Radical hybrid video-assisted thoracic segmentectomy: long-term results of minimally invasive anatomical sublobar resection for treating lung cancer

Abstract

We analysed the results of radical segmentectomy achieved through a hybrid video-assisted thoracic surgery (VATS) approach that used both direct vision and television monitor visualization at a median follow-up of over 5 years. Between April 2004 and October 2010, 102 consecutive patients able to tolerate lobectomy to treat clinical T1N0M0 non-small cell lung cancer (NSCLC) underwent hybrid VATS segmentectomy in which we used electrocautery without a stapler to divide the intersegmental plane detected by selective jet ventilation in addition to the path of the intersegmental veins. Curative resection was achieved in all patients. The median surgical duration and blood loss during the surgery were 129 min (range, 60-275 min) and 50 ml (range, 10-350 ml), respectively. The complication rate was 9.8% (10/102) with the most frequent being prolonged air leak, and there was no case of in-hospital death or 30-day mortality post procedure. Five and seven patients developed locoregional and distant recurrences, respectively. The overall and disease-free 5-year survival rates were 89.8% and 84.7%, respectively. Radical hybrid VATS segmentectomy including atypical resection of (sub)segments is a useful option for clinical stage-I NSCLC. The exact identification of anatomical intersegmental plane followed by dissection using electrocautery is critical from oncological and functional perspectives.

Division of the intersegmental plane during thoracoscopic segmentectomy: is stapling an issue?

“…In a series of 102 hybrid video assisted thoracic surgery (VATS) segmentectomy, electrocautery alone, i.e., without stapler, was used to divide the intersegmental plane and a fibrin sealant was applied along the raw surface of the remaining lung to prevent air leakage. PALs were observed in 4 patients (3.9%) and 3 (2.9%) had a late alveolo-pleural fistula requiring tube drainage (14). In our series, none of the 7 PALs (4.2%), required pleurodesis or reoperation.…”

Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP)

“…Electrocautery is often used to develop an intersegmental plane, typically referring to demarcation lines made by inflation-deflation lines. This conventional technique allows surgeons to easily imagine the threedimensional structure of the segment to be resected while creating intersegmental planes (7). However, despite multiple strategies reported and adequate risk-factor assessment (8)(9)(10), management of air leakage remains a major challenge.…”

“…Colorectal cancer [19] Sarcoma [11] Lung adenocarcinoma [7] Uterus [6] Oesophageal cancer [4] Hepatocellular carcinoma [3] Laryngeal cancer [3] Thyroid cancer [1] Urachal cancer [1] Inflammation and others (n=11) Inflammation, nonspecific [4] Intrapulmonary lymph node [4] Organising pneumonia [1] Sclerosing haemangioma [1] The in segmentectomy; plain CT is sufficient for VAL-MAP design). It usually takes 10 to 60 minutes to design the map and determine target bronchi, depending on the number of markings, the familiarity of the surgeon and/or bronchoscopist with the 3D software as well as the type of the software to be used.…”

Comparison of treatment outcomes between single-port video-assisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage: a retrospective observational study

“…Comparison of treatment outcomes between single-port videoassisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage: a retrospective observational study in local tumor recurrence rate and total 5-year survival rate between these two surgical options (5)(6)(7). Anatomic segmentectomy is clearly the less invasive.…”