As the incidence of lung cancer continues to rise, segmentectomy has emerged as a favored surgical technique for treating selective early-stage non-small cell lung cancer patients, gaining increasing support from thoracic surgery specialists. However, there remains a deficiency in clinical guidance concerning indications and other related aspects for segmentectomy. In April 2023, a collaborative effort among 15 Asia thoracic surgery experts led to the publication of the "Asian expert consensus on segmentectomy in non-small cell lung cancer: A modified Delphi study". This study presents a total of 36 expert consensus agreements across three aspects: patient indications, surgical approaches, lymph node assessment, outlining key principles of them. This paper intends to provide a brief interpretation of these consensuses for the reference of colleagues in clinical practice.
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 investigate the changes in pulmonary function after video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS) segmentectomy.MethodsA total of 59 patients (30 males and 29 females) who underwent segmentectomy in the Affiliated Hospital of Qingdao University from July to October 2017 were included. There were 33 patients (18 males and 15 females) in the VATS group and 26 patients (12 males and 14 females) in the RATS group. Lung function tests were performed before surgery, 1 month, 6 months, and 12 months after surgery. Intra- and inter-group comparisons of lung function retention values were performed between the two groups of patients to analyze differences in lung function retention after VATS and RATS segmentectomy.ResultsThe forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) in the VATS group and the RATS group were significantly lower than those before surgery (P<0.05), and they increased significantly within 6 months after surgery (P<0.05). The recovery was not obvious after 6 months (P>0.05), and they were still lower than those before surgery. In addition, the retentions of FEV1 and FVC in the VATS group and the RATS group were similar in 1 month, 6 months, and 12 months after operation with no statistical difference(P>0.05). ConclusionPulmonary function decreases significantly in 1 month after minimally invasive segmentectomy, and the recovery is obvious in 6 months after the operation, then the pulmonary function recovery gradually stabilizes 12 months after surgery. FEV1 of the patients in the two groups recovers to 93% and 94%, respectively. There is no statistical difference in pulmonary function retention after VATS and RATS segmentectomy.
Objective To make a survival analysis for the stage ⅠA non-small cell lung cancer patients who underwent lobectomy, segmentectomy or wedge resection and to discuss whether the segmentectomy and wedge resection can be used as a conventional operation. Methods The clinical data of 474 patients diagnosed with ⅠA non-small cell lung cancer from January 2012 to June 2015 in the First Affiliated Hospital of China Medical University were retrospectively anlyzed. There were 192 males and 282 females with a mean age of 60 years. Their sex, age, histological type, tumor size, surgical pattern, smoking, drinking, survival rate, disease-free survival rate, recurrence rate were compared. Results Disease-free survival rate of patients with wedge resection was significantly lower than that of the patients undergoing lobectomy and segmentectomy (P<0.05). When tumor diameter≤19 mm, the disease-free survival rate of patients with wedge resection was lower than that of patients with lobectomy (P=0.006) and segmentectomy (P=0.065). Disease-free survival rate of patients with tumor diameter of 20-<30 mm was significantly lower than that of patients with tumor diameter≤19 mm (P=0.026). Excluding patients with wedge resection, disease-free survival of the patients with lobectomy and segmentectomy and tumor diameter of 20-<30 mm was significantly lower than that of patients with tumor diameter≤19 mm (P=0.036). Patients with wedge resection had significant higher risk of local recurrence than that of patients undergoing lobectomy (P<0.001) and segmentectomy (P=0.002). Conclusion StageⅠA non-small cell lung cancer patients undergoing segmentectomy can obtain approximate survival and disease-free survival rate compared with those with lobectomy, especially in patients with tumor diameter≤19 mm. Pulmonary wedge resection as surgical treatment of lung cancer patients must be selected carefully according to the actual situation and surgical purposes.
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 analyze the application effects of artificial intelligence (AI) software and Mimics software in preoperative three-dimensional (3D) reconstruction for thoracoscopic anatomical pulmonary segmentectomy. MethodsA retrospective analysis was conducted on patients who underwent thoracoscopic pulmonary segmentectomy at the Second People's Hospital of Huai'an from October 2019 to March 2024. Patients who underwent AI 3D reconstruction were included in the AI group, those who underwent Mimics 3D reconstruction were included in the Mimics group, and those who did not undergo 3D reconstruction were included in the control group. Perioperative related indicators of each group were compared. ResultsA total of 168 patients were included, including 73 males and 95 females, aged 25-81 (61.61±10.55) years. There were 79 patients in the AI group, 53 patients in the Mimics group, and 36 patients in the control group. There were no statistical differences in gender, age, smoking history, nodule size, number of lymph node dissection groups, postoperative pathological results, or postoperative complications among the three groups (P>0.05). There were statistical differences in operation time (P<0.001), extubation time (P<0.001), drainage volume (P<0.001), bleeding volume (P<0.001), and postoperative hospital stay (P=0.001) among the three groups. There were no statistical differences in operation time, extubation time, bleeding volume, or postoperative hospital stay between the AI group and the Mimics group (P>0.05). There was no statistical difference in drainage volume between the AI group and the control group (P=0.494), while there were statistical differences in operation time, drainage tube retention time, bleeding volume, and postoperative hospital stay (P<0.05). ConclusionFor patients requiring thoracoscopic anatomical pulmonary segmentectomy, preoperative 3D reconstruction and preoperative planning based on 3D images can shorten the operation time, postoperative extubation time and hospital stay, and reduce intraoperative bleeding and postoperative drainage volume compared with reading CT images only. The use of AI software for 3D reconstruction is not inferior to Mimics manual 3D reconstruction in terms of surgical guidance and postoperative recovery, which can reduce the workload of clinicians and is worth promoting.
ObjectiveTo analyze the feasibility, advantages and disadvantages of the fluorescence method and the inflation-deflation method in defining the intersegmental plane during thoracoscopic lung segmental resection.MethodsFrom February to October 2018, 60 patients underwent thoracoscopic anatomical segmentectomy in Thoracic Surgery Department of Nanjing Chest Hospital, with 28 males and 32 females, aged from 25 to 82 years. Three-dimension computed tomography bronchography and angiography was used to reconstruct pulmonary vessels, bronchus and virtual intersegmental plane. Among them, 20 patients used the fluorescence method to define the intersegmental plane, and the other 40 patients used the traditional inflation-deflation method to define the intersegmental plane.ResultsFluorescent injection of indocyanine green (ICG) showed a clear intersegmental line with a duration sufficient to complete the label. With the fluorescence method, the intersegmental plane occurrence time was significantly shortened (10.75±3.78 s vs. 988.00±314.24 s, P<0.001) and had satisfactory repeatability. The lungs did not need to be inflated, which was convenient for the operation. And the operation time was shortened (108.75±31.28 min vs 138.00±32.47 min, P=0.002). No obvious ICG injection-related concurrency symptoms was found.ConclusionCompared with the traditional inflation-deflation method, the fluorescence method can display the intersegmental line quickly, accurately and clearly, reduce the difficulty of surgery, shorten the operation time, and provide reliable technical support for thoracoscopic anatomical segmentectomy. The fluorescence is a safe and effective method that is worthy of clinical application.
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.
ObjectiveTo explore the clinical application value of simple artery occlusion (SAO) in revealing intersegmental planes during thoracoscopic pulmonary segmentectomy. MethodsA retrospective analysis was conducted on the clinical data of patients who underwent thoracoscopic pulmonary segmentectomy at the First Affiliated Hospital of Xiamen University from February 2022 to December 2023. Patients were divided into a conventional group and a SAO group based on the method used to reveal the intersegmental plane during surgery. The two groups were compared in terms of intraoperative blood loss, operation time, postoperative drainage volume, time to intubation, postoperative pulmonary air leakage, and conversion to open thoracotomy rate. ResultsA total of 318 patients were included. There were 181 patients in the conventional group, including 86 males and 95 females, with an average age (53.35±9.20) years, and there were 137 patients in the SAO group, including 58 males and 79 females, with an average age (55.26±11.46) years. There were no statistical differences in general patient information between the two groups (P>0.05). The SAO group had less intraoperative blood loss [MD=17.568, 95%CI (9.968, 25.168), P<0.001] and postoperative drainage volume [MD=275.587, 95%CI (188.999, 362.175), P<0.001], shorter drainage tube duration [MD=1.000, 95%CI (1.000, 2.000), P<0.001] and operation time [MD=20.709, 95%CI (16.258, 25.159), P<0.001]. The incidence of postoperative pulmonary air leakage complications in the SAO group was lower than that in the conventional group [RR=0.361, 95%CI (0.181, 0.722), P=0.003]. ConclusionSAO can reduce surgical difficulty, shorten operation time, decrease the incidence of postoperative pulmonary air leakage, and enhance the safety of anatomical pulmonary segmentectomy, making it worthy of clinical promotion and application.