Optimal planning and management strategies for minimally invasive lung segmentectomies: an international Delphi consensus report

Abstract

OBJECTIVES CALGB140503/JCOG0802 RCTs comparing lobectomy with sublobar resection in stage IA NSCLC have confirmed the non-inferiority of segmentectomy. Additional insight is needed to improve preoperative work-up and intraoperative strategies to increase safety and promote the dissemination of minimally invasive segmentectomy (MIS). A Delphi panel study assessed the level of consensus among surgeons for the planning and management of MIS. METHODS Twenty-one expert lung surgeons represented academic institutions, major teaching hospitals, and community hospitals from Europe, North America, and Asia. A three-round Delphi methodology was employed to analyse the answers of each panellist. Recognising that questions with fewer response options have a higher consensus probability due to limited variability, weighted consensus thresholds were modified based on the number of response options. RESULTS The 21 panellists responded to all three rounds of questions. Based on the most robust consensus (94.4%), 3-D chest CT reconstructions are recommended only when planning complex segmentectomies. Surgeons should perform 3-D reconstructions chest CT scans (consensus = 83.3%). The most effective and safest technique is image-guided VATS in a hybrid operating room (consensus = 83.3%). Dyes with intravenous administration are the safest technique for identifying the intersegmental plane during MIS (consensus = 72.2%). Augmented/mixed reality will probably not immediately help reduce perioperative complications (consensus = 72.2%). CONCLUSIONS This Delphi Consensus supports 3-D reconstructions and preoperative pulmonary nodule localisation before complex MIS. These recommendations should be considered when allocating resources to improve MIS's safety and oncologic efficacy for patients with small, early-stage lung cancers.