Complete video-assisted thoracoscopic surgery anatomic segmentectomy for clinical stage I lung carcinoma - technique and feasibility

Abstract

This paper describes a prospective, observational, single-centre study of 20 consecutive patients with clinical stage I lung carcinoma undergoing anatomical sublobar resections using complete video-assisted thoracoscopic surgery (cVATS). Thirteen male and seven female patients with a median age of 68 (range 57-84) years and a median of four (range 0-9) relevant comorbid conditions presented with five right-sided and 15 left-sided tumours, with a median diameter of 2.3 (range 1.0-5.2) cm. Thirteen segmentectomies, three bisegmentectomies and four trisegmentectomies with lymphadenectomy of the N1 stations and the mediastinum were performed, with a median duration of 212 (range 91-397) min, a conversion rate to open surgery of 20% and conversion to lobectomy of 10%. In five patients, we noted 10 postoperative adverse events but no transfusions, no readmissions and zero mortality. Median drainage time was six days, with a median hospital stay of 8.5 days. According to the pTNM classification, 10, three, one, and six patients were staged as Ia, Ib, IIb and IIIa, respectively. The distance between the tumour and the parenchymal stapling line exceeded the tumour diameter in 56%, 0% and 0% of T1a, T1b and T2 tumours, respectively. To conclude, cVATS anatomical sublobar resections are technically feasible. We observed a favourable postoperative course in 20 multimorbid or aged patients. In patients fit for lobectomy, the tumour diameter should not exceed 2 cm.

Predictive factors for complications of anatomical pulmonary segmentectomies

“…Among the factors explaining why surgeons are reluctant to perform segmentectomy are: prolonged operative time, more complex anatomy with difficult identification of vessels and bronchi, management of the intersegmental plane with potential postoperative PALs, fear of venous injury that can lead to postoperative ischaemic complications and-in case of carcinoma-inability to achieve a complete lymph node dissection [5,6]. Recently, reports about the video-assisted approach and totally thoracoscopic approach have portrayed an image of segmentectomies that is associated with technical challenges [4,7].…”

Complete video‐assisted thoracoscopic multi‐subsegmentectomy based on patients' specific virtual 3‐D pulmonary models

“…Most local recurrences after segmentectomy are caused by an insufficient surgical margin and missed lymph node metastases at the hilum and/or mediastinum. In particular, radical segmentectomy, which is defined as a segmentectomy followed by both hilar and mediastinal lymph node dissection with a sufficient surgical margin, is able to play a role in local control, similar to a lobectomy in clinical stage I NSCLC patients .…”

Predictors of failure of intersegmental line creation using bronchoscopic jet ventilation for thoracoscopic pulmonary segmentectomy

“…Recently, lung cancer surgeries have shifted from lobectomy to segmentectomy since advances in computed tomography (CT) have enabled us to detect small and early-stage lung cancers. Although segmentectomy has anatomic and functional advantages over lobectomy [1][2][3][4], the procedure is generally more technically complex than lobectomy. In particular, recognition of the segmental fissures within the pulmonary parenchyma may be difficult with unclear boundaries between adjacent segments.…”