Comparison of Thoracoscopic Segmentectomy and Thoracoscopic Lobectomy for Small-Sized Stage IA Lung Cancer

Zhong, Caiyun; Fang, Wentao; Mao, Teng; Yao, Feng; Chen, Wenhu; Hu, De Jin

doi:10.1016/j.athoracsur.2012.04.047

Cited by 132 publications

(120 citation statements)

References 19 publications

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“…Within 2 months after surgery, segmentectomy spared 3-10% of initial FEV1, and after 12 months, 4-7% (difference between the loss induced by lobectomy and the loss induced by segmentectomy). Interestingly, results from a few studies suggest that this functional benefit may not translate into lower rates of post-operative complications, regardless of the procedure used, open [4,8,11,14] or VATS [6,[20][21][22].…”

Section: Commentsmentioning

confidence: 99%

Lung segmentectomy: does it offer a real functional benefit over lobectomy?

Charloux

Quoix

2017

Eur Respir Rev

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@ERSpublicationsLung segmentectomy offers mild post-operative to small long-term functional benefits over lobectomy http://ow.ly/dcPQ30fuCU9Cite this article as: Charloux A, Quoix E. Lung segmentectomy: does it offer a real functional benefit over lobectomy ? Eur Respir Rev 2017; 26: 170079 [https://doi.org/10.1183/16000617.0079-2017.ABSTRACT Anatomical segmentectomy has been developed to offer better pulmonary function preservation than lobectomy, in stage IA lung cancer. Despite the retrospective nature of most of the studies and the lack of randomised studies, a substantial body of literature today allows us to evaluate to what extent lung function decreases after segmentectomy and whether segmentectomy offers a real functional benefit over lobectomy. From the available series, it emerges that the mean decrease in forced expiratory volume in 1 s (FEV1) is low, ranging from −9% to −24% of the initial value within 2 months and −3 to −13% 12 months after segmentectomy. This reduction in lung function is significantly lower than that induced by lobectomy, but saves only a few per cent of pre-operative FEV1. Moreover, the published results do not firmly establish the functional benefit of segmentectomy over lobectomy in patients with poor lung function. Some issues remain to be addressed, including whether video-assisted thoracic surgery (VATS) segmentectomy may preserve lung function better than VATS lobectomy in patients with poor lung function, especially within the early days after surgery, and whether this may translate to lowering the functional limit for surgery. Eventually, trials comparing stereotactic ablative body radiotherapy, radiofrequency ablation and segmentectomy functional consequences are warranted.

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Section: Commentsmentioning

confidence: 99%

Lung segmentectomy: does it offer a real functional benefit over lobectomy?

Charloux

Quoix

2017

Eur Respir Rev

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“…Specific indications for lung segment resection as follows (8)(9)(10)(11): (I) IA in peripheral lung shadows, maximum diameter as follows especially for elder patients with compromised pulmonary function 2 cm from the cutting edge); (II) tumor solid component ratio maximum diameter as follows esive adenocarcinoma, Calculation method is the maximum diameter mediastinal window tumor solid components/the maximum diameter of lung window tumor; (III) high-resolution CT showed no swelling lymph nodes in mediastinal and pulmonary hilar and (or) FDG-PET show no tracer concentration in lymph node of mediastinal and pulmonary hilar; (IV) intraoperative frozen pathology showed lesions are atypical adenomatous hyperplasia, lung adenocarcinoma in situ, tiny invasive adenocarcinoma and adherent growth-oriented invasive adenocarcinoma, and N1, N2 lymph nodes and the cutting edge are negative, also can be used for cytology pathology after washing the edge of Endo-GIA stapler to exclude the possibility of positive margin; (V) involving the different lobe nodules require surgery over the same period; (VI) poor cardiopulmonary function, first second forced expiratory volume percentage of predicted value <50%; (VII) age >75 years, limited lung function compensation after surgery; (VIII) more complications ,cannot do lobectomy; (IX) the patient's own choice; (X) as a surgery method for cancer recurrent in lobectomy.…”

Section: Discussionmentioning

confidence: 99%

Anatomical video-assisted thoracoscopic surgery segmentectomies based on the three-dimensional reformation images

Bao

Zhang

et al. 2017

J. Vis. Surg.

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Segmentectomy was first done in 1939 by Churchill and Belsey in 1939. Video-assisted thoracoscopic surgery (VATS) segmentectomies are still more technically challenging than VATS lobectomies. With the increasing rate of early stage lung carcinomas, the thoracoscopic segmentectomies may have a major role in a near future. Four anatomical VATS segmentectomy videos clips were shared in this study. CT three-dimensional reformation could exactly show the small pulmonary nodule's precise position, clarifies the surrounding structures' relationship like the pulmonary artery (PA), pulmonary vein (PV), bronchus (B), fissure, and lymph nodes. Besides, the resection margin, skin incision, surgical approach can also be designed preoperatively. This feasible technique could increase the confidence for thoracic surgeons. Unnecessary explore time waste for locating small pulmonary nodules during the operation can be avoid, so the surgical accuracy can be improved, complications can be prevented, the duration of chest tube and length of hospital stay can be shortened.Keywords: Video-assisted thoracoscopic surgery (VATS); segmentectomy; three-dimensional reformation image Case No. 2: a 67-year-old male was admitted due to "lower extremity pain for more than one year". Chest CT: left upper lobe mass with the size of 3.0 cm × 3.5 cm, pulmonary function tests: FEV1 3.1 L (94%). He received VATS left upper lobe anterior segmentectomy. Operation hole: 4 cm incision in the left 4 th intercostal on the anterior axillary line; observation hole: 1.5 cm incision at the 7 th intercostal space on the left mid-axillary line. The operation took 5 hours, blood loss was 400 mL due to serious chest cavity adhesion. Postoperative complications were not observed, and he discharged on the 6 th day postoperatively.Pathology: bronchiolitis obliterans organizing pneumonia, BOOP ( Figure 3). Case No. 3: a 71-year-old female was admitted due to a ground glass opacity (GGO) was found after chest CT screening. The size of the GGO (1.5 cm × 1.2 cm) located in the superior segment of the left lower lobe (Figure 4 intercostal space on the left inferior angle line of scapula. Operation time took 2 hours, blood loss was 100 mL. There were no postoperative complications. She was discharged on the 7 th day postoperatively. Pathology: invasive adenocarcinoma, lepidic growth predominant (90%), T1bN0M0, stage IA2. No signs of recurrence or metastasis were found in 2 years' follow-up ( Figure 5). Case No. 4: a 73-year-old woman was admitted for founding a GGO during the screening test (1.0 cm × 1.0 cm) ( Figure 6). Her pulmonary function result was FEV1: 1.51 L (54.7% predicted). She was a non-smoker, with negative bronchoscopy findings. There were no positive past medical history and co-morbidities. The first 1.5 cm incision was selected in the eighth intercostal space in the midaxillary line, and was used for the camera (30 degree 10 mm high definition video thoracoscope). A 4-cm long incision was made in the fourth intercostal space in the preaxillary ...

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“…По данным С. Zhong и соавт. [39], по-сле торакоскопической сегментэктомии при НМРЛ менее 2 см показатели общей и безрецидивной 5-летней выжи-ваемости были сопоставимы с таковыми при торакоско-пической лобэктомии: 79,9 и 59,4%, против 81,0 и 64,2% соответственно. На частоту внутригрудных рецидивов не оказывал влияние объем торакоскопической опера-ции (5,1% при сегментэктомии и 4,9% при лоб эктомии), его диагностировали не позднее 24 мес после лечения.…”

Section: авторыunclassified

“…На частоту внутригрудных рецидивов не оказывал влияние объем торакоскопической опера-ции (5,1% при сегментэктомии и 4,9% при лоб эктомии), его диагностировали не позднее 24 мес после лечения. Многофакторный анализ безрецидивной выживаемости 120 больных установил неблагоприятное влияние на про-гноз только размер опухоли (p=0,039; OP=1,79; 95% ДИ 1,031-3,112) [39]. По мнению авторов, если опухоль более 2 см или она расположена на границе сегментов, а рассто-яние от новообразования до предполагаемой линии резек-ции легочной ткани менее 2 см, или обнаружены метаста-зы в лимфатических узлах корня сегмента, целесообразно расширить объем операции до лобэктомии.…”

Section: авторыunclassified

Surgical treatment in patients with Stage I peripheral non-small cell lung cancer: Results, prognosis, prospects

Колбанов¹,

Trakhtenberg²,

Пикин³

et al. 2016

Onkol. Z. im. P.A. Gercena

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Хирургическое лечение больных периферическим немелкоклеточным раком легкого I стадии: результаты, прогноз, перспективы К.И. Колбанов, а.Х. ТраХТенберг , о.в. ПИКИн, в.а. глушКо, в.а. багров Московский научно-исследовательский онкологический институт им. П.а. герцена -филиал Фгбу «национальный медицинский исследовательский радиологический центр» (дир. -чл.-корр. ран а.Д. Каприн) Минздрава россии, Москва, россия у функционально операбельных больных немелкоклеточным раком легкого (нМрл) методом выбора считают хирургиче-ское лечение, минимальный объем которого лобэктомия с медиастинальной лимфаденэктомией. Цель исследования -ретроспективная оценка результатов хирургического лечения больных периферическим нМрл Т1-2аN0M0 с учетом объема операции и ряда других клинико-морфологических факторов. Материал и методы. в анализ включены 363 паци-ента c периферическим нМрл до 4 см без метастазов в лимфатических узлах, которым выполнены лобэктомия (91,2%), сегментэктомия (3,6%) и неанатомическая резекция легкого (5,2%). Средний возраст больных составил 59,8 года, преоб-ладали мужчины (80,2%). опухоль относительно чаще локализовалась в правом легком (54,0%) и верхних долях (66,1%). у 188 пациентов диагностирована IA стадия (pT1а-bN0M0), у 175 -IB (рT2aN0M0). аденокарцинома выявлена у 47,4% больных, плоскоклеточный рак -у 39,2%, крупноклеточный -у 5,8%, аденоплоскоклеточный -у 6,0% и мукоэпидермо-идный -у 1,6%. Результаты. Послеоперационные осложнения диагностированы у 10,2% пациентов, летальность соста-вила 1,4%. общая 5-летняя выживаемость больных достигала 71%: при Т1a-b -76,1%, Т2а -67,1% (р>0,05). лучшие показатели наблюдались при плоскоклеточном раке (77,5%) и аденокарциноме (68,0%; р>0,05), более низкие -крупно-клеточном раке (50,4%; р=0,03). установлен неблагоприятный прогноз у больных после неанатомической резекция легко-го (43,8%; р<0,001) по сравнению с лобэктомией, выполненной из трансторакального доступа (72,4%) и сегментэктоми-ей (81,5%, р>0,05). Показатель общей 5-летней выживаемости после видеоторакоскопической лобэктомии сопоставим (77,6%) с таковым при торакотомных. При многофакторном анализе подтверждено негативное влияние на отдаленные результаты хирургического лечения морфологического типа нМрл и объема операции. Заключение. К неблагоприятным клинико-морфологическим факторам прогноза хирургического лечения больных нМрл (Т1-2аN0M0) следует относить крупноклеточный рак легкого и операцию в объеме неанатомической сублобарной резекции. Сегментэктомию как стан-дарт объема лечения можно рассматривать только у больных нМрл T1aN0M0. surgical treatment, the minimal volume of which is lobectomy with mediastinal lymphadenectomy, is considered the method of choice in functionally operable patients with non-small cell lung cancer (NsClC). Objective: to retrospectively assesse the results of surgical treatment in patients with peripheral NsClC (T1-2aN0M0) in view of the volume of surgery and a number of other clinical and morphological factors. Subjects and methods. The analysis included 363 patients with a peripheral NsCl...

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Comparison of Thoracoscopic Segmentectomy and Thoracoscopic Lobectomy for Small-Sized Stage IA Lung Cancer

Cited by 132 publications

References 19 publications

Lung segmentectomy: does it offer a real functional benefit over lobectomy?

Lung segmentectomy: does it offer a real functional benefit over lobectomy?

Anatomical video-assisted thoracoscopic surgery segmentectomies based on the three-dimensional reformation images

Surgical treatment in patients with Stage I peripheral non-small cell lung cancer: Results, prognosis, prospects

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