Background. As segmentectomy becomes widely used for lung cancer treatment, complex segmentectomy, which makes several, intricate intersegmental planes, remains controversial because of procedural complexity and risk of increased complications and incurability. Questions remain about mortality, morbidity, surgical margin, lymph nodes dissection, and postoperative pulmonary function. We evaluated operative and postoperative outcomes of complex compared with simple segmentectomy.Methods. We retrospectively reviewed patients with clinical stage I lung cancer who could tolerate lobectomy and underwent complex or simple segmentectomy between April 2007 and March 2017. Clinicopathologic, operative, and postoperative results of the complex (n [ 117) and simple (n [ 92) segmentectomy groups were compared.Results. No statistically significant differences were detected in age, sex, comorbidities, preoperative pulmonary function, tumor histology, and size. Although only median operative time (180 versus 143.5 minutes, p < 0.0001) was significantly longer in the complex group, 30-day mortality (0% versus 0%), overall complications (24.8% versus 22.8%), and prolonged air leakage (11.9% versus 10.9%) were nearly equivalent between the two groups, respectively. The complex group showed comparable results in median surgical margin distance (16.0 versus 17.5 mm) and number of dissected lymph nodes (6.0 versus 7.0 nodes). Margin relapse occurred in 2 patients in the simple group but none occurred in the complex group. Both groups also showed similar postoperative pulmonary functions.Conclusions. Complex segmentectomy is a safe option in the treatment of lung cancers with adequate operative outcomes.

OBJECTIVES Although segmentectomy for lung cancer has been widely accepted, complex segmentectomy, which creates several, intricate intersegmental planes, remains controversial. Potential arguments include risk of incurability and ‘failure of cancer control’. We compared the outcomes of complex segmentectomy versus lobectomy and evaluated its use in lung cancer treatment. METHODS We retrospectively reviewed clinical stage IA lung cancer patients who underwent complex segmentectomy (n = 99) or location-adjusted lobectomy (n = 94) between April 2009 and December 2017. Clinicopathological and postoperative results were compared. Factors affecting survival were assessed by the Kaplan–Meier method and the Cox regression analysis. RESULTS No significant differences were detected in 30-day mortality (0% vs 0%), overall complications (26.3% vs 21.3%) and prolonged air leakage (11.1% vs 9.6%) rates between the 2 groups, respectively. Comparable results were obtained for 5-year overall (93.5% vs 96.4%, respectively; P = 0.21) or recurrence-free (92.3% vs 88.5%, respectively; P = 0.82) survivals after complex segmentectomy or lobectomy. There were 2 (2.0%) recurrences after complex segmentectomy and 7 (7.5%) after lobectomy (P = 0.094), with 0 (0%) margin relapses in each group. Multivariable Cox regression analysis revealed that complex segmentectomy and lobectomy had a numerically similar impact on recurrence-free survival (hazard ratio 0.93, 95% confidence interval 0.32–2.69; P = 0.90). CONCLUSIONS Complex segmentectomy can provide acceptable short- and long-term outcomes in lung cancer treatment.

Objective The present study aimed to compare the outcomes of wedge resection and segmentectomy in patients with clinical stage I non–small-cell lung cancer (NSCLC) who were unfit for lobectomy. Methods Between April 2007 and December 2015, 99 patients with stage I NSCLC who were considered unfit for lobectomy and had undergone sublobar resection were identified. Propensity scores were estimated for multivariable analyses, and surgical outcomes were compared between patients who underwent wedge resection and those who underwent segmentectomy. Results Sixty patients underwent wedge resection and 39 underwent segmentectomy. Severe postoperative complications (&gt;Grade IIIa) were more frequent in segmentectomy (15.4%) than in wedge resection (3.3%, P = 0.054). Propensity score-adjusted multivariable analysis revealed that operative procedure was an independent predictive factor for severe postoperative complication (segmentectomy, odds ratio = 8.18; P = 0.021). Overall survival (OS) and recurrence-free survival (RFS) were not significantly different between wedge resection (5-year OS, 61.3%, 5-year RFS, 49.4%) and segmentectomy (5-year OS, 68.2%, 5-year RFS, 56.8 %, P = 0.95, P = 0.93, respectively). Propensity score-adjusted multivariable Cox analysis revealed that operative procedure was not an independent factor for OS (segmentectomy, hazard ratio = 1.21, P = 0.62) or RFS (segmentectomy, hazard ratio = 1.07, P = 0.84). Conclusion Segmentectomy was more toxic but failed to show the superiority of survival compared with wedge resection. Wedge resection may be the optimal procedure for patients with clinical stage I NSCLC who are considered to be unfit for lobectomy.

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Objective: The study objective was to compare cancer control between segmentectomy and wedge resection in patients with clinical stage IA non-small cell lung cancer.Methods: Between 2010 and 2015, 457 patients with clinical stage IA (8th edition) non-small cell lung cancer undergoing wedge resection or segmentectomy were identified at 3 institutions. Propensity scores were calculated on the basis of the extent of resection (wedge resection or segmentectomy) and included adjustment for confounding variables, such as age, sex, smoking status, pulmonary functions, laterality, tumor size, maximum standardized uptake value on 18 F-fluorodeoxyglucose positron emission tomography, presence of groundglass opacity on high-resolution computed tomography, histology, and visceral pleural invasion for multivariable analysis and matching. The primary end point was cumulative incidence of recurrence.

A 70-year-old man was referred to our department due to abnormal shadows on a chest radiograph. Computed tomography of the chest revealed a 3-cm nodule in the right middle lung lobe, and bronchoscopy revealed adenocarcinoma cells with EGFR mutations. A lung resection was performed. Histological analysis revealed tumors comprising tall columnar cells that were similar to an adenocarcinoma of the sigmoid colon that had been resected 13 years previously. Metastatic colorectal carcinoma was initially considered, but immunohistochemical staining indicated pulmonary enteric adenocarcinoma. Pulmonary enteric adenocarcinoma was first described in 1991, and about 30 cases have since been described in the English literature. However, its concept and etiology are not clear. It is important to distinguish pulmonary enteric adenocarcinoma from metastatic colorectal carcinoma because of obvious differences in therapeutic strategies and prognosis, especially with a past history of colorectal carcinoma. Immunohistochemical and gene mutation analyses seemed to be helpful.

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum and, therefore, an intrathoracic origin is considered to be rare. This report presents a case of giant thymoma arising in the thoracic cavity. A 61-year-old male presented with a chronic cough and breathlessness. Chest CT revealed a well enhanced giant mass approximately 18 cm in diameter in the right thoracic cavity. FDG-PET showed that the SUVmax of the tumor was 5.0 in the center and almost 2.5 in the surrounding area. A trans- bronchial needle biopsy was performed to find atypical cells. Surgery was scheduled based on the radiological and histological findings. A well-defined giant mass in the thoracic cavity, measuring 18 × 14.5 × 11 cm had undergone expansive growth without apparent invasion. The tumor was completely resected without combined resection of the other organs. The weight of the tumor was 1350 g. The tumor was histologically diagnosed to be type AB thymoma according to the World Health Organization classification and Masaoka stage IIB.

Segmentectomy with intraoperative assessment of lymph node metastasis and adequate surgical margin may be a feasible surgical procedure for pure solid tumors in clinical T1a-bN0M0 lung cancer.