Thoracoscopic wedge resection and segmentectomy for small-sized pulmonary nodules

Abstract

With the recent increase in the detection of small-sized lung nodules because of the widespread use of computed tomography (CT), limited resection and minimally invasive surgery are preferred by patients with these lesions. In particular, the detection of nodules that show ground-glass opacity during high-resolution CT has increased. Although lobectomy and lymph node dissection were the standard procedures used for treating lung cancer, limited wedge resection and segmentectomy have become acceptable for treating small-sized lung cancers with nodules showing ground-glass opacity. These limited procedures are widely performed, especially because they can be accomplished thoracoscopically.Furthermore, not only simple segmentectomy but also complex segmentectomy and subsegmentectomy can be performed using three-dimensional (3D)-CT to achieve sufficient resection based on tumor size.There are, however, technical difficulties in thoracoscopic wedge resection and segmentectomy. While it may be curative for small-sized lung nodules, it is sometimes difficult to correctly perform wedge resection when the tumor is not identified intraoperatively. In such cases, we usually perform tumor marking before operating. However, serious complications, such as cerebral air embolism, have been reported. Further, although it can sufficiently resect small-sized lung nodules, segmentectomy is more technically complex than wedge resection. Therefore, we have developed methods to overcome these technical difficulties. By using a hookwire method in a hybrid operating room and 3D-CT simulation for each wedge resection and segmentectomy, we have obtained good outcomes. Limited resection individualized for each patient will continue to evolve with applications such as CT. indeterminate lesions or cure small-sized GGO-dominant lung tumors, because the procedure is simple and easy (5). Although segmentectomy is generally thought to be more complex than wedge resection, the oncological outcomes of segmentectomy in a propensity-matched study were comparable to those of lobectomy for patients with earlystage non-small lung cell cancer (6). Segmentectomy has thus become widely used worldwide (7).If limited resection is possible for a small-sized lung nodule, a thoracoscopic approach is a highly desirable, minimally invasive option (8,9). The thoracoscopic approach has better outcomes than thoracotomy with regard to quality of life and complications, and is preferred over thoracotomy for its advantages of decreased postoperative pain, shortened chest-tube duration, shortened length of hospital stay, faster return to preoperative activity levels, and preserved pulmonary function (8,9).The combination of limited resection and minimally invasive surgery is, therefore, in great demand. In our institute, limited resection is preferred for small-sized GGO-dominant tumors. The aim of this article is to describe the role of limited thoracoscopic wedge resection and segmentectomy for small-sized lung nodules, with reference to recent literature. ...

Ground glass opacities: Imaging, pathology, and gene mutations

“…However, the extent of surgery is quite controversial. [7][8][9][10][11] Wedge resection, segmentectomy, and lobectomy are all currently used to treat GGO. Video 1 shows a sublobar resection performed in our center.…”

The feasibility of electromagnetic navigational bronchoscopic localization with fluorescence and radiocontrast dyes for video-assisted thoracoscopic surgery resection

“…In recent years, lung segmentectomy or wedge resection has been developed to offer better pulmonary preservation than lobectomy or pneumonectomy for lung malignancy (1,2). Sublobar resection has been used for the removal of inflammatory lung lesions or non-malignant lung masses (3,4); meanwhile, for early-stage lung malignancy (5-7), some groups have recommended the use of localization techniques to achieve a proper resection margin of more than 2 cm or the size of nodule (8)(9)(10).…”

Caracterización de nódulos pulmonares resecados. Experiencia de manejo por un programa multidisciplinario

“…Se definió como lobectomía, la resección de un lóbulo pulmonar; resección segmentaria, la resección de un segmento pulmonar que respeta los planos anatómicos, previa identificación de las estructuras broncovasculares correspondientes y resección en cuña, la resección sublobar que no respeta los planos anatómicos 12 .…”