CT引导下hookwire技术在肺小结节定位中的应用研究. 江西医药, 2018, 53(9): 913-915, 930.
19.	姜艳, 郭维亚, 齐一伟, 等. CT引导下Hookwire定位术在肺小结节患者中的临床应用及并发症发生因素分析. 大连医科大学学报, 2018, 40(3): 224-229.
20.	李俊芳, 王吴刚, 宫坤. 右肺肿瘤定位针进入左心腔超声表现1例. 中国超声医学杂志, 2019, 35(5): 480.
21.	Tsubokawa N, Mimae T, Sasada S, et al. Negative prognostic influence of micropapillary pattern in stage ⅠA lung adenocarcinoma. Eur J Cardiothorac Surg, 2016, 49(1): 293-299.
22.	Takahashi Y, Kuroda H, Oya Y, et al. Challenges for real-time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection. Thorac Cancer, 2019, 10(8): 1663-1668.

1. 金亮. 胸腔镜下肺段切除术在肺癌治疗中的现状. 中国微创外科杂志, 2018, 18(8): 749-752.
2. 陈亮, 王俊, 吴卫兵, 等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 21-28.
3. 王宁, 刘硕, 杨雷, 等. 2018全球癌症统计报告解读. 肿瘤综合治疗电子杂志, 2019, 5(1): 87-97.
4. Bedetti B, Bertolaccini L, Rocco R, et al. Segmentectomy versus lobectomy for stage Ⅰ non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2017, 9(6): 1615-1623.
5. Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage ⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
6. Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
7. Nomori H, Shiraishi A, Cong Y, et al. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy. Eur J Cardiothorac Surg, 2018, 53(3): 640-647.
8. Mohiuddin K, Haneuse S, Sofer T, et al. Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non-small cell lung cance. J Thorac Cardiovasc Surg, 2014, 147(4): 1169-1175.
9. Schuchert MJ, Pettiford BL, Keeley S, et al. Anatomic segmentectomy in the treatment of stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2007, 84(3): 926-932.
10. Drevet G, Ugalde Figueroa P. Uniportal video-assisted thoracoscopic surgery: Safety, efficacy and learning curve during the first 250 cases in Quebec, Canada. Ann Cardiothorac Surg, 2016, 5(2): 100-106.
11. Horinouchi H, Nomori H, Nakayama T, et al. How many pathological T1N0M0 non-small cell lung cancers can be completely resected in one segment? Special reference to high-resolution computed tomography findings. Surg Today, 2011, 41(8): 1062-1066.
12. 邱斌, 冀瑛, 白广宇, 等. 解剖性部分肺叶切除术治疗早期肺癌: 实践与发展. 中华胸部外科电子杂志, 2020, 7(4): 240-246.
13. 吴卫兵, 夏阳, 许晶, 等. 3D导航胸腔镜联合肺亚段切除术治疗肺段间结节的对比研究. 南京医科大学学报 (自然科学版), 2018, 38(10): 1424-1427.
14. 刘广杰, 贾宇轩, 徐文华, 等. 肺部同时性多发磨玻璃结节胸腔镜诊治流程研究. 中国全科医学, 2020, 23(15): 1956-1960.
15. 王礼同, 汤晓明, 黄华, 等. 电视胸腔镜手术前CT引导下亚甲蓝和/或Hookwire定位肺磨玻璃结节. 中国医学影像技术, 2019, 35(8): 1220-1223.
16. 徐灿, 陈宝俊, 史敏科, 等. CT引导微弹簧圈定位在胸腔镜切除孤立肺结节的临床研究. 中华腔镜外科杂志(电子版), 2017, 10(2): 102-104.
17. 王柏霖, 林吉兴, 申磊磊, 等. 硬化剂定位联合单操作孔胸腔镜切除肺部微小结节的临床应用价值. 解放军医学院学报, 2018, 39(5): 419-421.
18. 刘晓明, 胡燕, 朱萍. CT引导下hookwire技术在肺小结节定位中的应用研究. 江西医药, 2018, 53(9): 913-915, 930.
19. 姜艳, 郭维亚, 齐一伟, 等. CT引导下Hookwire定位术在肺小结节患者中的临床应用及并发症发生因素分析. 大连医科大学学报, 2018, 40(3): 224-229.
20. 李俊芳, 王吴刚, 宫坤. 右肺肿瘤定位针进入左心腔超声表现1例. 中国超声医学杂志, 2019, 35(5): 480.
21. Tsubokawa N, Mimae T, Sasada S, et al. Negative prognostic influence of micropapillary pattern in stage ⅠA lung adenocarcinoma. Eur J Cardiothorac Surg, 2016, 49(1): 293-299.
22. Takahashi Y, Kuroda H, Oya Y, et al. Challenges for real-time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection. Thorac Cancer, 2019, 10(8): 1663-1668.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical outcomes of thoracoscopic pulmonary segmentectomy

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