Current indications and outcomes for thoracoscopic segmentectomy for early stage lung cancer

Bilgi, Zeynep; Swanson, Scott J.

doi:10.21037/jtd.2019.07.06

Cited by 13 publications

(13 citation statements)

References 40 publications

(46 reference statements)

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“…[13][14][15][16][17] However, in the case of technically demanding operations like segmentectomy, one might question whether VATS is associated with procedural adverse events, which may eventually mitigate the benefits of the minimally invasive nature of the operation. Our study showed that despite being more technically demanding compared to other VATS operation, 18 VATS segmentectomy is associated with lower rates of postoperative complications when compared to thoracotomy segmentectomy.…”

Section: Discussionmentioning

confidence: 59%

Five-Year Experience with VATS Versus Thoracotomy Segmentectomy for Lung Tumor Resection

Sabra

Alwatari

Bierema

et al. 2020

Innovations�(Phila)

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Objective Segmentectomy for lung tumors has been performed with either video-assisted thoracoscopic surgery (VATS) or thoracotomy; however, there is a lack of contemporary, multicenter study that compares both approaches. The aim of this study was to compare the 30-day surgical outcomes of VATS versus thoracotomy for segmentectomy using a large national database. Methods We performed a retrospective analysis of prospectively maintained American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent segmentectomy for benign or malignant tumors between 2013 and 2017 were included and divided into 2 groups based on whether they received a thoracotomy or VATS approach. All VATS patients were then into 2 subgroups: early (2013 to 2015) and late (2016 to 2017). Propensity-matched analysis was conducted, and the perioperative variables and outcomes were compared. Results A total of 1,785 patients met the inclusion criteria. VATS segmentectomy was associated with shorter hospital stays (3.9 vs 5.8 days, P < 0.001) and higher rates of home discharge (94% vs 89%, P = 0.002) compared to thoracotomy segmentectomy. VATS was also associated with less postoperative pneumonia (2.8% vs 5.8%, P = 0.007), unplanned intubation (1.5% vs 3.5%, P = 0.016), prolonged intubation (0.6% vs 2.7%, P = 0.001), transfusion requirement (1.7% vs 5.8%, P < 0.001), and deep venous thrombosis (0.1% vs 1.1%, P = 0.03). Compared to the earlier VATS group, the late group was associated with less cardiac arrests (0% vs 0.8%, P = 0.025) and shorter hospital stays (3.3 vs 4.2 days, P < 0.001). Conclusions When compared with thoracotomy, VATS segmentectomy is associated with less postoperative complications and shorter hospital length of stay. VATS segmentectomy has been used more frequently and with improved outcomes.

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Section: Discussionmentioning

confidence: 59%

Five-Year Experience with VATS Versus Thoracotomy Segmentectomy for Lung Tumor Resection

Sabra

Alwatari

Bierema

et al. 2020

Innovations�(Phila)

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“…Recent studies have shown that NSCLC patients that received segmentectomies for lesions < 2 cm had similar oncologic effects compared with those that received lobectomies [8,9,10,11]. Patients receiving segmentectomies also had more protected lung function [12,13]. The NCCN guidelines indicate that the standard recommendation for the treatment of early NSCLC patients is anatomic pulmonary resection.…”

Section: Discussionmentioning

confidence: 99%

Lobectomy Versus Segmentectomy in Patients with Stage T (>2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

Wang¹,

Ren³

et al. 2020

Preprint

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Background: Whether lung segmentectomy is a safe and effective surgical treatment in patients with early non-small cell lung cancer (NSCLC) remains controversial. We have therefore reviewed the clinicopathologic characteristics and survival outcomes of patients receiving a lobectomy vs. segmentectomy to treat early T (>2 cm and ≤3 cm) N0M0 NSCLC.Methods: We obtained data from the Surveillance, Epidemiology, and End Results (SEER) database for patients who underwent lobectomy or segmentectomy between 2004 and 2015. To reduce bias and imbalance between the treatment groups, propensity score matching (PSM) analysis was performed. We used Kaplan-Meier curves to estimate overall survival (OS) and lung cancer-speciﬁc survival (LCSS), performed univariate and multivariate Cox proportional hazards regression analyses to identify independent prognostic factors for OS and CSS, and applied the Cox proportional hazards model to create forest plots. Results: A total of 5783 patients from the SEER database were included. Of these, 5531 patients underwent lobectomy, and 252 patients underwent segmentectomy. Before matching, both univariate and multivariate Cox regression analyses showed that patients who underwent lobectomy had better OS (hazard ratio [HR]: 1.561; 95% confidence interval [CI] 1.292-1.885; P <0.001) and LCSS (HR: 1.551; 95% CI 1.198-2.009; P=0.001) than patients who underwent segmentectomy. However, survival differences between the groups were not significant; OS (P=0.160) and LCSS (P=0.097) after matching. Regression analyses revealed that age, sex, lymph node dissection, and grade were independent predictors of OS and LCSS (P <0.05).Conclusions: For patients with stage T (>2 cm and ≤3 cm) N0M0 non-small cell lung cancer, segmentectomy can achieve the same OS and LCSS compared with lobectomy. A large number of patients require further long-term follow-up analyses.

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“…Anatomic segmentectomy is an alternative strategy for management of small pulmonary lesions. Ideal lesions for segmentectomy are peripheral, less than 2 cm in size, and well centered within the target segment in order to achieve appropriate margins (26)(27)(28)(29)(30)(31). Caution should be taken for lesions that cross intersegmental planes, as margins are unlikely to be adequate (26).…”

Section: Segmentectomymentioning

confidence: 99%

Image-guided video assisted thoracoscopic surgery (iVATS) and the future of surgical management

Steimer¹,

White²

2022

Curr Chall Thorac Surg

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The increased utilization of computed tomography for diagnostic imaging has led to an influx of incidentally discovered pulmonary nodules. Both thoracic surgeons and radiologists are burdened with risk stratifying these lesions for observation versus biopsy or resection. The diagnostic accuracy of percutaneous biopsy is dependent on the lesion's size, density, and anatomic location. Nodules that are not amenable to percutaneous biopsy are often referred to surgeons for excisional biopsy. Certain characteristics make some lesions more difficult to resect than others. Small (<1 cm), partially solid, pure ground glass, and central lesions can be difficult to palpate intraoperatively. These lesions can be challenging to resect with thoracoscopic and robotic assisted approaches due to diminished tactile feedback and smaller incisions. Over the past 30 years, techniques have been developed to assist surgeons in locating these lesions with the use of hook wires, fiducials, dyes, and radiolabeled isotopes. These markers are placed preoperatively but are prone to migration or diffusion. In this chapter a new localization and resection technique, image-guided video assisted thoracoscopic surgery (iVATS) is reviewed. iVATS is an attractive option for both patients and surgeons since the localization procedure and parenchymal resection are performed under a single anesthetic.A detailed description of the iVATS technique, success rate, and common complications are reviewed. For pulmonary nodules that are centered within a defined bronchovascular segment, upfront segmentectomy is a reasonable option for obtaining pathologic diagnosis. Since segmentectomy relies on surgeon knowledge and experience with segmental anatomy, non-palpable lesions can be easily treated with this technique. Pearls and pitfalls of the most common segmental resections are addressed. Despite the refinement of localization techniques, small pulmonary nodules continue to present a diagnostic challenge. Ongoing innovation of new clinical tools has generated promising options for the future. In this chapter, we will review some of the tools undergoing development including computer generated algorithms for nodule risk assessment, liquid biopsy, three-dimensional printing, and superselective segmentectomy. Some technologies are focused on creating non-invasive methods to determine if a nodule is benign or malignant, while others seek to improve localization techniques. All of the described tools will need further validation but will potentially streamline the diagnosis and treatment of pulmonary nodules for future clinical practice.

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Current indications and outcomes for thoracoscopic segmentectomy for early stage lung cancer

Cited by 13 publications

References 40 publications

Five-Year Experience with VATS Versus Thoracotomy Segmentectomy for Lung Tumor Resection

Five-Year Experience with VATS Versus Thoracotomy Segmentectomy for Lung Tumor Resection

Lobectomy Versus Segmentectomy in Patients with Stage T (>2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

Image-guided video assisted thoracoscopic surgery (iVATS) and the future of surgical management

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Current indications and outcomes for thoracoscopic segmentectomy for early stage lung cancer

Cited by 13 publications

References 40 publications

Five-Year Experience with VATS Versus Thoracotomy Segmentectomy for Lung Tumor Resection

Five-Year Experience with VATS Versus Thoracotomy Segmentectomy for Lung Tumor Resection

Lobectomy Versus Segmentectomy in Patients with Stage T (&gt;2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

Image-guided video assisted thoracoscopic surgery (iVATS) and the future of surgical management

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Lobectomy Versus Segmentectomy in Patients with Stage T (>2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study