Thoracoscopic anatomic segmentectomies for lung cancer: technical aspects

Gossot, Dominique; Lutz, Jon A.; Grigoroiu, Mădălina; Brian, Emmanuel; Seguin‐Givelet, Agathe

doi:10.21037/jovs.2016.10.04

Cited by 17 publications

(16 citation statements)

References 25 publications

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“…Recently, segmentectomy for small non-small cell lung cancers has been widely performed and the validity of this procedure including video-assisted thoracoscopic surgery (VATS) segmentectomy has been established (1)(2)(3)(4). In a systematic meta-analytical review, Cao et al (5) found no significant difference in overall survival (OS) or disease-free survival (DFS) in the intentional or radical segmentectomy group compared with lobectomy, but significantly worse outcomes for palliative segmentectomy in the compromised group.…”

Section: Introductionmentioning

confidence: 99%

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

et al. 2018

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Background: Division of intersegmental planes is one of the important practical issues for segmentectomy to obtain feasible outcomes without relapse for clinical stage I non-small cell lung cancer. Almost all surgeons perform this procedure using a stapler. However, division of intersegmental planes for segmentectomy can also be performed by electrocautery. In this article, we demonstrate the merits and drawbacks of division of the intersegmental plane by electrocautery for segmentectomy. Methods: Of those 125 patients who underwent segmentectomy with clinical stage I primary lung cancer, we compared cautery cases (n=50) with stapler cases (n=75). The cautery group included 29 cases (58.0%) with partial use of a staple at the end of division. Results: Operative time was significantly longer in cautery cases (281±72 min) than stapler in cases (235±86 min; P=0.003). No difference in the duration of chest tube placement was evident between cautery (3.0±3.0 days) and stapler groups (2.8±1.7 days; P=0.613). However, delayed air leakage occurred significantly more frequently in cautery cases (14.0%) than in stapler cases (4.0%; P=0.048). Five-year overall survival (OS) in clinical stage I was 94.7% in cautery cases and 80.5% in stapler cases (log-rank P=0.047). Five-year disease-free survival (DFS) was 80.0% and 71.3%, respectively (log-rank P=0.075). Conclusions: The merits of cautery division include the ability to achieve meticulous division of the intersegmental plane and good preservation of the shape of residual segments. Conversely, the drawbacks include prolonged air leakage. Pleural suture or closure of residual segments may be useful to prevent delayed air leakage.

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Section: Introductionmentioning

confidence: 99%

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

et al. 2018

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“…This decision was due to a shortage of annotated data sets to use for lymph node detection and a sensitivity (also known as the true positive rate or recall) in the region of 85% which was considered not reliable enough for clinical deployment ( 23 ). Neither CT or 3D-CT models incorporate the effects of intra-operative organ movement, for example caused by lung deflation, which can lead to spatial disorientation of the surgeon and/or induce landmark deviations from pre-operative data ( 16 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

Surgeon Knowledge of the Pulmonary Arterial System and Surgical Plan Confidence Is Improved by Interactive Virtual 3D-CT Models of Lung Cancer Patient Anatomies

et al. 2021

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Objective: Interactive three-dimensional virtual models of pulmonary structures (3D-CT) may improve the safety and accuracy of robotic-assisted thoracic surgery (RATS). The aim of this study was to evaluate the impact of 3D-CT models as an imaging adjunct on surgical confidence and anatomical assessment for lobectomy planning.Methods: We retrospectively analyzed the response of 10 specialist thoracic surgeons who each reviewed 10 pre-operative images of patients undergoing robotic-assisted lobectomy lung cancer cases from June to November 2018 in our institute, resulting in 100 data points. The number of arteries, veins, and bronchi entering the resected lobes were determined from the operation video recording by the operating surgeon. 3D-CT models were generated for each case and made available for online visualization and manipulation. Thoracic surgeons were invited to participate in the survey which consisted of evaluation of CT (control) and 3D-CT (intervention) models. A questionnaire regarding anatomical structures, surgical approach, and confidence was administered.Results: Ten participants were recruited. 3D-CT models led to a significant (p < 0.003) increase in the surgeons' ability to correctly identifying pulmonary arteries entering the resection lobes in 35% (CT) and 57% (3D-CT) of cases. A significant (p < 1e-13) improvement in anatomy assessment and surgical plan confidence was observed for the 3D-CT arm, with median Likert scale scores of “2–Slightly easy” (CT) and “4–Very easy” (3D-CT).Conclusion: The use of 3D-CT models for thoracic surgery planning increases the surgeon confidence in recognizing anatomical structures, largely by enhanced appreciation of anatomical variations in the segmental pulmonary arterial system. Further studies are needed to investigate if 3D-CT models can be used in providing precise information about segmental artery distribution and therefore surgical planning of sub-lobar resections.

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“…Sublobar resections (SLR) include both non-anatomical wedge resections and anatomical resections of segments and subsegments with isolated division of both vascular and bronchial structures (i.e., anatomical segmentectomy). These procedures have specially spread within the last decade due to the diffusion and development of minimally invasive thoracic procedures, and the concept of "lung-sparing surgery", which means preserving as much lung parenchyma as possible [ Figure 1] [5,[21][22][23][24] .…”

Section: The Role Of Sublobar Resection In Lung Cancermentioning

confidence: 99%

Sublobar minimally invasive surgery vs. stereotactic ablative radiotherapy for early stage non-small cell lung cancer

Gálvez¹,

Bolufer²,

Corcoles³

et al. 2020

Mini-invasive Surg

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Although lobectomy has been traditionally considered the standard treatment for early stage non-small cell lung cancer (NSCLC), lung-sparing resections usually called “sublobar resections” have exponentially increased in their use in the age of minimally-invasive surgery. Sublobar resection, especially anatomical segmentectomy, has shown comparable oncological outcomes in tumors less than 2 cm in diameter without nodal involvement and distant metastasis. On the other hand, more advanced radiation techniques such as stereotactic ablative radiotherapy, have shown excellent local control rates in stage I NSCLC, with low rates of post-treatment complications, so not only is its role growing in inoperable patients, but also in standard-risk stage I patients. There is a need for multicenter randomized trials addressing specifically this issue. This review aims to collect comparative data about the outcomes of both treatment strategies in early stage NSCLC.

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Thoracoscopic anatomic segmentectomies for lung cancer: technical aspects

Cited by 17 publications

References 25 publications

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

Division of the intersegmental plane using electrocautery for segmentectomy in clinical stage I non-small cell lung cancer

Surgeon Knowledge of the Pulmonary Arterial System and Surgical Plan Confidence Is Improved by Interactive Virtual 3D-CT Models of Lung Cancer Patient Anatomies

Sublobar minimally invasive surgery vs. stereotactic ablative radiotherapy for early stage non-small cell lung cancer

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