Clinical outcomes of thoracoscopic pulmonary segmentectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Kunliang ,  CHEN Jian , ZHAN Bicheng , LIU Yongzhi , WANG Xiao , LIU Jian

Department of Cardiothoracic Surgery, Anqing Municipal Hospital, Anhui Medical University, Anqing, 246003, Anhui, P.R.China;

Corresponding?author：

CHEN Jian, Email: 423287497@qq.com

Keywords：

Thoracoscopic surgery; segmentectomy; lung cancer; pulmonary nodule

DOI：

10.7507/1007-4848.202007088

Video：

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Objective To explore the clinical issues associated with video-assisted pulmonary segmentectomy and to provide reference for better implementation of thoracoscopic pulmonary segmentectomy and reduction of perioperative complications through analyzing the clinical results of thoracoscopic segmentectomy.Methods The clinical data of 90 patients who planned to undergo thoracoscopic segmentectomy in our department from October 2017 to December 2019 were retrospectively analyzed, including 35 males with an average age of 60.34±9.40 years and 55 females with an average age of 56.09±12.11 years. The data including lung nodule number, benign or malignant, preoperative location by Hookwire, preoperative planning and actual implementation, operation time, intraoperative blood loss, postoperative drainage volume and time of drainage tube removal, postoperative hospital stay and complications were collected and analyzed.Results Among the 90 patients, 38 were preoperatively positioned by Hook-wire, 52 were directly operated on; 87 were completed under thoracoscopic surgery among whom 3 underwent passive lobectomy after segmentectomy under thoracoscopic surgery, and 3 were converted to thoracotomy among whom 1 underwent lobectomy. Operation time was 198.58±56.42 min, intraoperative blood loss was 129.78±67.51 mL, lymph node samples were 6.43±1.41, drainage time was 2.98±1.25 d, the amount of postoperation drainage was 480.00±262.00 mL, hospital stay was 7.60±2.38 d. In all patients, 73 had single nodules and 17 had multiple nodules. Totally 113 pulmonary nodules were resected, 14 (12.39%) were benign nodules and 99 (87.61%) were malignant nodules. There was no perioperative death or serious complications.Conclusion For those pulmonary parenchymal nodules which meet the indications, it is feasible to perform thoracoscopic anatomic pulmonary segmentectomy according to preoperative thin-slice CT and three-dimensional computed tomography-bronchography and angiography (3D-CTBA) reconstruction results. Preoperative Hookwire localization can ensure effective edge resection and reduce unplanned lobotomy for intersegmental nodules and non-palpable peripheral pure ground-glass nodules.

Citation： GUO Kunliang, CHEN Jian, ZHAN Bicheng, LIU Yongzhi, WANG Xiao, LIU Jian. Clinical outcomes of thoracoscopic pulmonary segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(3): 319-324. doi: 10.7507/1007-4848.202007088 Copy

1.	金亮. 胸腔鏡下肺段切除術在肺癌治療中的現狀. 中國微創外科雜志, 2018, 18(8): 749-752.
2.	陳亮, 王俊, 吳衛兵, 等. 胸腔鏡精準肺段切除術技術流程和質量控制. 中國胸心血管外科臨床雜志, 2019, 26(1): 21-28.
3.	王寧, 劉碩, 楊雷, 等. 2018全球癌癥統計報告解讀. 腫瘤綜合治療電子雜志, 2019, 5(1): 87-97.
4.	Bedetti B, Bertolaccini L, Rocco R, et al. Segmentectomy versus lobectomy for stage Ⅰ non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2017, 9(6): 1615-1623.
5.	Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage ⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
6.	Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
7.	Nomori H, Shiraishi A, Cong Y, et al. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy. Eur J Cardiothorac Surg, 2018, 53(3): 640-647.
8.	Mohiuddin K, Haneuse S, Sofer T, et al. Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non-small cell lung cance. J Thorac Cardiovasc Surg, 2014, 147(4): 1169-1175.
9.	Schuchert MJ, Pettiford BL, Keeley S, et al. Anatomic segmentectomy in the treatment of stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2007, 84(3): 926-932.
10.	Drevet G, Ugalde Figueroa P. Uniportal video-assisted thoracoscopic surgery: Safety, efficacy and learning curve during the first 250 cases in Quebec, Canada. Ann Cardiothorac Surg, 2016, 5(2): 100-106.
11.	Horinouchi H, Nomori H, Nakayama T, et al. How many pathological T1N0M0 non-small cell lung cancers can be completely resected in one segment? Special reference to high-resolution computed tomography findings. Surg Today, 2011, 41(8): 1062-1066.
12.	邱斌, 冀瑛, 白廣宇, 等. 解剖性部分肺葉切除術治療早期肺癌: 實踐與發展. 中華胸部外科電子雜志, 2020, 7(4): 240-246.
13.	吳衛兵, 夏陽, 許晶, 等. 3D導航胸腔鏡聯合肺亞段切除術治療肺段間結節的對比研究. 南京醫科大學學報 (自然科學版), 2018, 38(10): 1424-1427.
14.	劉廣杰, 賈宇軒, 徐文華, 等. 肺部同時性多發磨玻璃結節胸腔鏡診治流程研究. 中國全科醫學, 2020, 23(15): 1956-1960.
15.	王禮同, 湯曉明, 黃華, 等. 電視胸腔鏡手術前CT引導下亞甲藍和/或Hookwire定位肺磨玻璃結節. 中國醫學影像技術, 2019, 35(8): 1220-1223.
16.	徐燦, 陳寶俊, 史敏科, 等. CT引導微彈簧圈定位在胸腔鏡切除孤立肺結節的臨床研究. 中華腔鏡外科雜志(電子版), 2017, 10(2): 102-104.
17.	王柏霖, 林吉興, 申磊磊, 等. 硬化劑定位聯合單操作孔胸腔鏡切除肺部微小結節的臨床應用價值. 解放軍醫學院學報, 2018, 39(5): 419-421.
18.	劉曉明, 胡燕, 朱萍. CT引導下hookwire技術在肺小結節定位中的應用研究. 江西醫藥, 2018, 53(9): 913-915, 930.
19.	姜艷, 郭維亞, 齊一偉, 等. CT引導下Hookwire定位術在肺小結節患者中的臨床應用及并發癥發生因素分析. 大連醫科大學學報, 2018, 40(3): 224-229.
20.	李俊芳, 王吳剛, 宮坤. 右肺腫瘤定位針進入左心腔超聲表現1例. 中國超聲醫學雜志, 2019, 35(5): 480.
21.	Tsubokawa N, Mimae T, Sasada S, et al. Negative prognostic influence of micropapillary pattern in stage ⅠA lung adenocarcinoma. Eur J Cardiothorac Surg, 2016, 49(1): 293-299.
22.	Takahashi Y, Kuroda H, Oya Y, et al. Challenges for real-time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection. Thorac Cancer, 2019, 10(8): 1663-1668.

1. 金亮. 胸腔鏡下肺段切除術在肺癌治療中的現狀. 中國微創外科雜志, 2018, 18(8): 749-752.
2. 陳亮, 王俊, 吳衛兵, 等. 胸腔鏡精準肺段切除術技術流程和質量控制. 中國胸心血管外科臨床雜志, 2019, 26(1): 21-28.
3. 王寧, 劉碩, 楊雷, 等. 2018全球癌癥統計報告解讀. 腫瘤綜合治療電子雜志, 2019, 5(1): 87-97.
4. Bedetti B, Bertolaccini L, Rocco R, et al. Segmentectomy versus lobectomy for stage Ⅰ non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2017, 9(6): 1615-1623.
5. Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage ⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
6. Moon MH, Moon YK, Moon SW. Segmentectomy versus lobectomy in early non-small cell lung cancer of 2 cm or less in size: A population-based study. Respirology, 2018, 23(7): 695-703.
7. Nomori H, Shiraishi A, Cong Y, et al. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy. Eur J Cardiothorac Surg, 2018, 53(3): 640-647.
8. Mohiuddin K, Haneuse S, Sofer T, et al. Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤2 cm) non-small cell lung cance. J Thorac Cardiovasc Surg, 2014, 147(4): 1169-1175.
9. Schuchert MJ, Pettiford BL, Keeley S, et al. Anatomic segmentectomy in the treatment of stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2007, 84(3): 926-932.
10. Drevet G, Ugalde Figueroa P. Uniportal video-assisted thoracoscopic surgery: Safety, efficacy and learning curve during the first 250 cases in Quebec, Canada. Ann Cardiothorac Surg, 2016, 5(2): 100-106.
11. Horinouchi H, Nomori H, Nakayama T, et al. How many pathological T1N0M0 non-small cell lung cancers can be completely resected in one segment? Special reference to high-resolution computed tomography findings. Surg Today, 2011, 41(8): 1062-1066.
12. 邱斌, 冀瑛, 白廣宇, 等. 解剖性部分肺葉切除術治療早期肺癌: 實踐與發展. 中華胸部外科電子雜志, 2020, 7(4): 240-246.
13. 吳衛兵, 夏陽, 許晶, 等. 3D導航胸腔鏡聯合肺亞段切除術治療肺段間結節的對比研究. 南京醫科大學學報 (自然科學版), 2018, 38(10): 1424-1427.
14. 劉廣杰, 賈宇軒, 徐文華, 等. 肺部同時性多發磨玻璃結節胸腔鏡診治流程研究. 中國全科醫學, 2020, 23(15): 1956-1960.
15. 王禮同, 湯曉明, 黃華, 等. 電視胸腔鏡手術前CT引導下亞甲藍和/或Hookwire定位肺磨玻璃結節. 中國醫學影像技術, 2019, 35(8): 1220-1223.
16. 徐燦, 陳寶俊, 史敏科, 等. CT引導微彈簧圈定位在胸腔鏡切除孤立肺結節的臨床研究. 中華腔鏡外科雜志(電子版), 2017, 10(2): 102-104.
17. 王柏霖, 林吉興, 申磊磊, 等. 硬化劑定位聯合單操作孔胸腔鏡切除肺部微小結節的臨床應用價值. 解放軍醫學院學報, 2018, 39(5): 419-421.
18. 劉曉明, 胡燕, 朱萍. CT引導下hookwire技術在肺小結節定位中的應用研究. 江西醫藥, 2018, 53(9): 913-915, 930.
19. 姜艷, 郭維亞, 齊一偉, 等. CT引導下Hookwire定位術在肺小結節患者中的臨床應用及并發癥發生因素分析. 大連醫科大學學報, 2018, 40(3): 224-229.
20. 李俊芳, 王吳剛, 宮坤. 右肺腫瘤定位針進入左心腔超聲表現1例. 中國超聲醫學雜志, 2019, 35(5): 480.
21. Tsubokawa N, Mimae T, Sasada S, et al. Negative prognostic influence of micropapillary pattern in stage ⅠA lung adenocarcinoma. Eur J Cardiothorac Surg, 2016, 49(1): 293-299.
22. Takahashi Y, Kuroda H, Oya Y, et al. Challenges for real-time intraoperative diagnosis of high risk histology in lung adenocarcinoma: A necessity for sublobar resection. Thorac Cancer, 2019, 10(8): 1663-1668.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical outcomes of thoracoscopic pulmonary segmentectomy

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