Video-assisted thoracoscopic surgery (VATS) segmentectomy for small peripheral lung cancer tumors: intermediate results

Shiraishi, Takeshi; Shirakusa, Takayuki; Iwasaki, Atsushi; Hiratsuka, Masafumi; Yamamoto, Satoshi; Kawahara, Katsunobu

doi:10.1007/s00464-003-9269-4

Cited by 34 publications

(41 citation statements)

References 22 publications

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“…VATS is less invasive and provides benefits due to the rapid postoperative recovery and shortening the hospital stay. 4) We have reported that VATS segmentectomy for early stage lung cancer is a good surgical option when the patient is well-selected 5,6) ; however, VATS sublobar resection as definitive management for early stage lung cancer remains controversial and might be associated with increased local recurrence rates.…”

Section: Introductionmentioning

confidence: 99%

Ki-67 Labeling Index Is Associated with Recurrence after Segmentectomy under Video-assisted Thoracoscopic Surgery in Stage I Non-small Cell Lung Cancer

Yamashita

Moroga

Tokuishi

et al. 2011

Ann Thorac Cardiovasc Surg

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In the relapsed patients, 3 (6.8%) were local recurrences and 2 (4.5%) were distant metastases. There was no significant difference between clinicopathological factors and recurrence; however, patients with Ki-67 LI less than 5% showed better disease-free survival than patients with Ki-67 LI over 5% (p = 0.04). In multivariate Cox regression analysis, although there was no significantly different in disease-free survival by age, histology, tumor size, only Ki-67 LI showed a significant prognostic factor of recurrence (HR = 12.5, 95% CI = [1.1-1407], p = 0.04). Conclusions: Ki-67 LI after VATS segmentectomy was a prognostic factor of disease-free survival in NSCLC and the treatment of choice for patients with positive LI may be considered, in addition to adjuvant chemotherapy, or lobectomy.

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Section: Introductionmentioning

confidence: 99%

Ki-67 Labeling Index Is Associated with Recurrence after Segmentectomy under Video-assisted Thoracoscopic Surgery in Stage I Non-small Cell Lung Cancer

Yamashita

Moroga

Tokuishi

et al. 2011

Ann Thorac Cardiovasc Surg

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“…Our surgical technique is similar to a previous report 8) ; if necessary, a utility access port of 3-4 cm in length was added to the 4 ports. All procedures were performed by visualization through a monitor, so-called complete VATS or total thoracoscopy.…”

Section: Surgical Techniquementioning

confidence: 84%

Thoracoscopic Segmentectomy with Intraoperative Evaluation of Sentinel Nodes for Stage I Non-Small Cell Lung Cancer

Moroga

Yamashita

Tokuishi

et al. 2012

Ann Thorac Cardiovasc Surg

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Objectives: Segmentectomy is the treatment of choice for small-sized non-small cell lung cancer (NSCLC); however, it is difficult to decide the surgical procedure because accurate evaluation of hilar lymph node metastasis remains unclear. We here report the outcome of video-assisted thoracic surgery (VATS) segmentectomy with and without the assessment of sentinel nodes. Materials and Methods: Eighty-three patients with stage IA NSCLC underwent VATS segmentectomy between January 2003 and December 2010. Twenty patients underwent indocyanine green fluorescence imaging for sentinel node biopsy (SNB) and 63 did not. Intraoperative real-time quantitative RT-PCR to determine the expression of CK-19 was used for evaluation of metastasis. Perioperative outcome, local recurrence rates and survival were compared in both groups. Results: Sentinel lymph nodes were identified in 16 of 20 patients (80%) with segmentectomy in the SNB group. The false negative rate was 0%. By RT-PCR for CK-19 expression, only one of these patients showed positive sentinel nodes, which indicated isolated tumor cells; however, segmentectomy was not converted to lobectomy. Seven of 63 patients with VATS segementectomy without SNB and none of the SNB group relapsed. In the relapsed patients without SNB, 4 (6.3%) were local recurrences and 3 (4.7%) were distant metastases. Recurrence-free survival rates in both groups were not significantly different because of the short follow-up period of the SNB group. Conclusions: Our study demonstrated that VATS segmentectomy with SNB was useful for deciding intraoperatively to perform segmentectomy with an accurate lymph node status.

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“…Based on our previous experience with the uniportal VATS technique, we started to perform the subxiphoid approach for lobectomy with the potential advantage of decreased postoperative pain, better cosmesis and easier specimen retrieval compared to the transthoracic approach (13). Segmental anatomic resections are more complex procedures and require a perfect knowledge of the distal lung anatomy (14). The increased use of low-dose CT for screening will result in more diagnosed lung cancer in the early stage (15) therefore segmentectomy is being performing more frequently.…”

Section: Discussionmentioning

confidence: 99%

Subxiphoid uniportal video-assisted thoracoscopic middle lobectomy and anterior anatomic segmentectomy (S3)

González-Rivas¹,

Yang²,

Jiang³

et al. 2016

J. Thorac. Dis.

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The video-assisted thoracoscopic surgery (VATS) approach for combined lobectomy and segmentectomy in the same lung is an infrequent procedure, rarely reported in the literature. Currently, Most of the surgeons still use 2-3 thoracic incisions for thoracoscopic anatomic resections. However, the uniportal approach is gaining worldwide acceptance in the recent years. The main advances of uniportal VATS during the last years are related to improvements in surgical technique by implementing new technology. The experience acquired with the uniportal technique allows expert uniportal VATS surgeons to explore new approaches in order to minimize even more the surgical invasiveness. Recently the aim to avoid the intercostal nerve damage created by the transthoracic incision has led to the creation of a novel procedure entitled uniportal VATS subxiphoid approach. Here we report the first case of a lobectomy combined with anatomic segmentectomy performed through a uniportal subxiphoid approach. (Figure 1). Pulmonary function tests were normal. The patient was proposed for uniportal VATS subxiphoid middle lobectomy and anterior anatomic segmentectomy of the right upper lobe. Surgical technique (Figure 2)The procedure was performed under general anesthesia and double lumen endotracheal intubation. The patient was positioned in lateral position with 60 degrees of inclination. The surgeon and scrub nurse were located in front of the patient and the assistant in the opposite side. A 3-cm midline vertical incision was made below the sterno-costal triangle, (longitudinal incision is made when the infrasternal angle is <70°). The rectus abdominis was divided and the xiphoid process was partially resected in order to have more space for instrumentation. Upon finding the infra-sternal angle between the xiphoid process and the subcostal margin, the right pleura was opened by finger dissection via the infra-sternal angle above the level of the diaphragm. The pericardial fatty tissue was removed and a wound protector was placed. The use of a wound protector helps the insertion of the camera and instruments, without the need of a sternal lifter. A 10-mm, 30-degrees video camera and double articulated instruments combined with several specific longer VATS instruments were used through the same subxiphoid incision. The lung was free of adhesions and a middle lobectomy and anterior anatomic segmentectomy of the right upper lobe (S3) were performed. The mean postoperative time was 70 minutes. A single chest tube was placed at the end of the operation through the subxiphoid incision.Postoperative pain was managed with PCA (Patientcontrolled analgesia) pump as required with sufentanyl citrate 1 mL: 50 mcg and regular medication with flurbiprofen 50 mg every 4 hours alternated with paracetamol 1 gr every 4 hours.The postoperative course of the patient was uneventful, the chest tube was removed on the second postoperative day and the patient was discharged home on the 4 th postoperative day with no complications. The final pathology r...

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Video-assisted thoracoscopic surgery (VATS) segmentectomy for small peripheral lung cancer tumors: intermediate results

Cited by 34 publications

References 22 publications

Ki-67 Labeling Index Is Associated with Recurrence after Segmentectomy under Video-assisted Thoracoscopic Surgery in Stage I Non-small Cell Lung Cancer

Ki-67 Labeling Index Is Associated with Recurrence after Segmentectomy under Video-assisted Thoracoscopic Surgery in Stage I Non-small Cell Lung Cancer

Thoracoscopic Segmentectomy with Intraoperative Evaluation of Sentinel Nodes for Stage I Non-Small Cell Lung Cancer

Subxiphoid uniportal video-assisted thoracoscopic middle lobectomy and anterior anatomic segmentectomy (S3)

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