Application of thoracoscopic anatomic sublobar resection in the treatment of pulmonary nodules_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Qirui , HU Bin , WANG Yang , LI Tong , MIAO Jinbai , YOU Bin , FU Yili ,  LI Hui

Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, P.R.China;

Corresponding author：

LI Hui, Email: huilee@vip.sina.com

Keywords：

Lung cancer; sublobar resection; segmentectomy; wedge resection

DOI：

10.7507/1007-4848.202104094

Video：

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Objective To investigate the surgical procedure selection, operation technique and safety of anatomic sublobar resection for pulmonary nodules. Methods The clinical data of 242 patients with clinical stage ⅠA lung cancer who underwent anatomic sublobar resection in our hospital between 2017 and 2020 were retrospectively analyzed. There were 81 males and 161 females with a median age of 57.0 (50.0, 65.0) years. They were divided into 4 groups according to the surgical methods, including a segmentectomy group (n=148), a combined segmentectomy group (n=31), an enlarged segmentectomy group (n=43) and an anatomic wedge resection group (n=20). The preoperative CT data, operation related indexes and early postoperative outcomes of each group were summarized. Results The median medical history of the patients was 4.0 months. The median maximum diameter of nodule on CT image was 1.1 cm, and the consolidation/tumor ratio (CTR) was ≤0.25 in 81.0% of the patients. A total of 240 patients were primary lung adenocarcinoma. The median operation time was 130.0 min, the median blood loss was 50.0 mL, the median chest drainage time was 3.0 d, and the hospitalization cost was (53.0±12.0) thousand yuan. The operation time of combined segmentectomy was longer than that of the segmentectomy group (P=0.001). The operation time (P=0.000), intraoperative blood loss (P=0.000), lymph nodes dissected (P=0.007) and cost of hospitalization (P=0.000) in the anatomic wedge resection group were shorter or less than those in the other three groups. There was no significant difference in the drainage time, total drainage volume, air leakage or postoperative hospital stay among the four groups (P>0.05). Conclusion The combined application of segmentectomy and wedge resection technique provides a more flexible surgical option for the surgical treatment of early lung cancer with ground glass opacity as the main component.

Citation： CHEN Qirui, HU Bin, WANG Yang, LI Tong, MIAO Jinbai, YOU Bin, FU Yili, LI Hui. Application of thoracoscopic anatomic sublobar resection in the treatment of pulmonary nodules. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(1): 30-35. doi: 10.7507/1007-4848.202104094 Copy

1.	郑荣寿, 孙可欣, 张思维, 等. 2015 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
2.	National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
3.	Sawabata N, Ohta M, Matsumura A, et al. Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: A multicenter prospective study. Ann Thorac Surg, 2004, 77(2): 415-420.
4.	Jensik RJ, Faber LP, Milloy FJ, et al. Segmental resection for lung cancer. A fifteen-year experience. J Thorac Cardiovasc Surg, 1973, 66(4): 563-572.
5.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
6.	Khullar OV, Liu Y, Gillespie T, et al. Survival after sublobar resection versus lobectomy for clinical stage ⅠA lung cancer: An analysis from the National Cancer Data Base. J Thorac Oncol, 2015, 10(11): 1625-1633.
7.	Dai C, Shen J, Ren Y, et al. Choice of surgical procedure for patients with non-small-cell lung cancer ≤1 cm or > 1 to 2 cm among lobectomy, segmentectomy, and wedge resection: A population-based study. J Clin Oncol, 2016, 34(26): 3175-3182.
8.	Onaitis MW, Furnary AP, Kosinski AS, et al. Equivalent survival between lobectomy and segmentectomy for clinical stage ⅠA lung cancer. Ann Thorac Surg, 2020, 110(6): 1882-1891.
9.	Kamigaichi A, Tsutani Y, Kagimoto A, et al. Comparing segmentectomy and lobectomy for clinical stage ⅠA solid-dominant lung cancer measuring 2. 1 to 3 cm. Clin Lung Cancer, 2020, 21(6): e528-e538.
10.	Ijsseldijk MA, Shoni M, Siegert C, et al. Oncological outcomes of lobar resection, segmentectomy, and wedge resection for T1a non-small-cell lung carcinoma: A systematic review and meta-analysis. Semin Thorac Cardiovasc Surg, 2020, 32(3): 582-590.
11.	Nomori H, Shiraishi A, Yamazaki I, et al. Extent of segmentectomy that achieves greater lung preservation than lobectomy. Ann Thorac Surg, 2020, 20: S0003-4975(20)31930-5.
12.	Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: Post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med, 2018, 6(12): 915-924.
13.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
14.	Roman M, Labbouz S, Valtzoglou V, et al. Lobectomy vs. segmentectomy. A propensity score matched comparison of outcomes. Eur J Surg Oncol, 2019, 45(5): 845-850.
15.	Handa Y, Tsutani Y, Mimae T, et al. Surgical procedure selection for stageⅠ lung cancer: Complex segmentectomy versus wedge resection. Clin Lung Cancer, 2021, 22(2): e224-e233.
16.	Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2020, 12: S0022-5223(20)33043-9.
17.	Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical ⅠA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol, 2011, 6(4): 751-756.
18.	Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.
19.	Aokage K, Saji H, Suzuki K, et al. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211). Gen Thorac Cardiovasc Surg, 2017, 65(5): 267-272.
20.	Raman V, Jawitz OK, Voigt SL, et al. The effect of tumor size and histologic findings on outcomes after segmentectomy vs. lobectomy for clinically node-negative non-small cell lung cancer. Chest, 2021, 159(1): 390-400.
21.	Kamigaichi A, Tsutani Y, Fujiwara M, et al. Postoperative recurrence and survival after segmentectomy for clinical stage 0 or ⅠA lung cancer. Clin Lung Cancer, 2019, 20(5): 397-403.
22.	Nishio W, Yoshimura M, Maniwa Y, et al. Re-assessment of intentional extended segmentectomy for clinical T1aN0 non-small cell lung cancer. Ann Thorac Surg, 2016, 102(5): 1702-1710.
23.	Lin CY, Chang CC, Liu YS, et al. Stapled video-assisted thoracoscopic segmentectomy preserves as much lung volume as nonstapled video-assisted thoracoscopic segmentectomy. Asian J Surg, 2021, 44(1): 131-136.
24.	Wang W, Hu Z, Zhao J, et al. Both the presence of a micropapillary component and the micropapillary predominant subtype predict poor prognosis after lung adenocarcinoma resection: A meta-analysis. J Cardiothorac Surg, 2020, 15(1): 154.
25.	Tsutani Y, Suzuki K, Koike T, et al. High-risk factors for recurrence of stageⅠlung adenocarcinoma: Follow-up data from JCOG0201. Ann Thorac Surg, 2019, 108(5): 1484-1490.
26.	Eguchi T, Kameda K, Lu S, et al. Lobectomy is associated with better outcomes than sublobar resection in spread through air spaces (STAS)-positive T1 lung adenocarcinoma: A propensity score-matched analysis. J Thorac Oncol, 2019, 14(1): 87-98.
27.	北京医学会胸外科分会, 中国医疗保健国际交流促进会胸外科分会. 基于高分辨 CT 影像学指导≤2 cm 磨玻璃结节肺癌手术方式胸外科专家共识(2019 版). 中国胸心血管外科临床杂志, 2020, 27(4): 395-400.
28.	Qian F, Yang W, Wang R, et al. Prognostic significance and adjuvant chemotherapy survival benefits of a solid or micropapillary pattern in patients with resected stageⅠB lung adenocarcinoma. J Thorac Cardiovasc Surg, 2018, 155(3): 1227-1235.
29.	Liu H, Yin Q, Yang G, et al. Prognostic impact of tumor spread through air spaces in non-small cell lung cancers: A meta-analysis including 3564 patients. Pathol Oncol Res, 2019, 25(4): 1303-1310.
30.	Kadota K, Kushida Y, Kagawa S, et al. Limited resection is associated with a higher risk of locoregional recurrence than lobectomy in stageⅠlung adenocarcinoma with tumor spread through air spaces. Am J Surg Pathol, 2019, 43(8): 1033-1041.
31.	Zhang Z, Liu Z, Feng H, et al. Predictive value of radiological features on spread through air space in stage cⅠA lung adenocarcinoma. J Thorac Dis, 2020, 12(11): 6494-6504.
32.	Chen D, Wang X, Zhang F, et al. Could tumor spread through air spaces benefit from adjuvant chemotherapy in stageⅠlung adenocarcinoma? A multi-institutional study. Ther Adv Med Oncol, 2020, 12: 1758835920978147.
33.	Nomori H, Mori T, Shiraishi A, et al. Long-term prognosis after segmentectomy for cT1N0M0 non-small cell lung cancer. Ann Thorac Surg, 2019, 107(5): 1500-1506.

1. 郑荣寿, 孙可欣, 张思维, 等. 2015 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
2. National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
3. Sawabata N, Ohta M, Matsumura A, et al. Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: A multicenter prospective study. Ann Thorac Surg, 2004, 77(2): 415-420.
4. Jensik RJ, Faber LP, Milloy FJ, et al. Segmental resection for lung cancer. A fifteen-year experience. J Thorac Cardiovasc Surg, 1973, 66(4): 563-572.
5. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
6. Khullar OV, Liu Y, Gillespie T, et al. Survival after sublobar resection versus lobectomy for clinical stage ⅠA lung cancer: An analysis from the National Cancer Data Base. J Thorac Oncol, 2015, 10(11): 1625-1633.
7. Dai C, Shen J, Ren Y, et al. Choice of surgical procedure for patients with non-small-cell lung cancer ≤1 cm or > 1 to 2 cm among lobectomy, segmentectomy, and wedge resection: A population-based study. J Clin Oncol, 2016, 34(26): 3175-3182.
8. Onaitis MW, Furnary AP, Kosinski AS, et al. Equivalent survival between lobectomy and segmentectomy for clinical stage ⅠA lung cancer. Ann Thorac Surg, 2020, 110(6): 1882-1891.
9. Kamigaichi A, Tsutani Y, Kagimoto A, et al. Comparing segmentectomy and lobectomy for clinical stage ⅠA solid-dominant lung cancer measuring 2. 1 to 3 cm. Clin Lung Cancer, 2020, 21(6): e528-e538.
10. Ijsseldijk MA, Shoni M, Siegert C, et al. Oncological outcomes of lobar resection, segmentectomy, and wedge resection for T1a non-small-cell lung carcinoma: A systematic review and meta-analysis. Semin Thorac Cardiovasc Surg, 2020, 32(3): 582-590.
11. Nomori H, Shiraishi A, Yamazaki I, et al. Extent of segmentectomy that achieves greater lung preservation than lobectomy. Ann Thorac Surg, 2020, 20: S0003-4975(20)31930-5.
12. Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: Post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med, 2018, 6(12): 915-924.
13. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
14. Roman M, Labbouz S, Valtzoglou V, et al. Lobectomy vs. segmentectomy. A propensity score matched comparison of outcomes. Eur J Surg Oncol, 2019, 45(5): 845-850.
15. Handa Y, Tsutani Y, Mimae T, et al. Surgical procedure selection for stageⅠ lung cancer: Complex segmentectomy versus wedge resection. Clin Lung Cancer, 2021, 22(2): e224-e233.
16. Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2020, 12: S0022-5223(20)33043-9.
17. Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical ⅠA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol, 2011, 6(4): 751-756.
18. Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.
19. Aokage K, Saji H, Suzuki K, et al. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211). Gen Thorac Cardiovasc Surg, 2017, 65(5): 267-272.
20. Raman V, Jawitz OK, Voigt SL, et al. The effect of tumor size and histologic findings on outcomes after segmentectomy vs. lobectomy for clinically node-negative non-small cell lung cancer. Chest, 2021, 159(1): 390-400.
21. Kamigaichi A, Tsutani Y, Fujiwara M, et al. Postoperative recurrence and survival after segmentectomy for clinical stage 0 or ⅠA lung cancer. Clin Lung Cancer, 2019, 20(5): 397-403.
22. Nishio W, Yoshimura M, Maniwa Y, et al. Re-assessment of intentional extended segmentectomy for clinical T1aN0 non-small cell lung cancer. Ann Thorac Surg, 2016, 102(5): 1702-1710.
23. Lin CY, Chang CC, Liu YS, et al. Stapled video-assisted thoracoscopic segmentectomy preserves as much lung volume as nonstapled video-assisted thoracoscopic segmentectomy. Asian J Surg, 2021, 44(1): 131-136.
24. Wang W, Hu Z, Zhao J, et al. Both the presence of a micropapillary component and the micropapillary predominant subtype predict poor prognosis after lung adenocarcinoma resection: A meta-analysis. J Cardiothorac Surg, 2020, 15(1): 154.
25. Tsutani Y, Suzuki K, Koike T, et al. High-risk factors for recurrence of stageⅠlung adenocarcinoma: Follow-up data from JCOG0201. Ann Thorac Surg, 2019, 108(5): 1484-1490.
26. Eguchi T, Kameda K, Lu S, et al. Lobectomy is associated with better outcomes than sublobar resection in spread through air spaces (STAS)-positive T1 lung adenocarcinoma: A propensity score-matched analysis. J Thorac Oncol, 2019, 14(1): 87-98.
27. 北京医学会胸外科分会, 中国医疗保健国际交流促进会胸外科分会. 基于高分辨 CT 影像学指导≤2 cm 磨玻璃结节肺癌手术方式胸外科专家共识(2019 版). 中国胸心血管外科临床杂志, 2020, 27(4): 395-400.
28. Qian F, Yang W, Wang R, et al. Prognostic significance and adjuvant chemotherapy survival benefits of a solid or micropapillary pattern in patients with resected stageⅠB lung adenocarcinoma. J Thorac Cardiovasc Surg, 2018, 155(3): 1227-1235.
29. Liu H, Yin Q, Yang G, et al. Prognostic impact of tumor spread through air spaces in non-small cell lung cancers: A meta-analysis including 3564 patients. Pathol Oncol Res, 2019, 25(4): 1303-1310.
30. Kadota K, Kushida Y, Kagawa S, et al. Limited resection is associated with a higher risk of locoregional recurrence than lobectomy in stageⅠlung adenocarcinoma with tumor spread through air spaces. Am J Surg Pathol, 2019, 43(8): 1033-1041.
31. Zhang Z, Liu Z, Feng H, et al. Predictive value of radiological features on spread through air space in stage cⅠA lung adenocarcinoma. J Thorac Dis, 2020, 12(11): 6494-6504.
32. Chen D, Wang X, Zhang F, et al. Could tumor spread through air spaces benefit from adjuvant chemotherapy in stageⅠlung adenocarcinoma? A multi-institutional study. Ther Adv Med Oncol, 2020, 12: 1758835920978147.
33. Nomori H, Mori T, Shiraishi A, et al. Long-term prognosis after segmentectomy for cT1N0M0 non-small cell lung cancer. Ann Thorac Surg, 2019, 107(5): 1500-1506.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of thoracoscopic anatomic sublobar resection in the treatment of pulmonary nodules

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