Interest of anatomical segmentectomy over lobectomy for lung cancer: a nationwide study

Berg, Elodie; Madelaine, Leslie; Baste, Jean-Marc; Dahan, M.; Thomas, Philippe; Falcoz, Pierre‐Emmanuel; Martinod, Emmanuel; Bernard, Alain; Pagès, Pierre-Benoît

doi:10.21037/jtd-20-2203

Cited by 7 publications

(5 citation statements)

References 34 publications

(40 reference statements)

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“…This is somewhat counterintuitive, considering that more lung parenchyma resection is needed in procedures involving a segmentectomy rather than a lobectomy. However, varied outcomes have been reported regarding PAL incidence associated with those procedures in propensity-matching studies [ 21 , 22 ] and safety analysis of a randomized control study [ 23 ]. A possible advantage of segmentectomy, if any, is the remnant lung volume in the thoracic cavity.…”

Section: Discussionmentioning

confidence: 99%

“…A possible advantage of segmentectomy, if any, is the remnant lung volume in the thoracic cavity. The remaining lobes could be placed against the remaining segments, which may patch over minor pleural lacerations or fix the lung position, preventing weak points of the pleura from being torn by tension, as discussed by Berg et al [ 22 ]. This “remnant lung” hypothesis is concordant with the lower leak incidence in the right middle lobectomy than other lobe lobectomies [ 24 , 25 ], in the points of the longer parenchymal resection lines, larger volume of remaining lungs, and relative position of the resected lung.…”

Section: Discussionmentioning

confidence: 99%

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Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis

Sueyoshi,

Merlini,

Otsubo

et al. 2024

J Cardiothorac Surg

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Background Early chest tube removal should be considered to enhance recovery after surgery. The current study aimed to provide a predictive algorithm for air leak episodes (ALE) and to create a knowledge base for early chest tube removal. Methods This retrospective study enrolled patients who underwent thoracoscopic anatomical pulmonary resections in our unit. We defined ALE as any airflow ≥ 10 mL/min recorded in the follow-up charts based on the digital thoracic drainage device. Multivariate regression analysis was used to control for preoperative and intraoperative confounding factors. The ALE prediction algorithm was constructed by combining an additive ALE risk-scoring system using the coefficients of the significant predictive factors with the intraoperative water-sealing test. Results In 485 consecutive thoracoscopic major pulmonary resections, ALE developed in 209 (43%) patients. Statistically significant ALE-associated preoperative factors included male sex, lower body mass index, radiologically evident emphysema, lobectomy, and upper lobe surgery. Significant ALE-associated intraoperative factors were incomplete fissure and pleural adhesion. The ALE risk scoring demonstrated an average area under the receiver operating characteristic curve of 0.72 in the fivefold cross-validation test. The ALE prediction algorithm correctly predicted ALE-absent patients at a negative predictive value of 80%. Conclusions The algorithm may promote the optimization of the chest tube-dwelling duration by identifying potential ALE-absent patients for accelerated tube removal.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis

Sueyoshi,

Merlini,

Otsubo

et al. 2024

J Cardiothorac Surg

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“…Thanks to advances in anesthesia [ 57 ] and surgery, the mortality rate of lung surgery has decreased over the years [ 58 , 59 ]. Today, the 30-day mortality rate has further decreased to 2% after open lobectomy, 1.3% after minimally invasive lobectomy, and less than 1% after segmentectomy [ 47 , 60 , 61 ].…”

Section: Advances In Thoracic Surgery—the Evolving Landscape Of First...mentioning

confidence: 99%

“…Segmentectomy is indicated not only for compromised patients [ 92 ] but also for specific cases and selected patients [ 3 , 36 , 37 ], with pure ground-glass opacity <2 cm, adenocarcinoma in situ <2 cm, or minimally invasive or invasive adenocarcinoma <2 cm [ 93 ], if expected margins are >1 cm or measuring at least the size of the tumor. In these indications, segmentectomy provided the same short- and long-term outcomes as lobectomy [ 47 , 60 , 94 ].…”

Section: Advances In Thoracic Surgery—the Evolving Landscape Of First...mentioning

confidence: 99%

Beyond the Frontline: A Triple-Line Approach of Thoracic Surgeons in Lung Cancer Management—State of the Art

Bottet

Piton

Selim

et al. 2023

Cancers

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Non-small cell lung cancer (NSCLC) is now described as an extremely heterogeneous disease in its clinical presentation, histology, molecular characteristics, and patient conditions. Over the past 20 years, the management of lung cancer has evolved with positive results. Immune checkpoint inhibitors have revolutionized the treatment landscape for NSCLC in both metastatic and locally advanced stages. The identification of molecular alterations in NSCLC has also allowed the development of targeted therapies, which provide better outcomes than chemotherapy in selected patients. However, patients usually develop acquired resistance to these treatments. On the other hand, thoracic surgery has progressed thanks to minimally invasive procedures, pre-habilitation and enhanced recovery after surgery. Moreover, within thoracic surgery, precision surgery considers the patient and his/her disease in their entirety to offer the best oncologic strategy. Surgeons support patients from pre-operative rehabilitation to surgery and beyond. They are involved in post-treatment follow-up and lung cancer recurrence. When conventional therapies are no longer effective, salvage surgery can be performed on selected patients.

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“…Both resection extent and surgical complexity, as well as influence of incision, should be carefully considered. A good example is that in a propensity score-matched study, less severe postoperative complications were noticed after segmentectomy than after lobectomy (OR 0.52, p <0.0001) ( 22 ). However, the difference between the two groups disappeared after they were matched by the VATS approach.…”

Section: Reducing Perioperative Risks In High-risk and Good-risk Pati...mentioning

confidence: 99%

What Do We Talk About Now When We Talk About Segmentectomy for GGO?

Chen

Yang

et al. 2022

Front. Surg.

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Segmentectomy has been considered as a compromised procedure in patients with early-stage lung cancer who could not tolerate standard lobectomy. By computed tomography (CT) screening, lung cancers are increasingly detected in earlier stages, especially those appearing as ground glass opacity (GGO)-containing lesions on CT scan. This has led to the revival of segmentectomy as an intentional procedure with the aim of curing selected patients, as GGO-containing lesions represent a special group of diseases that are relatively indolent in nature and seldom have lymphatic involvement. Limited resections, especially anatomical segmentectomy, may, thus, be helpful in reducing perioperative risks and preserving higher pulmonary function for patients while retaining similar oncological outcomes. However, clinical trials focusing specifically on the role of segmentectomy in the treatment of GGO-containing lung cancers are still lacking, especially in the minimally invasive surgery setting. Emerging evidence suggests that for such lesions, the oncological non-inferiority of segmentectomy to standard lobectomymay not be limited to lesions with a size ≤ 2 cm. More importantly, it is still unclear whether segmentectomy could indeed minimize perioperative risks and to what extent it could help preserve higher pulmonary function in good-risk patients with less extent of lung parenchyma resection. Hence, it is critical to reevaluate the efficacies of minimally invasive segmentectomy including not only oncological outcomes but also perioperative results and pulmonary function changes compared with lobectomy in good-risk patients with GGO-containing lung cancers. All these remain to be explored in future studies and robust evidence is still needed to prove that patients would indeed benefit from the combination of segmentectomy and minimally invasive surgery.

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Interest of anatomical segmentectomy over lobectomy for lung cancer: a nationwide study

Cited by 7 publications

References 34 publications

Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis

Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis

Beyond the Frontline: A Triple-Line Approach of Thoracic Surgeons in Lung Cancer Management—State of the Art

What Do We Talk About Now When We Talk About Segmentectomy for GGO?

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