The data suggest that the inflection point for the learning curve was achieved after 84 cases in our institution. Therefore, increased aptitude with video-assisted thoracic surgery is achievable within a relatively short time.

With the recent increase in the detection of small-sized lung nodules because of the widespread use of computed tomography (CT), limited resection and minimally invasive surgery are preferred by patients with these lesions. In particular, the detection of nodules that show ground-glass opacity during high-resolution CT has increased. Although lobectomy and lymph node dissection were the standard procedures used for treating lung cancer, limited wedge resection and segmentectomy have become acceptable for treating small-sized lung cancers with nodules showing ground-glass opacity. These limited procedures are widely performed, especially because they can be accomplished thoracoscopically.Furthermore, not only simple segmentectomy but also complex segmentectomy and subsegmentectomy can be performed using three-dimensional (3D)-CT to achieve sufficient resection based on tumor size.There are, however, technical difficulties in thoracoscopic wedge resection and segmentectomy. While it may be curative for small-sized lung nodules, it is sometimes difficult to correctly perform wedge resection when the tumor is not identified intraoperatively. In such cases, we usually perform tumor marking before operating. However, serious complications, such as cerebral air embolism, have been reported. Further, although it can sufficiently resect small-sized lung nodules, segmentectomy is more technically complex than wedge resection. Therefore, we have developed methods to overcome these technical difficulties. By using a hookwire method in a hybrid operating room and 3D-CT simulation for each wedge resection and segmentectomy, we have obtained good outcomes. Limited resection individualized for each patient will continue to evolve with applications such as CT. indeterminate lesions or cure small-sized GGO-dominant lung tumors, because the procedure is simple and easy (5). Although segmentectomy is generally thought to be more complex than wedge resection, the oncological outcomes of segmentectomy in a propensity-matched study were comparable to those of lobectomy for patients with earlystage non-small lung cell cancer (6). Segmentectomy has thus become widely used worldwide (7).If limited resection is possible for a small-sized lung nodule, a thoracoscopic approach is a highly desirable, minimally invasive option (8,9). The thoracoscopic approach has better outcomes than thoracotomy with regard to quality of life and complications, and is preferred over thoracotomy for its advantages of decreased postoperative pain, shortened chest-tube duration, shortened length of hospital stay, faster return to preoperative activity levels, and preserved pulmonary function (8,9).The combination of limited resection and minimally invasive surgery is, therefore, in great demand. In our institute, limited resection is preferred for small-sized GGO-dominant tumors. The aim of this article is to describe the role of limited thoracoscopic wedge resection and segmentectomy for small-sized lung nodules, with reference to recent literature. ...

Ligation can be used safely for small-diameter segmental bronchial stump closures in anatomic lung segmentectomies or subsegmentectomies. The use of a polymer clip can be an alternative method to close the bronchial stump of subsegmentectomies.

Background: Although a well-acknowledged component of curative surgery for lung cancer, investigators have recently questioned the need for mediastinal lymph node dissection (MLND) in early-stage lung cancer cases. As such, the accurate prediction of N2 stage prior to surgery has become increasingly critical. But diagnostic biomarkers predicting N2 metastases are deficient, which are urgently needed.Methods: We extracted the data of non-small cell lung cancer (NSCLC) patients whose clinical information and follow-up data are complete and without preoperative induction therapy from the Surveillance, Epidemiology, and End Results (SEER) database. The SEER program registries routinely collect demographic and clinic data on patients. And the prognostic differences were analyzed according to the presence or absence of MLND in their lung resection using the R package. Subsequently, the correlations between pN2 metastasis and clinical characteristics were analyzed. In parallel, the long noncoding RNAs (lncRNAs) associated with pN2 status were screened in The Cancer Genome Atlas (TCGA) database by expression difference analysis between pN0-N1 and pN2 patients using limma. Their diagnostic efficiency for detecting N2 metastases was evaluated using receiver operating characteristic (ROC) curves, and a combined diagnostic model was constructed using logistic regression and ROC curve analyses in lung adenocarcinoma (LUAD).Results: There were 16,772 patients in MLND group, and 2,699 cases in no-MLND group. The clinical data from SEER showed that the incidence of N2 metastasis was low in pT1 NSCLC (1,023/16,772, 6.10%), but the prognosis of no-MLND patients was poorer than those who underwent MLND (P<0.001, HR =1.605). Pathological N2 metastasis was correlated with age, histologic type, and tumor size. On the other hand, five lncRNAs (LINC00892, AC099522.2, LINC01481, SCAMP1-AS1, and AC004812.2) were screened and confirmed as potential diagnostic biomarkers for detecting N2 metastasis in pT1 LUAD. The AUC of the combined indicators was 0.857.Conclusions: MLND may be oncologically necessary for selected T1 NSCLC patients based on the

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