Comparison of surgical outcomes between thoracoscopic anatomical sublobar resection including and excluding subsegmentectomy

Matsui, Takuya; Takahashi, Yusuke; Shirai, Suguru; Nakanishi, Keita; Nakada, Takeo; Haneda, Hiroshi; Okuda, Kunio; Nakanishi, Ryoichi

doi:10.1007/s11748-020-01556-3

Cited by 7 publications

(20 citation statements)

References 18 publications

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“…The margin of pulmonary resection required to achieve complete resection for NSCLC patients has been a hot debated issue in the last years. Sublobar resections like segmentectomy, subsegmentectomy, and even wedge resection are becoming increasingly popular, which is also re ected in the literature in recent years [7,12]. In particular, small tumors with a diameter <2cm, are potentially most suitable for sublobar resection [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…Hence, the margin of pulmonary resection required to achieve complete resection of the malignancy has been an eagerly debated issue in the last years [2,6]. Thus, there is a special interest in the selective use of sublobar, parenchyma-sparing resection techniques like anatomic segmentectomy, subsegmentectomy, or even extended wedge resection in the management of small < 2cm nodules [3,5,7]. The comparison of long-term survival rates between lobectomy and sublobar resections is discussed controversially [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, little to no lymphadenectomy is performed intraoperatively. In addition, some studies do not present data on long-term survival rates [7,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Sublobar Resection Without Staging and Diagnostic for Tumors <2 cm is no Adequate Therapy for Non-Small Cell Lung Cancer Patients

Heldwein

Schlachtenberger

Doerr

et al. 2022

Preprint

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Purpose: Sublobar resection is a frequently performed surgical approach for Non-Small Cell Lung Cancer (NSCLC) patients with <2cm nodules. Retrospective studies are claiming that survival rates after sublobar resection are comparable to that after anatomical resection although studies dealing with sublobar resection do not perform guideline-based staging and little to no lymphadenectomy. Methods: 747 patients underwent surgery for NSCLC at our institution between 2012 and 2020. We retrospectively reviewed data of NSCLC patients with <2cm tumors (n=236). Nodal upstaging and lymphangiosis- (L1) and hemangiosis carcinomatosa (V1) were analyzed. pN0 patients were compared to patients with nodal upstaging. One-, three and five-year survival rates were measured. Survival was assessed by Kaplan-Meier curves.Results: Mean tumor size was 1.4cm±0.39 in our cohort. Of our patients, 14% showed a cT1a tumor and 86% of patients cT1b. 24.0±12.3 lymph nodes were dissected and analyzed per patient, and 0.7±2.0 of those were affected. Of our patients, 16.1% showed an L1 affection and 7.6% a V1 affection. Lymph node involvement was diagnosed in 11(4.7%) patients preoperatively. 39(16.5%) patients were upstaged due to lymph node involvement postoperatively (p<0.001). Upstaged patients showed significantly worse 3- (upstaged: 60.6% vs. pN0: 83.2%; p=0.01) and 5-year (upstages: 38% vs. pN0 71.5%; p=0.02) survival rates.Conclusion: Of our patients with <2cm NSCLC 16.5% were nodal upstaged postoperatively. These results underline that lymphadenectomy during surgery is crucial for NSCLC patients irrespective of the tumor size and the surgical approach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sublobar Resection Without Staging and Diagnostic for Tumors <2 cm is no Adequate Therapy for Non-Small Cell Lung Cancer Patients

Heldwein

Schlachtenberger

Doerr

et al. 2022

Preprint

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“…Previous studies have sought to evaluate the safety and efficacy of subsegmentectomy compared to segmentectomy (21)(22)(23) and found that the surgical time, blood loss, duration of hospitalization, and complications of the subsegmentectomy were not superior to those of the segmentectomy (see Table 1). Further, the blood loss and postoperative air leakage were less in the subsegmentectomy group than the segmentectomy group, which was mainly due to the use of a stapler in the subsegmentectomy group; postoperative air leakage was more likely to occur in the segmentectomy group if the intersegmental plane was dissected with energy instruments (24).…”

Section: Discussionmentioning

confidence: 99%

Single-port combined subsegment resection (RS3b + S1bi) with a rare branching segment pattern of the bronchi and vessels: case report and literature review

Yin¹,

Zhu²,

Zhang³

et al. 2022

Ann Transl Med

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Background: Video-assisted thoracoscopic surgery segmentectomy is increasingly being used to resect peripheral small lung cancer. However, to manage some lesions which locate between segment deep inside the parenchyma is still challenging. Generally, wedge resection and segmentectomy are optional for peripheral small lung cancer. However, it is hard to achieve safe surgical margins if the lesion is located in the segment plane deep inside the parenchyma, especially close to the segment hilum. In that situation, lobectomy and bi-segmentectomy are usually performed for the sake of safe margins with the price of excessive normal lung tissue lost. To ensure safe surgical margins and preserve normal lung tissue as far as possible, combined subsegmentectomy is feasible and it is required precise preoperative plan including surgical margin delineation, bronchi and vessels variation and surgical procedure. The variation of bronchi and segment vein in our current case are rare and the branching pattern of pulmonary artery-inferior trunk (Tr.inf) is firstly reported in our case.Case Description: In 2019, a 41-year-old female presented to the Thoracic Clinic with a history of a 7-mm sized, mixed-density ground-glass opacity (GGO) in the right upper lobe. The lesion located in the segmental plane between S3b and S1b deep inside the parenchyma. We performed precise preoperative planning with 3-dimension pulmonary bronchi and vessels reconstruction and resected RS3b + S1bi via single-port approach. The patient was discharged from hospital on the 5th postoperative day without any complications. Chest computed tomography (CT) scans in the 12 th and 24 th months after surgery showed good lung recovery, and no atelectasis or pulmonary congestion was observed. Notably, we observed a new branching pattern of A1b, which came from the inferior trunk, combined with A3a. Additionally, we performed a literature review to analyze the variation patterns of segmental structures in the right upper lobe, and the indications, effects, and safety of combined subsegmentectomy.Conclusions: Our case and review of literature showed that combined subsegmentectomy was feasible for lesion deep inside parenchyma if a detailed preoperative plan and delicate procedures during surgery were implemented.

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“…Subsegmentectomy is performed with the assistance of threedimensional computed tomography bronchography and angiography (3D-CTBA) and supported by superb surgical techniques (15). Although recent studies showed that subsegmentectomy had comparable outcomes compared with segmentectomy in small sized NSCLC (16), whether patients with early stage benefit from subsegmentectomy still remains controversial. There is a lack of sufficient evidence regarding the clinical outcome of subsegmentectomy compared with segmentectomy.…”

Section: Introductionmentioning

confidence: 99%

Subsegmentectomy versus segmentectomy resection for the treatment of operable patients with stage IA non-small cell lung cancer: A meta-analysis

Song

Li²,

Hao³

et al. 2023

Front. Surg.

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BackgroundThere were new points of interest in performing subsegmentectomy and segmentectomy for patients with early stage non-small cell lung cancer (NSCLC). However, whether patients who underwent subsegmentectomy could obtain satisfactory clinical outcomes remains unclear. The present study aimed to compare the clinical outcomes and security of surgical procedures between subsegmentectomy and segmentectomy.MethodsA systematic review and meta-analysis was performed through five online databases to identify the included literatures which presented intact clinical outcome data among different surgical procedures. The included studies were evaluated based on precise and predefined inclusion criteria.ResultsThere were 4 published studies identified in this meta-analysis. A total of 325 patients who underwent subsegmentectomy and 904 patients who underwent segmentectomy were involved in this analysis. The duration of drainage [MD −0.19; 95%CI (−0.36, −0.02), p = 0.03] and postoperative hospital stay [MD −0.30; 95%CI (−0.58, −0.02), p = 0.009] of subsegmentectomy were significantly less than that of segmentectomy. There was no statistically significant difference among recurrence rate [OR 0.85; 95%CI (0.21, 3.42), p = 0.82], operation time, blood loss, incidence of complications [OR 0.83; 95%CI (0.58, 1.20), p = 0.33] between subsegmentectomy and segmentectomy in patients with stage IA NSCLC.ConclusionThe meta-analysis was firstly performed to compare perioperative outcomes among surgical procedures. The perioperative outcomes were comparable between subsegmentectomy and segmentectomy. Subsegmentectomy might be an alternative treatment for the deep tumor with size less than 1.5 cm and mainly composed of Ground Glass Opacity (GGO).

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Comparison of surgical outcomes between thoracoscopic anatomical sublobar resection including and excluding subsegmentectomy

Cited by 7 publications

References 18 publications

Sublobar Resection Without Staging and Diagnostic for Tumors <2 cm is no Adequate Therapy for Non-Small Cell Lung Cancer Patients

Sublobar Resection Without Staging and Diagnostic for Tumors <2 cm is no Adequate Therapy for Non-Small Cell Lung Cancer Patients

Single-port combined subsegment resection (RS3b + S1bi) with a rare branching segment pattern of the bronchi and vessels: case report and literature review

Subsegmentectomy versus segmentectomy resection for the treatment of operable patients with stage IA non-small cell lung cancer: A meta-analysis

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Comparison of surgical outcomes between thoracoscopic anatomical sublobar resection including and excluding subsegmentectomy

Cited by 7 publications

References 18 publications

Sublobar Resection Without Staging and Diagnostic for Tumors &lt;2 cm is no Adequate Therapy for Non-Small Cell Lung Cancer Patients

Sublobar Resection Without Staging and Diagnostic for Tumors &lt;2 cm is no Adequate Therapy for Non-Small Cell Lung Cancer Patients

Single-port combined subsegment resection (RS3b + S1bi) with a rare branching segment pattern of the bronchi and vessels: case report and literature review

Subsegmentectomy versus segmentectomy resection for the treatment of operable patients with stage IA non-small cell lung cancer: A meta-analysis

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Sublobar Resection Without Staging and Diagnostic for Tumors <2 cm is no Adequate Therapy for Non-Small Cell Lung Cancer Patients

Sublobar Resection Without Staging and Diagnostic for Tumors <2 cm is no Adequate Therapy for Non-Small Cell Lung Cancer Patients