Complex segmentectomy is not a complex procedure relative to simple segmentectomy

Okubo, Yu; Yoshida, Yukihiro; Yotsukura, Masayuki; Nakagawa, Kazuo; Watanabe, Shun‐ichi

doi:10.1093/ejcts/ezab367

Cited by 17 publications

(12 citation statements)

References 18 publications

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“…Complex segmentectomies can be more challenging to perform as vessels and bronchi must be dissected to the periphery and include several intersegmental planes in three dimensions. Although several reports have described complex segmentectomy to be equally safe as simple segmentectomy ( 15 , 16 ), whether U-VATS complex segmentectomy can also be performed just as safely is unclear.…”

Section: Introductionmentioning

confidence: 99%

Uniportal thoracoscopic pulmonary segmentectomy provides good perioperative results and early postoperative recovery

Numajiri¹,

Matsuura²,

Igai³

et al. 2022

J Thorac Dis

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Background: Although video-assisted thoracoscopic surgery (VATS) segmentectomy has become widespread, the advantage of uniportal VATS (U-VATS) segmentectomy over multiportal VATS (M-VATS) remains controversial. The purpose of this study was to verify the safety and usefulness of U-VATS segmentectomy compared with conventional hybrid/multiportal segmentectomy.Methods: Here, we retrospectively reviewed the data from anatomical pulmonary segmentectomy cases in a single institution from March 2010 to March 2021. Patients were divided into the U-VATS and hybrid/ multiportal VATS (H/M-VATS) groups. Perioperative results were compared between the groups after matching for patient background characteristics. In addition, cases of complex segmentectomy were selected from each group and compared in terms of perioperative results.Results: A total of 180 patients underwent pulmonary segmentectomy during the study period at this institution, comprising 57 cases in the U-VATS group and 123 cases in the H/M-VATS group. After matching for age, sex, disease, tumor location, and type of segmentectomy, no significant differences between the groups were seen in blood loss, major intraoperative bleeding, rate of conversion to thoracotomy, postoperative complications, or re-hospitalization within 30 days after discharge. Operation time (141±46 vs.174±45 min, P<0.001), postoperative drainage duration (1.5±1.2 vs. 2.3±1.8 days, P=0.007), and postoperative hospital stay (3.4±2.0 vs. 4.6±2.5 days, P=0.006) were significantly lower in the U-VATS group. Subgroup analysis of the complex segmentectomy cases also revealed that operation time (146±34 vs. 185±47 min, P<0.001), postoperative drainage duration (1.5±1.3 vs. 2.2±1.2 days, P=0.021), and postoperative hospital stay (3.0±1.4 vs. 4.9±2.1 days, P<0.001) were significantly reduced in the U-VATS group.Conclusions: U-VATS segmentectomy appears as safe and feasible as H/M-VATS segmentectomy. An experienced surgeon can make a smooth transition to U-VATS.

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Section: Introductionmentioning

confidence: 99%

Uniportal thoracoscopic pulmonary segmentectomy provides good perioperative results and early postoperative recovery

Numajiri¹,

Matsuura²,

Igai³

et al. 2022

J Thorac Dis

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“…In recent years, segmentectomy has been considered to be a more advantageous surgical method for treating small lung nodules ( 6 , 29 , 30 ). However, not precision resection of lung segments often leads to inadequate surgical margins, especially in complex situations ( 31 , 32 ). Moreover, studies comparing not precision resection of lung segments with lobectomy have yielded conflicting results ( 33 , 34 ).…”

Section: Discussionmentioning

confidence: 99%

The safety and efficacy of the fissure-first approach in lung segmentectomy for patients with incomplete fissures

Zhu,

Zheng,

Chen

et al. 2024

Front. Oncol.

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BackgroundLung segmentectomy has gained much more attention as an important surgical method for treating early-stage lung cancer. However, incomplete fissures increase the difficulty of lung segmentectomy. The aim of this study was to analyze the safety and efficacy of the fissure-first approach in precision resection of lung segments for patients with incomplete fissures.MethodsThe clinical data of patients with incomplete fissures who underwent lung segmentectomy were retrospectively analyzed. Date was divided into fissure-first approach in lung segmentectomy group (group A) and fissure-last approach in lung segmentectomy group (group B). The general linear data, operation times, intraoperative adverse events, postoperative recovery dates and complications were compared.ResultsA total of 122 patients with complete clinical data were included. Patients in group B had more COPD (p < 0.05), and the lesions in group A were more closely related to the hilum of the lung (p < 0.05). Compared to Group B, Group A achieved better surgical outcomes, such as operation time, postoperative hospital stays, intraoperative bleeding, number of intrapulmonary lymph nodes sampled, counts of resected subsegments (except the upper lobe of the right lung), and rate of conversion to thoracotomy (all p < 0.05).ConclusionThe fissure-first approach is a safe and effective surgical approach in lung segmentectomy for patients with incomplete fissures. This approach can reduce the counts of resected subsegments and improve techniques in lung segmentectomy for patients with lung incomplete fissures.

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“…Furthermore, Okubo and colleagues discovered that the complex segmentectomy group had surgical margins that were closer, measuring 22 mm (IQR, 14–30 mm), as opposed to the simple segmentectomy group, which had margins of 25 mm (IQR, 17–35 mm). Consequently, they recommended that surgeons exercise caution and strive to achieve sufficient surgical margins ( 17 ). With a greater accumulation of complex segmentectomy cases, our current study revealed that there were no significant differences between the two groups regarding the distance of surgical margins.…”

Section: Discussionmentioning

confidence: 99%

Learning curve for complex segmentectomy via uniportal video-assisted thoracoscopic surgery for the treatment of early-stage lung cancer

Ahn,

Moon

2024

J Thorac Dis

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Background Recently, segmentectomy has emerged as a viable treatment option for early-stage lung cancer. Segmentectomy can be divided into simple segmentectomy and complex segmentectomy. While simple segmentectomy is a relatively straightforward surgical procedure, complex segmentectomy poses a considerable challenge because of its intricate anatomical variations and the need for a complex surgical approach. The introduction of uniportal video-assisted thoracoscopic surgery (VATS) further complicates matters. This study aimed to assess whether thoracic surgeons, who have previously conducted only uniportal VATS lobectomy and simple segmentectomy, could effectively navigate the learning curve when undertaking their first complex segmentectomy procedure. Methods A single surgeon with experience limited to uniportal VATS lobectomy and simple segmentectomy began performing uniportal VATS complex segmentectomy in 2019, completing 167 cases of complex segmentectomy during the same period and performing 70 cases of simple segmentectomy. We analyzed the learning curve by comparing the surgical outcomes and operative time curves between simple segmentectomy and complex segmentectomy. Results The complex segmentectomy group exhibited similarities with the simple segmentectomy group in terms of patient and tumor characteristics, operative outcomes, and postoperative outcomes, with the exception of the complex segmentectomy group showing slightly reduced chest tube drainage and shorter hospital stays. The operative times and time curve patterns showed no significant difference between the two groups, indicating a potential lack of a distinct learning curve for complex segmentectomy. Conclusions Complex segmentectomy via uniportal VATS, when performed by surgeons proficient in simple segmentectomy and lobectomy techniques, has comparable outcomes and potentially eliminates the need for an extensive learning curve. This approach expands the options for treating early-stage non-small-cell lung cancer (NSCLC), allowing for tailored patient care. Further studies are needed to assess long-term outcomes.

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Complex segmentectomy is not a complex procedure relative to simple segmentectomy

Cited by 17 publications

References 18 publications

Uniportal thoracoscopic pulmonary segmentectomy provides good perioperative results and early postoperative recovery

Uniportal thoracoscopic pulmonary segmentectomy provides good perioperative results and early postoperative recovery

The safety and efficacy of the fissure-first approach in lung segmentectomy for patients with incomplete fissures

Learning curve for complex segmentectomy via uniportal video-assisted thoracoscopic surgery for the treatment of early-stage lung cancer

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