Objective To evaluate the feasibility and safety of complete video-assisted thoracoscopic surgery （VATS）anatomic segmentectomy. Methods Clinical data of 26 patients with lung diseases who underwent complete VATS anatomic segmentectomy in the First Affiliated Hospital of Nanjing Medical University from November 2010 to July 2011 were retrospectively analyzed. There were 8 male and 18 female patients with their age of 13-81 （53.2±3.1） years. There were 23 patients with pulmonary nodules including 13 patients who underwent direct surgical resection and 10 patients with ground-glass opacity nodules （3 patients received preoperative localization and the other 7 patients received direct surgical resection）. All the 3 patients with non-nodule pulmonary diseases （bronchiectasis, pulmonary bulla and pulmonary cyst respectively） underwent direct surgical resection. Results All the 26 patients received complete VATS anatomic segme- ntectomy successfully. The operation time was 150-250 （193.7±7.3） min，and intraoperative blood loss was 10-200 （65.7±12.7） ml. Patients with lung cancer received 4-7 （5.1±0.3） stations of lymph node dissection and the number of lymph node dissection was 4-16 （12.3±0.5） for each patient. There was no in-hospital death or postoperative complication. Postoperative thoracic drainage time was 3-7 （3.9±0.4） days. All the patients were discharge uneventfully. Lung cancer patients were followed up for 3-6 months without recurrence or metastasis. Conclusion Complete VATS anatomic segmentectomy is a safe and feasible surgical procedure.
Abstract： Objective To investigate the application of a silicone guiding tube for endoscopic linear stapling device in complete video-assisted thoracoscopic lobectomy and segmentectomy，so as to improve the safety and efficiency of manipulating the endoscopic linear stapling device. Methods We retrospectively analyzed clinical data of 178 patients with peripheral non-small cell lung caner and 26 patients with benign lung lesions who underwent surgical resection in First Affiliated Hospital of Nanjing Medical University from October 2009 to December 2011. There were 85 males and 119 females with their average age of 62±11 years. A total of 172 patients underwent complete video-assisted thoracoscopic lobectomy and 32 patients underwent segmentectomy. We designed a silicone guiding tube to facilitate the use of endoscopic linear stapling device. With the help of the tube， a1l pulmonary arteries， veins， bronchus and interlobar fissure involved were managed with endoscopic linear stapling devices. Results Three patients （1.47%）underwent conversion to thoracotomy because of dense lymph node adhesion， and all other complete video-assisted thoracoscopic surgeries were successfully performed. There was no blood vessel injury， severe postoperative complications or perioperative death. The use rate of the tube was 95.6% （303/317）， 66.9% （115/172）， 22.7% （39/172） and 78.5% （255/325） in pulmonary arteries， veins， bronchus and interlobar fissure stapling for lobectomy respectively， and 94.4% （34/36）， 77.3% （17/22）， 25.0% （8/32）， 33.1% （45/136） in pulmonary arteries， veins， bronchus and interlobar fissure stapling for segmentectomy respectively. For lobectomy， a total of 986 staples were used with an average of 5.7 staples for each patient， the average operative time was 192.5±54.0 min and average intraoperative blood loss was 118.1±104.1 ml. For segmentectomy， a total of 226 staples were used with an average of 7.1 staples for each patient， the average operative time was 193.7±37.4 min and average intraoperative blood loss was 60.9±78.0 ml. Conclusion Using a silicone guiding tube can facilitate the application of endoscopic linear stapling device， shorten the learning curve of complete video-assisted thoracoscopic lobectomy and segmentectomy， and improve the safety， convenience and economical efficiency of endoscopic linear stapling device.
ObjectiveTo evaluate the safety and efficacy of segmentectomy for early stage non-small cell lung cancer. MethodsWe retrospectively analyzed the clinical data of 88 patients with pulmonary malignant or benign lung tumor who underwent segmentectomy in our hospital between January 2007 and December 2012. There were 45 male and 43 female patients. There were 29 patients in the segmentectomy group and 59 patients in the lobectomy group. Nonsmall cell lung cancer patients underwent segmentectomy were matched with non-small cell lung cancer patients who underwent lobectomy. Perioperative factors and tumor relative prognosis were analyzed. ResultsSegmentectomy were performed in 29 patients in our institution. Average operation time was 210 minutes. Intraoperative blood loss was 166 ml. Postoperative drainage was 2 147 ml. The average extubation duration was 6 days. No significant difference was found in operation time (P>0.999), intraoperative blood loss (P=0.207), postoperative drainage (P=0.946), extubation duration (P=0.804), and postoperative complication (P>0.999) between segmentectomy pulmonary benign disease and segmentectomy lung cancer groups. Compared with lobectomy, segmentectomy showed similar operation time (P=0.462), intraoperative blood loss (P=0.783), extubation duration (P=0.072), complication ratio (P>0.999), and postoperative recurrence/metastasis ratio (P=0.417). While the number of N1 lymph nodes (P=0.033) and N1 station (P=0.024) were fewer in the segmentectomy group than those in the lobectomy group. The overall survival rate (P=0.340) and disease free survival rate (P=0.373) were both comparable between the segmentectomy and the lobectomy group. ConclusionSegmentectomy could be an alternate of lobectomy for patients with selective pulmonary benign disease, and for some early stage non-small cell lung cancer patients with restricted pulmonary function.
ObjectiveTo systematically review the postoperative recovery of lung function in patients with early stage non-small cell lung cancer (NSCLC) after different operation, such as lobectomy versus segmentectomy and video-assisted thoracoscopic surgery (VATS) versus traditional open chest surgery.MethodsClinical studies about effect of different surgical methods on lung function in patients with early NSCLC were searched from PubMed, EMbase, The Cochrane Library, CBM and CNKI databases from inception to October 1st, 2016. Two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was conducted by RevMan 5.3 and MetaAnalyst software.ResultsA total of 25 studies involving 2 924 patients were included. The results of meta-analysis showed that: compared with lobectomy group, one-second rate difference (ΔFEV1%) (MD=–0.03, 95%CI –0.03 to –0.03, P<0.001) and predictive value of forced vital capacity difference (ΔFVC%) (MD=–0.09, 95%CI –0.11 to –0.06, P<0.001) of preoperative to postoperative in segmentectomy group were higher. However, there was no significant difference between two groups in first second forced expiratory volume difference (ΔFEV1) (MD=0.01, 95%CI –0.10 to 0.11, P=0.92). Compared with thoracotomy group, VATS group had lower ΔFEV1 (MD=–0.19, 95%CI –0.27 to –0.10, P<0.0001), ΔFVC (MD=–0.20, 95%CI –0.37 to –0.03, P=0.02), ΔFEV1% (MD=–0.03, 95%CI –0.06 to –0.01, P<0.001) of preoperative to postoperative (≤3 months), and maximum minute ventilation (ΔMVV) (MD=–5.59, 95%CI –10.38 to –1.52, P=0.008) of preoperative to postoperative (≥6 months). However, there were no statistically significant differences in difference of carbon monoxide diffusion rate (ΔDLCO%) (MD=–0.04, 95%CI –0.09 to 0.02, P=0.16), ΔFEV1% (MD=–0.02, 95%CI –0.06 to 0.02, P=0.32) and ΔFEV1 (MD=1.13, 95%CI –0.92 to 3.18, P=0.28).ConclusionThe protective effect of segmentectomy on postoperative pulmonary function is better than that of lobectomy. VATS has a protective effect on the ventilation function within 3 months and 6 months after surgery. Due to limited quantity and quality of included studies, the above conclusions are needed to be validated by more high quality studies.
More and more relevant research results show that anatomical segmentectomy has the same effect as traditional lobectomy in the surgical treatment of early-stage non-small cell lung cancer (diameter<2.0 cm). Segmentectomy is more difficult than lobotomy. Nowadays, with the promotion of personalization medicine and precision medicine, three-dimensional technique has been widely applied in the medical field. It has advantages such as preoperative simulation, intraoperative positioning, intraoperative navigation, clinical teaching and so on. It plays a key role in the discovery of local anatomical variation of pulmonary segment. This paper reviewed the clinical application of three-dimensional technique and briefly described the clinical application value of this technique in segmentectomy.
ObjectiveTo compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections.MethodsThe patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed.ResultsThere was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041).ConclusionSegmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.
Objective To summarize the perioperative and long-term outcomes of ground-glass opacity (GGO) dominant early stage lung cancer patients treated by anatomic segmentectomy. Methods We collected clinical data of 756 patients from Western China Lung Cancer Database, who underwent intentional anatomic segmentectomy [tumor size (T) ≤ 2 cm, GGO ≥ 50%] in the Department of Thoracic Surgery, West China Hospital, Sichuan University from 2009 to 2018. There were 233 males and 523 females at a median age of 53 (25-83) years including 290 (38.4%) patients of simple segmentectomy and 466 (61.6%) patients of complex segmentectomy. All patients were diagnosed as adenocarcinoma, including 338 (44.7%) patients of minimally invasive adenocarcinoma and 418 (55.3%) patients of invasive adenocarcinoma. Results The median operative time was 115 (38-300) min, the median blood loss was 20 (5-800) mL, 58 (7.7%) patients had postoperative complications and the postoperative stay was 4 (2-24) days. The median follow-up period was 43.0 (30.1-167.9) months. Five-year overall survival rate was 99.5% [95%CI (98.8%, 100.0%)], 5-year recurrence-free survival rate was 98.8% [95%CI (97.5%, 100.0%)], and 5-year lung cancer-specific survival rate was 100.0%. ConclusionAnatomic segmentectomy has favorable perioperative outcomes and excellent prognosis in GGO dominant early stage lung cancer patients.
ObjectiveTo analyze the effect of indocyanine green (ICG) fluorescence dual-visualization technique on evaluating tumor margins during the thoracoscopic segmentectomy. MethodsA total of 36 patients who underwent thoracoscopic anatomical segmentectomy using ICG fluorescence dual-visualization technique in our hospital from December 2020 to June 2021 were retrospectively included. There were 15 males and 21 females aged from 20 to 69 years. The clinical data of the patients were retrospectively analyzed. ResultsThe ICG fluorescence dual-visualization technique clearly showed the position of lung nodules and the plane boundary line between segments during the operation. There was no ICG-related complication. The average operation time was 98.6±21.3 min, and the average intraoperative bleeding amount was 47.1±35.3 mL, the average postoperative drainage tube placement time was 3.3±2.8 d, the average postoperative hospital stay was 5.4±1.8 d, and the average tumor resection distance was 2.6±0.7 cm. There was no perioperative period death, and one patient suffered a persistent postoperative air leak. ConclusionThe ICG fluorescence dual-visualization technique is safe and feasible for evaluating the tumor margins during thoracoscopic segmentectomy. It simplifies the surgical procedure, shortens the operation time, ensures sufficient tumor margins, and reserves healthy pulmonary parenchyma to the utmost extent, providing reliable technical support for thoracoscopic anatomical segmentectomy.
Whether anatomical segmentectomy can replace lobectomy in the treatment of early-stage lung cancer remains controversial. A large number of studies have been conducted for decades to explore whether pulmonary segmentectomy can treat early-stage lung cancer, which is actually to explore the indications of intentional segmentectomy. With the development of scientific researches, it is found that many characteristics affect the malignancy of lung cancer, and the different grades of each characteristic affect the prognosis of patients. It is worth exploring whether different surgical approaches can be used for early-stage lung cancer with different characteristics and different grades. This article reviews the literature and studies to discuss the advances in indications of segmentectomy for early-stage lung in terms of tumor size, consolidation-to-tumor ratio, pathological classification and tumor location, respectively. The objective of this review is to help thoracic surgeons to objectively and scientifically select the surgical method according to the clinical characteristics of early-stage lung cancer.
With the wide popularization of low-dose computed tomography screening for lung cancer, the proportion of early detection of lung cancer has increased significantly. Due to the favorable prognosis of ground-glass nodule-lung cancer, a prospective multicenter clinical trial in Japan has confirmed the safety and efficacy of segmentectomy. Identification of the intersegmental plane is one of the key steps in segmentectomy. Understanding its physiological mechanism can provide a theoretical basis for optimizing the identification technique, identifying intersegmental plane more accurately and quickly, improving the surgical effect and reducing complications. This article mainly introduces the identification technology of the intersegmental plane and its physiological mechanism in pulmonary segmentectomy.