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Ohtani-Kim SJY, Samejima J, Wakabayashi M, Tada M, Koike Y, Miyoshi T, Tane K, Aokage K, Tsuboi M. Effect of Resected Lung Volume on Pulmonary Function and Residual Lung Volume in Patients Undergoing Segmentectomy: A Retrospective Study. Ann Surg Oncol 2024:10.1245/s10434-024-15550-z. [PMID: 38864984 DOI: 10.1245/s10434-024-15550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/16/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE We elucidated the effects of planned resection volume on postoperative pulmonary function and changes in residual lung volume during segmentectomy. METHODS This study included patients who underwent thoracoscopic segmentectomy between January 2017 and December 2022 and met eligibility criteria. Pre- and post-resection spirometry and computed tomography were performed. Three-dimensional reconstructions were performed by using computed tomography images to calculate the volumes of the resected, remaining, and nonoperative side regions. Based on the resected region volume, patients were divided into the higher and lower volume segmentectomy groups. Changes in lung volume and pulmonary function before and after the surgery were comparatively analyzed. RESULTS The median percentage of resected lung volume was 10.9%, forming the basis for categorizing patients into the two groups. Postoperative forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) ratios to preoperative measurements in both groups did not differ significantly (FEV1, p = 0.254; FVC, p = 0.777). Postoperative FEV1 and FVC ratios to their predicted postoperative values were significantly higher in the higher volume segmentectomy group than in the lower volume segmentectomy group (FEV1, p = 0003; FVC, p < 0.001). The higher volume segmentectomy group showed significantly greater post-to-preoperative lung volume ratio in overall, contralateral, ipsilateral, residual lobe and residual segment than the lower volume segmentectomy group. CONCLUSIONS Postoperative respiratory function did not differ significantly between the higher- and lower-volume segmentectomy groups, indicating improved respiratory function because of substantial postoperative residual lung expansion. Our findings would aid in determining the extent of resection during segmentectomy.
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Affiliation(s)
- Seiyu Jeong-Yoo Ohtani-Kim
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Joji Samejima
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Masashi Wakabayashi
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center Hospital East, Kashiwa, Japan
| | - Makoto Tada
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Yutaro Koike
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tomohiro Miyoshi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kenta Tane
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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Mayer N, Kestenholz P, Minervini F. Resecting less, breathing better? Eur J Cardiothorac Surg 2024; 65:ezae233. [PMID: 38867689 DOI: 10.1093/ejcts/ezae233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/10/2024] [Indexed: 06/14/2024] Open
Affiliation(s)
- Nora Mayer
- Divison of Thoracic Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6004 Lucerne, Switzerland
| | - Peter Kestenholz
- Divison of Thoracic Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6004 Lucerne, Switzerland
| | - Fabrizio Minervini
- Divison of Thoracic Surgery, Cantonal Hospital Lucerne, Spitalstrasse, 6004 Lucerne, Switzerland
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Peng J, Guo G, Wang Z, Zhuang L, Ma Y, Yuan B, Zhang M, Tao Q, Zhao Y, Zhao L, Dong X. Factors Associated With Radiological Lung Growth Rate After Lobectomy in Patients With Lung Cancer. J Surg Res 2024; 298:251-259. [PMID: 38636181 DOI: 10.1016/j.jss.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/21/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION This study is a retrospective study. This study aims to explore the association between lobectomy in lung cancer patients and subsequent compensatory lung growth (CLG), and to identify factors that may be associated with variations in CLG. METHODS 207 lung cancer patients who underwent lobectomy at Yunnan Cancer Hospital between January 2020 and December 2020. All patients had stage IA primary lung cancer and were performed by the same surgical team. And computed tomography examinations were performed before and 1 y postoperatively. Based on computed tomography images, the volume of each lung lobe was measured using computer software and manual, the radiological lung weight was calculated. And multiple linear regressions were used to analyze the factors related to the increase in postoperative lung weight. RESULTS One year after lobectomy, the radiological lung weight increased by an average of 112.4 ± 20.8%. Smoking history, number of resected lung segments, preoperative low attenuation volume, intraoperative arterial oxygen partial pressure/fraction of inspired oxygen ratio and postoperative visual analog scale scores at 48 h were significantly associated with postoperative radiological lung weight gain. CONCLUSIONS Our results suggest that CLG have occurred after lobectomy in adults. In addition, anesthetists should maintain high arterial oxygen partial pressure/fraction of inspired oxygen ratio during one-lung ventilation and improve acute postoperative pain to benefit CLG.
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Affiliation(s)
- Jing Peng
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Gang Guo
- Department of Thoracic Surgery II, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunman, China
| | - Zhonghui Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Li Zhuang
- Department of Palliative Medicine, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Yuhui Ma
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Bin Yuan
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Mingxiong Zhang
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Qunfen Tao
- Department of Operation Room, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Yanqiu Zhao
- Department of Thoracic Surgery II, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunman, China
| | - Li Zhao
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China.
| | - Xingxiang Dong
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China.
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Tsubokawa N, Mimae T, Mimura T, Kamigaichi A, Fujiwara M, Kawamoto N, Miyata Y, Okada M. Clinical Significance of Preserving Pulmonary Function After Lung Resection in Early-Stage Non-Small-Cell Lung Cancer. Clin Lung Cancer 2024; 25:329-335.e1. [PMID: 38429143 DOI: 10.1016/j.cllc.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/21/2023] [Accepted: 01/18/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION To determine the association between changes in pulmonary function before and after surgery, and the subsequent prognosis, of patients with early-stage non-small-cell lung cancer (NSCLC). METHODS A total of 485 patients who underwent lobectomy or segmentectomy for NSCLC with whole tumor size ≤2 cm and clinical stage IA at 2 institutions were retrospectively reviewed. The relationship between the postoperative reduction rate in vital capacity (VC), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) and overall survival (OS) was investigated. OS determined the cut-off value of the reduction rate, according to the reduction rate of every 10% in pulmonary function. RESULTS Multivariable Cox regression analysis showed that a reduction rate in VC at 12 months postoperatively was an independent prognostic factor for OS (hazard ratio, 1.05; 95% confidence interval [CI], 1.02-1.07; P < .001) but those in FVC and FEV1 were not. OS was classified into good and poor with 20% reduction rate in VC. OS and recurrence-free survival (RFS) in a higher than 20% reduction rate in VC were worse than those in ≤20% reduction rate in VC (5 year-OS; 82.0% vs. 93.4%; P = .0004. Five year-RFS; 80.3% vs. 89.8%; P = .0018, respectively). Multivariable logistic analysis showed that lobectomy was a risk factor for the higher than 20% reduction rate in VC (odds ratio, 1.61; 95% CI, 1.01-2.56; P = .045). CONCLUSIONS Postoperative decrease in VC was significantly associated with the prognosis. Preserving pulmonary function is important for survival of patients with early-stage NSCLC.
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Affiliation(s)
| | - Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Takeshi Mimura
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | | | - Makoto Fujiwara
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Nobutaka Kawamoto
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
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Bou-Samra P, Singhal S. Precision Oncology in Lung Cancer Surgery. Surg Oncol Clin N Am 2024; 33:311-320. [PMID: 38401912 DOI: 10.1016/j.soc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
Precision in lung cancer surgery is our ability to use the most cutting edge and up to date information to provide personalized and targeted surgical care to our patients. It aims to tailor patient care to patient and tumor characteristics and susceptibilities as well as to optimize the ways treatments are administered. This may include specific perioperative medical treatment, changing operative techniques to more minimally invasive ones if the situation permits, performing sub-anatomical surgeries when possible, and using innovative tumor visualization methods to enhance detection of previously occult disease to ultimately decrease the extent of the planned resection.
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Affiliation(s)
- Patrick Bou-Samra
- The University of Pennsylvania - Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Sunil Singhal
- Department of Thoracic Surgery, Perelman School of Medicine, University of Pennsylvania, 14th Floor PCAM South Tower, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Ichimura H, Kobayashi K, Gosho M, Sekine Y, Sugai K, Kawamura T, Saeki Y, Suzuki H, Kobayashi N, Goto Y, Sato Y. Relationship between changes in pulmonary function and patient-reported outcomes of lung cancer surgery. Surg Today 2024; 54:195-204. [PMID: 37306743 DOI: 10.1007/s00595-023-02716-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE To investigate the relationship between changes in pulmonary function (PF) and patient-reported outcomes (PROs) of lung cancer surgery. METHODS We recruited 262 patients who underwent lung resection for lung cancer, to evaluate the PROs, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30 and the Lung Cancer 13-question supplement (LC13). The patients underwent PF tests and PRO assessments preoperatively (Pre) and 1 year after surgery (Y1). Changes were calculated by subtracting the value at Pre from the value at Y1. We set two cohorts: patients under the ongoing protocol (Cohort 1) and patients who were eligible for lobectomy with clinical stage I lung cancer (Cohort 2). RESULTS Cohorts 1 and 2 comprised 206 and 149 patients, respectively. In addition to dyspnea, changes in PF were also correlated with scores for global health status, physical and role function scores, fatigue, nausea and vomiting, pain, and financial difficulties. Absolute correlation coefficient values ranged from 0.149 to 0.311. Improvement of emotional and social function scores was independent of PF. Sublobar resection preserved PF more than lobectomy did. Wedge resection mitigated dyspnea in both cohorts. CONCLUSION The correlation between PF and PROs was found to be weak; therefore, further studies are needed to improve the patient's postoperative experience.
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Affiliation(s)
- Hideo Ichimura
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan.
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Keisuke Kobayashi
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Masahiko Gosho
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yasuharu Sekine
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Kazuto Sugai
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Tomoyuki Kawamura
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Yusuke Saeki
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Hisashi Suzuki
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Naohiro Kobayashi
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukinobu Goto
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Isaka T, Ito H, Yokose T, Saito H, Narimatsu H, Adachi H, Miura J, Murakami K, Kikunishi N, Shigeta N, Rino Y. Long-term changes in psoas muscle mass after lobectomy and segmentectomy for early-stage lung cancer. J Cachexia Sarcopenia Muscle 2023; 14:2540-2549. [PMID: 37740651 PMCID: PMC10751413 DOI: 10.1002/jcsm.13328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/12/2023] [Accepted: 08/21/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Segmentectomy is considered a less invasive procedure than lobectomy for patients with non-small cell lung cancer (NSCLC); however, little is known about the physiological mechanism underlying the lower invasiveness of segmentectomy. This study is aimed to compare the differences in the long-term changes in the psoas muscle mass after segmentectomy and lobectomy in patients with NSCLC. METHODS Overall 315 recurrence-free patients who underwent segmentectomy (n = 93) or lobectomy (n = 222) for clinical stage 0-I NSCLC between January 2016 and December 2018 and underwent computed tomography during the entire period of 6 months ≤ postoperative year (POY) 0.5 < 12 months, 12 months ≤ POY 1 < 24 months, 24 months ≤ POY 2 < 36 months, and 36 months ≤ POY 3 < 48 months were included. Bilateral psoas muscle area (PMA) at the L3 level was measured using each cross-sectional computed tomography scan. Differences between the segmentectomy and lobectomy groups in the mean change of postoperative PMA from the preoperative period were analysed using Student's t-test and mixed analysis of variance. Multivariable analysis was performed to identify the risk factors for PMA loss on POY 3 using logistic regression analysis. RESULTS The lobectomy group had a significantly larger PMA change than the segmentectomy group during each postoperative period (P < 0.001). Mixed analysis of variance revealed that the mean PMA change was significantly smaller in the segmentectomy group than in the lobectomy group during the observation period (P < 0.001). The mean change in the PMA was significantly larger from POY1 (-2.5%) to POY2 (-3.9%) and POY3 (-4.7%) in the lobectomy group (P = 0.003 and P < 0.001). However, PMA remained unchanged during the postoperative observation period in the segmentectomy group. In the multivariable analysis, the risk factors for PMA change ≤-3.3% (cut-off: mean change of PMA) at POY3 included lobectomy [odds ratio (OR), 3.32; 95% confidence interval (CI), 1.90-5.82; P < 0.001], male sex (OR, 1.92; 95% CI, 1.02-3.62; P = 0.044) and open thoracotomy (OR, 1.84; 95% CI, 1.11-3.05; P = 0.017). After propensity score matching, the mean change in PMA was smaller in the segmentectomy group (n = 75) than in the lobectomy group (n = 75) during the postoperative observation period (P < 0.001). CONCLUSIONS Psoas muscle mass was better maintained during the postoperative period by segmentectomy than by lobectomy. Psoas muscle mass reduction progressed over a long postoperative period after lobectomy. Segmentectomy via complete video-assisted thoracic surgery is associated with a lower likelihood of sarcopenia progression.
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Affiliation(s)
- Tetsuya Isaka
- Department of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
- Department of SurgeryYokohama City UniversityYokohamaJapan
| | - Hiroyuki Ito
- Department of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
| | | | - Haruhiro Saito
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Hiroto Narimatsu
- Department of Genetic MedicineKanagawa Cancer CenterYokohamaJapan
- Cancer Prevention and Cancer Control DivisionKanagawa Cancer Center Research InstituteYokohamaJapan
- Graduate School of Health InnovationKanagawa University of Human ServicesKawasakiJapan
| | - Hiroyuki Adachi
- Department of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
| | - Jun Miura
- Department of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
| | - Kotaro Murakami
- Department of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
| | | | - Naoko Shigeta
- Department of Thoracic SurgeryKanagawa Cancer CenterYokohamaJapan
| | - Yasushi Rino
- Department of SurgeryYokohama City UniversityYokohamaJapan
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Jiang S, Wang B, Zhang M, Liu Z, Xiao Z, Gong J, Wang X, Zhang Z, Zhang Z. Quality of life after lung cancer surgery: sublobar resection versus lobectomy. BMC Surg 2023; 23:353. [PMID: 37980480 PMCID: PMC10657598 DOI: 10.1186/s12893-023-02259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND This study aimed to compare the postoperative quality of life (PQOL) between non-small-cell lung cancer (NSCLC) patients who underwent video-assisted thoracoscopic sublobar resection (subsegment, segment, or wedge) and lobectomy. Meanwhile, we developed a PQOL scale for patients with NSCLC after optimization. METHODS Developing and evaluating the postoperative quality-of-life scale of non-small-cell lung cancer (NSCLC-PQOL) followed by the international principles for developing quality-of-life scale. Therefore, we used the NSCLC-PQOL scale to evaluate the PQOL of patients who underwent different surgeries. RESULTS The overall PQOL of patients who underwent video-assisted thoracoscopic lobectomy and sublobar resection gradually worsened from discharge to 3 months postoperatively and progressively improved from three to 6 months postoperatively. And the sublobar resection group showed better PQOL in chest tightness, breath shortness, breathlessness, cough and expectoration than the lobectomy group, and the differences were statistically significant (P < 0.05). The final version of the NSCLC-PQOL contained three dimensions: "signs-symptoms", "psychological and psychiatric", and "social-life" dimensions. CONCLUSIONS The sublobar resection group showed better PQOL in "chest tightness", "breath shortness", "breathlessness", "cough", and "expectoration" than the lobectomy group. Twenty-two items formed a well-behaved PQOL scale after being validated satisfactorily. The scale was a suitable rating tool for evaluating the NSCLC-PQOL of patients. TRIAL REGISTRATION As this study was a retrospective study and not a clinical trial, we did not register this study in the Chinese Clinical Trial Registry.
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Affiliation(s)
- Shuai Jiang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, 1 Huanhu West Road, Tianjin, 300020, China
| | - Bao Wang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, 1 Huanhu West Road, Tianjin, 300020, China
| | - Mengzhe Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, 1 Huanhu West Road, Tianjin, 300020, China
| | - Zuo Liu
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, 1 Huanhu West Road, Tianjin, 300020, China
| | - Zengtuan Xiao
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, 1 Huanhu West Road, Tianjin, 300020, China
| | - Jialin Gong
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, 1 Huanhu West Road, Tianjin, 300020, China
| | - Xiaofei Wang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, 1 Huanhu West Road, Tianjin, 300020, China
| | - Zhenning Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, 1 Huanhu West Road, Tianjin, 300020, China
| | - Zhenfa Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, 1 Huanhu West Road, Tianjin, 300020, China.
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Moon RJ, Taylor R, Miklavc P, Mehdi SB, Grant SW, Bittar MN. Wedge resection versus lobectomy in T1 lung cancer patients: a propensity matched analysis. J Cardiothorac Surg 2023; 18:252. [PMID: 37620956 PMCID: PMC10464042 DOI: 10.1186/s13019-023-02303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/10/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES Performing wedge resection rather than lobectomy for primary lung cancer remains controversial. Recent studies demonstrate no survival advantage for non-anatomical resection compared to lobectomy in patients with early-stage lung cancer. The objective of this study was to investigate whether in patients with T1 tumours, non-anatomical wedge resection is associated with equivalent survival to lobectomy. METHODS This was a retrospective cohort study of patients who underwent lung resection at the Lancashire Cardiac Centre between April 2005 and April 2018. Patients were subjected to multidisciplinary team discussion. The extent of resection was decided by the team based on British Thoracic Society guidelines. The primary outcome was overall survival. Propensity matching of patients with T1 tumours was also performed to determine whether differences in survival rates exist in a subset of these patients with balanced pre-operative characteristics. RESULTS There were 187 patients who underwent non-anatomical wedge resection and 431 patients who underwent lobectomy. Cox modelling demonstrated no survival difference between groups for the first 1.6 years then a risk of death 3-fold higher for wedge resection group after 1.6 years (HR 3.14, CI 1.98-4.79). Propensity matching yielded 152 pairs for which 5-year survival was 66.2% for the lobectomy group and 38.5% for the non-anatomical wedge group (SMD = 0.58, p = 0.003). CONCLUSIONS Non-anatomical wedge resection was associated with significantly reduced 5-year survival compared to lobectomy in matched patients. Lobectomy should remain the standard of care for patients with early-stage lung cancer who are fit enough to undergo surgical resection.
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Affiliation(s)
- Robert J Moon
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK.
| | - Rebecca Taylor
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Pika Miklavc
- School of Science, Engineering and Environment, University of Salford, Manchester, UK
| | - Syed B Mehdi
- Department of Respiratory Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Stuart W Grant
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
| | - Mohamad Nidal Bittar
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
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Tsubokawa N, Mimura T, Tadokoro K, Yamashita Y. Risk factors for long-term decline in post-operative pulmonary function after lung resection. Jpn J Clin Oncol 2023; 53:245-252. [PMID: 36546715 DOI: 10.1093/jjco/hyac193] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The study aimed to examine the risk factors for long-term decline in pulmonary function after anatomical resection for lung cancer and the effects of the decrease on survival. METHODS We retrospectively examined 489 patients who underwent anatomical resection for lung cancer between 2010 and 2020. Pulmonary function tests were performed preoperatively and at 1, 3, 6 and 12 months after surgery. The lower interquartile medians of the reduction rates of forced expiratory volume in 1 s and vital capacity at 12 months after surgery were taken as the cut-off values of risk factors for the decrease in post-operative pulmonary function. RESULTS Forced expiratory volume in 1 s and vital capacity decreased the most in the first month after surgery and then gradually recovered. Vital capacity continued to increase even after 6 months post-surgery, whereas forced expiratory volume in 1 s stabilized. Multivariable logistic analysis showed that the number of resected segments (odds ratio, 2.09; 95% confidence interval, 1.12-3.89; P = 0.019) was a risk factor for the decrease in forced expiratory volume in 1 s at 12 months, and the numbers of resected segments (odds ratio, 1.36; 95% confidence interval, 1.13-1.63; P < 0.001) and post-operative complications (odds ratio, 2.32; 95% confidence interval, 1.01-5.35; P = 0.047) were independent risk factors for decrease in vital capacity. Multivariate cox regression analysis showed that the decrease in vital capacity at 12 months was significantly associated with overall survival (hazard ratio, 2.02; 95% confidence interval, 1.24-3.67; P = 0.004). CONCLUSIONS Long-term decrease in vital capacity, which was influenced by the number of resected segments and post-operative complications, adversely affected survival.
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Affiliation(s)
- Norifumi Tsubokawa
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Takeshi Mimura
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Kazuki Tadokoro
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Yoshinori Yamashita
- Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
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Patterns of Postoperative Changes in Lung Volume and Perfusion Assessed by Dual-Energy CT: Comparison of Lobectomy and Limited Resection. AJR Am J Roentgenol 2023; 220:660-671. [PMID: 36321980 DOI: 10.2214/ajr.22.28450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND. Pulmonary function tests (PFTs) and perfusion scintigraphy have limited utility for evaluating postoperative changes in regional pulmonary function after lung cancer resection surgery. OBJECTIVE. The purpose of this study is to compare postoperative changes in lung volume and perfusion, as assessed by dual-energy CT (DECT), between patients undergoing surgical resection of lung cancer by lobectomy versus limited resection as well as to assess associations between such changes and the lobar location of the resected tumor. METHODS. This study entailed a retrospective post hoc analysis of a prospective study that enrolled patients awaiting lung cancer resection surgery between March 2019 and February 2020. Eighty-one patients (38 men and 43 women; mean age, 60.5 ± 8.9 [SD] years), 43 of whom underwent lobectomy and 38 of whom underwent limited resection, were included. Patients underwent thoracic DECT and PFT evaluation preoperatively and at 6 months postoperatively. Pulmonary lobes were segmented. Lobar lung volume and lung perfusion ratios (both relative to whole-lung values) were computed. Perfusion measures reflected DECT-derived iodine content. Patients completed 6-month postoperative quality-of-life (QOL) questionnaires. RESULTS. Patients undergoing lobectomy, compared with those undergoing limited resection, had greater increases in the lung volume ratio of the ipsilateral nonresected lobe(s) (mean, 42.3% ± 24.2% [SD] vs 22.9% ± 13.2%, p < .001) and the contralateral lung (mean, 14.6% ± 14.0% vs 6.4% ± 6.9%, p = .002) as well as greater increases in the lung perfusion ratio of the ipsilateral nonresected lobe(s) (mean, 39.9% ± 20.7% [SD] vs 22.8% ± 17.8%, p < .001) and the contralateral lung (mean, 20.9% ± 9.4% vs 4.3% ± 5.6%, p < .001). In patients with right lower lobe tumors, the largest postoperative increases in the lung volume ratio were in the right middle lobe in those undergoing lobectomy (mean, 44.1% ± 21.0%) and limited resection (mean, 24.6% ± 14.5%), whereas the largest postoperative increase in the lung perfusion ratio was in the left lower lobe in those undergoing lobectomy (mean, 53.9% ± 8.6%) and in the right middle lobe in those undergoing limited resection (mean, 32.5% ± 24.1%). Otherwise, the largest increases in lung volume and perfusion ratios occurred in the ipsilateral nonresected lobes (vs the contra-lateral lobes), regardless of the operative approach used and the lobar location. Changes in the lung volume and perfusion ratios in the ipsilateral lobe(s) and the contralateral lung showed weak correlations with certain quality-of-life scores (e.g., for role functioning: ρ = 0.234-0.279 [volume] and -0.233 to -0.284 [perfusion]). CONCLUSION. DECT depicts patterns of lung volume and perfusion changes after lung cancer surgery, depending on the surgical approach (lobectomy vs limited resection) used and the lobar location of the tumor. CLINICAL IMPACT. DECT-derived metrics can help understand variable physiologic impacts of lung cancer resection surgeries.
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Detterbeck FC, Mase VJ, Li AX, Kumbasar U, Bade BC, Park HS, Decker RH, Madoff DC, Woodard GA, Brandt WS, Blasberg JD. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 2: systematic review of evidence regarding resection extent in generally healthy patients. J Thorac Dis 2022; 14:2357-2386. [PMID: 35813747 PMCID: PMC9264068 DOI: 10.21037/jtd-21-1824] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, stereotactic body radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in generally healthy patients is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results In healthy patients there is no short-term benefit to sublobar resection vs. lobectomy in randomized and non-randomized comparisons. A detriment in long-term outcomes is demonstrated by adjusted non-randomized comparisons, more marked for wedge than segmentectomy. Quality-of-life data is confounded by the use of video-assisted approaches; evidence suggests the approach has more impact than the resection extent. Differences in pulmonary function tests by resection extent are not clinically meaningful in healthy patients, especially for multi-segmentectomy vs. lobectomy. The margin distance is associated with the risk of recurrence. Conclusions A systematic, comprehensive summary of evidence regarding resection extent in healthy patients with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation on which to build a framework for individualized clinical decision-making.
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Affiliation(s)
- Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
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13
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Sun Y, Zhang Q, Wang Z, Shao F. Real-time image-guided indocyanine green fluorescence dual-visualization technique to measure the intraoperative resection margin during thoracoscopic segmentectomy. Asia Pac J Clin Oncol 2022; 19:e39-e44. [PMID: 35599444 DOI: 10.1111/ajco.13771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/06/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
AIMS The primary goal of thoracoscopic segmentectomy is the complete resection of early pulmonary carcinoma while sparing as much of the normal pulmonary parenchyma as possible, but an obvious trade-off exists between the pulmonary parenchymal preservation and an adequate resection margin. In this clinical trial, we explored a real-time image-guided indocyanine green (ICG) fluorescence dual-visualization technique to confirm the resection margin by improving the intraoperative localization of the pulmonary nodule and identification of the intersegmental boundary line (IBL). METHODS This study was utilized in 35 patients with a screening-detected lung nodule <2 cm to complete thoracoscopic segmentectomy from December 2020 to June 2021. Computed tomography-guided localization of the pulmonary nodule with ICG solution was performed on the day of surgery. During the surgery, after dissecting the targeted pulmonary segmental arteries, ICG at 5 mg/body was injected into the systemic vein. RESULTS We observed no toxicity. The dual-visualization technique was successfully implemented in all 35 patients to achieve a negative resection margin, which was more than 2 (mean 2.71 ± 0.59) cm, or the size of the tumor based on the final pathological examinations. No intraoperative complications occurred and only one patient had postoperative prolonged air leaks, which was ceased 8 days later after conservative management without reoperation. CONCLUSIONS This method is a safe and feasible alternative to ensure a negative resection margin without removing an unreasonable amount of pulmonary parenchyma during pulmonary segmentectomy. Future studies will be needed to compare this method to alternative techniques in a clinical trial.
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Affiliation(s)
- Yungang Sun
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing, China.,Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Pulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical University, Nanjing, China
| | - Qiang Zhang
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing, China.,Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Pulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical University, Nanjing, China
| | - Zhao Wang
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing, China.,Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Pulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical University, Nanjing, China
| | - Feng Shao
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing, China.,Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Pulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical University, Nanjing, China
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14
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Shi Y, Wu S, Ma S, Lyu Y, Xu H, Deng L, Chen X. Comparison Between Wedge Resection and Lobectomy/Segmentectomy for Early-Stage Non-small Cell Lung Cancer: A Bayesian Meta-analysis and Systematic Review. Ann Surg Oncol 2022; 29:1868-1879. [PMID: 34613537 PMCID: PMC8493945 DOI: 10.1245/s10434-021-10857-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgery has become an accepted method for the treatment of early-stage non-small cell lung cancer (NSCLC). The purpose of this Bayesian meta-analysis was to compare the overall survival (OS), disease-free survival (DFS), and relapse-free survival (RFS) between wedge resection and lobectomy/segmentectomy for treatment of early-stage NSCLC. METHODS Eligible studies were retrieved from Web of Science, PubMed, MEDLINE, Cochrane Library, EMBASE, CNKI, and WanFang up to July 2021 and screened based on established selection criteria. The Bayesian meta-analysis was performed with the combination of the reported survival outcomes of the individual studies using a random-effect model. The OS, DFS, and RFS of the wedge resection group was compared with the lobectomy/segmentectomy group. The hazard ratio (HR) and standard error were extracted or calculated for each study using the Kaplan-Meier method. RESULTS This study was registered with PROSPERO (INPLASY202080090).The pooled OS hazard ratio between segmentectomy and lobectomy was 1.1 [95% confidence interval (CI) 0.92-1.4], the pooled HR between lobectomy and wedge resection was 0.71 [95% CI 0.52-0.96], and the pooled HR between segmentectomy and wedge was 0.80 [95% CI 0.56-1.10]. The pooled HR of DFS or RFS was not statistically significant among the three surgical approaches. CONCLUSIONS Patients with early-stage NSCLC received lobectomy had the lowest hazard ratio of OS than patients received wedge resection, indicating that the overall survival of patients received lobectomy was higher than patients received wedge resection. However, regarding DFS and RFS, the three surgical approaches showed no significant difference.
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Affiliation(s)
- Yucong Shi
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, Guangdong China
| | - Sizhi Wu
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, Guangdong China
- Department of Geriatrics Respiratory Medicine, Guangzhou First People’s Hospital, Guangzhou, Guangdong China
| | - Shengsuo Ma
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, Guangdong China
| | - Yiwen Lyu
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, Guangdong China
| | - Huachong Xu
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, Guangdong China
| | - Li Deng
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, Guangdong China
| | - Xiaoyin Chen
- School of Traditional Chinese Medicine, Jinan University, Guangzhou, Guangdong China
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15
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Wang X, Guo H, Hu Q, Ying Y, Chen B. Pulmonary function after segmentectomy versus lobectomy in patients with early-stage non-small-cell lung cancer: a meta-analysis. J Int Med Res 2021; 49:3000605211044204. [PMID: 34521244 PMCID: PMC8447102 DOI: 10.1177/03000605211044204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Segmentectomy is widely performed for early-stage lung cancer. However, the
effects of segmentectomy versus lobectomy on pulmonary function remain
unclear. We performed a meta-analysis with the aim of comparing
segmentectomy and lobectomy in terms of preservation of pulmonary function
in patients with early-stage non-small-cell lung cancer (NSCLC). Methods We conducted a literature search of PubMed using the terms ‘pulmonary
function’ AND ‘segmentectomy’ AND ‘lobectomy’. The primary outcomes of
interest were the forced expiratory volume in 1 second (FEV1), FEV1 as
percent of predicted (%FEV1), change in FEV1 (Δ%FEV1), and the ratio of
postoperative to preoperative FEV1. Results Thirteen studies comprising 2027 patients met the inclusion and exclusion
criteria and were included for analysis, including 787 patients in the
segmentectomy group and 1240 patients in the lobectomy group. Patients in
the segmentectomy group showed significantly better preservation of FEV1 and
%FEV1 compared with the lobectomy group. The reduction in FEV1 after surgery
was significantly less in the segmentectomy group compared with the
lobectomy group, and Δ%FEV1 was significantly higher in the segmentectomy
group than in the lobectomy group. Conclusion Segmentectomy results in better preservation of pulmonary function compared
with lobectomy in patients with early-stage NSCLC.
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Affiliation(s)
- Xinxin Wang
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Haixie Guo
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Quanteng Hu
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Yongquan Ying
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Baofu Chen
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
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16
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Ito Y, Suzuki H, Sasahara Y, Mitsukawa N, Yoshino I. Can surgical repair for pectus excavatum contribute to lung growth? Interact Cardiovasc Thorac Surg 2021; 33:928-934. [PMID: 34423359 DOI: 10.1093/icvts/ivab203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study investigates whether the surgical correction of chest deformity is associated with the growth of the lung parenchyma after surgery for pectus excavatum. METHODS Ten patients with pectus excavatum who were treated by the Nuss procedure were examined. The preoperative and postoperative computed tomography (2.5 ± 1.2 years after surgery) scans were performed, and the Haller index, lung volume and lung density were analyzed using a three-dimensional image analysis system (SYNAPSE VINCENT, Fujifilm, Japan). The radiological lung weight was calculated as follows: lung volume (ml) × lung density (g/ml). RESULTS The average age of the 10 patients (men 8; women 2) was 13.8 years (range: 6-26 years). The Haller index was significantly improved from the preoperative value of 5.18 ± 2.20 to the postoperative value of 3.68 ± 1.38 (P = 0.0025). Both the lung volume and weight had significantly increased by 107.1 ± 19.6% and 121.6 ± 11.3%, respectively, after surgery. CONCLUSIONS A significant increase in the weight of the lung after surgical correction suggests that the growth of the lung parenchyma is associated with the correction of chest deformity in younger patients with pectus excavatum.
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Affiliation(s)
- Yuki Ito
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshitaro Sasahara
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Robot-assisted lobectomy in a patient with poor lung function: Another advantage of robot-assisted thoracoscopic surgery. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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18
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Xu Z, Gao X, Ren B, Zhang S, Xu L. A bibliometric analysis of segmentectomy versus lobectomy for non-small cell lung cancer research (1992-2019). Medicine (Baltimore) 2021; 100:e25055. [PMID: 33787587 PMCID: PMC8021308 DOI: 10.1097/md.0000000000025055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/12/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This study intends to create a series of scientific maps to quantitatively estimate hot spots and emerging trends in segmentectomy versus lobectomy for non-small cell lung cancer (NSCLC) research with bibliometric methods. METHODS Articles published on segmentectomy versus lobectomy for NSCLC were extracted from the Web of Science Core Collection (WoSCC). Extracted information was analyzed quantitatively using bibliometric analysis by CiteSpace to find hot spots and frontiers in this research area. RESULTS A total of 362 scientific articles on segmentectomy versus lobectomy for NSCLC were collected, and the annual publication rate increased over time from 1992 to 2019. The leading country and the leading institution were the United States and University of Pittsburgh, respectively. Furthermore, the most prolific researchers were, namely, James D. Luketich, Rodney J. Landreneau, Matthew J. Schuchert, Morihito Okada, and David O. Wilson. The analysis of keywords pointed out that carcinoma, bronchogenic carcinoma, limited resection, segmental resection, and morbidity are hot spots and lymph node dissection, minimally invasive surgery, impact, epidemiology, and high risk are research frontiers in this field. CONCLUSION Publications related to segmentectomy versus lobectomy for NSCLC have made great achievements based on bibliometric analysis in recent years. However, further research and global collaboration are still required. Finally, we find that segmentectomy for the treatment of NSCLC is receiving much more attention from researchers globally compared with lobectomy in this research area.
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Affiliation(s)
- Zhiyun Xu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital
- The Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Xiang Gao
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital
- The Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Binhui Ren
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital
| | - Shuai Zhang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital
| | - Lin Xu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital
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Kuroda H, Sakata S, Takahashi Y, Nakada T, Oya Y, Sugita Y, Sakakura N, Matushita H, Sakao Y. Subsegmental resection preserves regional pulmonary function: A focus on thoracoscopy. Thorac Cancer 2021; 12:1033-1040. [PMID: 33586330 PMCID: PMC8017248 DOI: 10.1111/1759-7714.13841] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to evaluate regional postoperative preserved pulmonary function (PPPF) and three‐dimensional (3D) volumetric changes according to the number of resected subsegments and investigate the factors that most affected pre‐/post PPPF. Methods Patients who underwent thoracoscopic lobectomy (n = 73), and segmentectomy (n = 87) were eligible for inclusion in the study. They were classified according to the number of resected subsegments which ranged from 1 to 10. The percentage of pre‐/postoperative forced expiratory volume in 1 s (FEV1) was used for comparison. Furthermore, lung volumetric changes were calculated using 3D computed tomography (CT) volumetry. Results The percentage of pre‐/postoperative EFV1 between 4 and 5–7 and between 5–7 and 10 were significant (p = 0.03 and p < 0.01, respectively), but not between 1–2 to 4 (p = 0.99). The difference between volumetric changes in the left lower lobe of patients with a number of resected subsegments was significant (p < 0.01). On univariate and multivariate analyses, chronic inflammation was significant for decrease in recovery percentages. When the PPPF was compared among resected subsegments, it gradually decreased with an increase in the number of patients without a postoperative procrastination of inflammation (p < 0.01). Conclusions Segmentectomy is feasible and useful for PPPF. Even a relatively large‐volume resection procedure where 5–7 subsegments are resected can preserve pulmonary function. Chronic inflammation was statistically identified as a risk factor for postoperative preserved pulmonary function. Key points
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Affiliation(s)
- Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shozo Sakata
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yusuke Takahashi
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.,Department of Translational Oncoimmunology, Aichi Cancer Research Institute, Nagoya, Japan
| | - Takeo Nakada
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuko Oya
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yusuke Sugita
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroakazu Matushita
- Department of Translational Oncoimmunology, Aichi Cancer Research Institute, Nagoya, Japan
| | - Yukinori Sakao
- Department of Surgery, Division of Thoracic Surgery, The Teikyo University, Tokyo, Japan
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Zhang W, Chen L, Wang J, Wen W, Xu X, Zhu Q. [A Study on the Authenticity of Preoperative Pulmonary Bronchial Angiography by DeepInsight Software]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:88-93. [PMID: 33478197 PMCID: PMC7936079 DOI: 10.3779/j.issn.1009-3419.2021.104.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Precise segmentectomy has become the first choice of surgical treatment for pulmonary nodules and early lung cancer, and the key and difficult point of the surgery lies in the precise location and resection of the lesion. DeepInsight is an auxiliary software for precise lung surgery jointly developed by our center and Neusoft Company, which can determine the precise anatomy of the lung and locate the location of lung lesions before operation. This study is to verify the authenticity and reliability of DeepInsight lung bronchial angiography assisted surgery. METHODS In this study, 1,020 patients with pulmonary nodules <2.0 cm in diameter were included in the Department of Thoracic Surgery Jiangsu Provincial People's Hospital from August 1, 2016 to December 31, 2019. Computed tomographic angiography (CTA) was performed on all the included patients before surgery. The DeepInsight software was used to perform preoperative bronchial angiography on the operative side of the lung to identify the affected pulmonary segments, pulmonary arteries and pulmonary veins. Two thoracic surgeons independently assessed the visibility of the affected pulmonary vessels using the 5-point method, and the χ² test assessed the consistency between observers. In addition, virtual imaging and real anatomy of pulmonary vessels on the operative side were performed during the operation, and the involved pulmonary vessels were finally determined by 2 chief physicians of thoracic surgery. RESULTS There were no statistically significant differences between the number and spatial anatomy of the vessels involved in the pulmonary virtual imaging using DeepInsight software before operation and the number of vessels involved during operation in 1,020 patients. And the consistency among observers is quite satisfactory. CONCLUSIONS The DeepInsight software virtual imaging of pulmonary bronchial vessels can accurately reconstruct the actual pulmonary vessels and assist the completion of pulmonary segmental resection.
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Affiliation(s)
- Wang Zhang
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Liang Chen
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Wang
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei Wen
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xinfeng Xu
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Quan Zhu
- Department of Thoracic Surgery, Jiangsu Provincial People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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21
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How preserved regional pulmonary function after thoracoscopic segmentectomy in clinical stage I non-small cell lung cancers in right upper lobe. Gen Thorac Cardiovasc Surg 2021; 69:960-966. [PMID: 33387329 DOI: 10.1007/s11748-020-01561-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the efficacy of regional respiratory preservation after pulmonary resection for clinical stage I non-small cell lung cancer (NSCLC) in right upper lobe. METHODS This retrospective study analysed patients with clinical stage I NSCLC who underwent open thoracotomy lobectomy (OTL, n = 45), thoracoscopic lobectomy (TSL, n = 137), and thoracoscopic segmentectomy (TSS, n = 37) in right upper lobe. The forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were examined at 3 and 6-12 months after the operation. The pre- and post-operative lung volumes were evaluated by three-dimensional reconstructed computed tomography. The rates of post- and pre-operative FVC, FEV1, and lung volumes were compared amongst the three groups. RESULTS Significant differences were found in both FVC and FEV1 at 6-12 months between TSL and OTL (p < 0.01 and p = 0.02, respectively). The respiratory recovery rates of FVC and FEV1 at 6-12 months were significantly higher in TSS (98.6% ± 1.52% and 96.5% ± 1.66%) than in TSL (93.4% ± 0.79% and 90.4% ± 0.86%) (FVC: p < 0.01 and FEV1: p < 0.01). The volumetric changes were greater in TSL than in TSS for the right middle lobe (19.6% ± 2.39% and 9.59% ± 4.66%; p = 0.06) and right lower lobe (48.3% ± 2.84% and 27.9% ± 5.47%; p < 0.01) CONCLUSION: TSS might be superior to TSL or OTL depending on the moderate expansion of the remaining right lobes.
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Darras M, Ojanguren A, Forster C, Zellweger M, Perentes JY, Krueger T, Gonzalez M. Short-term local control after VATS segmentectomy and lobectomy for solid NSCLC of less than 2 cm. Thorac Cancer 2020; 12:453-461. [PMID: 33270380 PMCID: PMC7882390 DOI: 10.1111/1759-7714.13766] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction VATS pulmonary segmentectomy is increasingly proposed as a parenchyma‐sparing resection for tumors smaller than 2 cm in diameter. The aim of this study was to compare short‐term oncological results and local control in solid non‐small cell lung cancers (NSCLCs) <2 cm surgically treated by intentional VATS segmentectomy or lobectomy. Methods This study was a single center retrospective study of consecutive patients undergoing VATS lobectomy (VL) or segmentectomy (VS) for solid <2 cm NSCLC from January 2014 to October 2019. Results In total, 188 patients with a median age of 65 years (male/female: 99/89) underwent VS (n = 96) or VL (n = 92). Segmentectomies in the upper lobes were performed in 57% and as a single segment in 55% of cases. There was no statistically significant difference between VS and VL in terms of demographics, comorbidities, postoperative outcomes, dissected lymph node stations (2.89 ± 0.95 vs. 2.93 ± 1, P = 0.58), rate of pN1 (2.2% vs. 2.1%, P = 0.96) or pN2 upstaging (1.09% vs. 1.06%, P = 0.98). Adjuvant chemotherapy was given in 15% of patients in the VL and 11% in the VS group. During follow‐up (median: 23 months), no patients presented with local nodal recurrence or on the stapler line (VS group). Three patients on VL and two in VS groups presented with recurrence on the remnant operated lung. New primary pulmonary tumors were diagnosed in 3.3% and 6.3% of patients in the VL and VS groups, respectively. Conclusions Despite the short follow‐up, our preliminary data shows that local control is comparable for VATS lobectomy and VATS segmentectomy for patients with NSCLC <2 cm.
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Affiliation(s)
- Marc Darras
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Amaya Ojanguren
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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23
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Zhang J, Bai W, Guo C, Liu L, Wang G, Huang C, Chen Y, Zhang Y, Li S. Postoperative Short-term Outcomes Between Sublobar Resection and Lobectomy in Patients with Lung Adenocarcinoma. Cancer Manag Res 2020; 12:9485-9493. [PMID: 33061635 PMCID: PMC7534848 DOI: 10.2147/cmar.s266376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/28/2020] [Indexed: 12/24/2022] Open
Abstract
Background To investigate postoperative temporary consequences of the enrolled patients with lung adenocarcinoma. Patients and Methods We analyzed the clinical data of patients with lung adenocarcinoma admitted by the same surgical team of Peking Union Medical College Hospital (PUMCH) from July 2019 to December 2019. Statistical methods including propensity score matching (PSM) analysis was used to analyze the differences among them. Results A total of 108 patients were enrolled, including 50 patients with sublobar resection and 58 patients with lobectomy. Before PSM, there were statistically significant differences in age (p=0.015), hospitalization costs (p=0.042), lymphadenectomy (p=0.000), pathological staging (p=0.000), number of lymph nodes removed (p=0.000), number of positive lymph nodes (p=0.034), chest drainage duration (p=0.000), total chest drainage (p=0.000), length of postoperative hospital stays (p=0.000), postoperative D-dimer level (p=0.030) and perioperative lymphocyte margin (LM) (p=0.003) between sublobar resection and lobectomy. After PSM, there were statistical differences in number of lymph nodes removed (p=0.000), chest drainage duration (p=0.031) and total chest drainage (p=0.002) between sublobar resection and lobectomy. Whether with PSM analysis or not, there were no significant differences in other blood test results, such as inflammation indicators, postoperative neutrophil-lymphocyte ratio (NLR), albumin level, perioperative activity of daily living (ADL) scale scoring margin, complications, postoperative admission to intensive care unit (ICU) and readmission within 30 days. NLR was associated with total chest drainage (p=0.000), length of postoperative hospital stays (p=0.000), postoperative D-dimer level (p=0.050) and ADL scale scoring margin (p=0.003) between sublobar resection and lobectomy. Conclusion Sublobar resection, including wedge resection and segmentectomy, was as safe and feasible as lobectomy in our study, and they shared similar short-term outcomes. Postoperative NLR could be used to detect the clinical outcomes of patients. Secondary resectability of pulmonary function (SRPF) should be the main purpose of sublobar resection.
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Affiliation(s)
- Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Wenliang Bai
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Guige Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Ye Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
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24
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饶 孙, 叶 联, 崔 欣, 孙 芩, 曹 润, 肖 寿, 杨 继, 王 维, 赵 光, 黄 云. [Progress in Survival Prognosis of Segmentectomy for
Early-stage Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:830-836. [PMID: 32957171 PMCID: PMC7519961 DOI: 10.3779/j.issn.1009-3419.2020.102.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 12/24/2022]
Abstract
Surgery is currently the most appropriate treatment for early-stage non-small cell lung cancer (NSCLC). Increasing unilateral or bilateral multiple primary lung cancer being found, segmentectomy has attracted wide attention for its unique advantages in the treatment for such tumors. Ground glass opacity dominant early-stage NSCLC is associated with a good prognosis and can be cured by segmentectomy, however, the treatment of solid-dominant NSCLC remains controversial owing to the invasive nature. With the in-depth study on the lymph node metastasis pathway, radiological characteristics and molecular biology of NSCLC, a large part of solid nodules with certain characteristics can also be cured by segmentectomy. This paper reviews the research status and progress about the indication of segmentectomy.
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Affiliation(s)
- 孙银 饶
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 联华 叶
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 欣 崔
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 芩玲 孙
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 润 曹
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 寿勇 肖
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 继琛 杨
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 维 王
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 光强 赵
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 云超 黄
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
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25
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Zeng W, Zhang W, Zhang J, You G, Mao Y, Xu J, Yu D, Peng J, Wei Y. Systematic review and meta-analysis of video-assisted thoracoscopic surgery segmentectomy versus lobectomy for stage I non-small cell lung cancer. World J Surg Oncol 2020; 18:44. [PMID: 32106856 PMCID: PMC7047378 DOI: 10.1186/s12957-020-01814-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether video-assisted thoracoscopic surgery (VATS) segmentectomy and VATS lobectomy provide similar perioperative and oncological outcomes in stage I non-small cell lung cancer (NSCLC) is still controversial. METHODS Meta-analysis of 12 studies comparing outcomes after VATS lobectomy and VATS segmentectomy for stage I NSCLC. Data were analyzed by the RevMan 5.3 software. RESULTS Disease-free survival (HR 1.19, 95% CI 0.89 to 1.33, P = 0.39), overall survival (HR 1.11, 95% CI 0.89 to 1.38, P = 0.36), postoperative complications (OR = 1.10, 95% CI 0.69 to 1.75, P = 0.7), intraoperative blood loss (MD = 3.87, 95% CI - 10.21 to 17.94, P = 0.59), operative time (MD = 10.89, 95% CI - 13.04 to 34.82, P = 0.37), air leak > 5 days (OR = 1.20, 95% CI 0.66 to 2.17, P = 0.55), and in-hospital mortality (OR = 1.67, 95% CI 0.39 to 7.16, P = 0.49) were comparable between the groups. Postoperative hospital stay (MD = - 0.69, 95% CI - 1.19 to - 0.19, P = 0.007) and number of dissected lymph nodes (MD = - 6.44, 95%CI - 9.49 to - 3.40, P < 0.0001) were significantly lower in VATS segmentectomy patients. CONCLUSIONS VATS segmentectomy and VATS lobectomy provide similar oncological and perioperative outcomes for stage I NSCLC patients. This systematic review was registered on PROSPERO and can be accessed at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID = CRD42019133398.
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Affiliation(s)
- Weibiao Zeng
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianyong Zhang
- Department of General Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Guangmiao You
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu'ang Mao
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianjun Xu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dongliang Yu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinhua Peng
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiping Wei
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
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Li J, Ma H, Sun Z, Sun Q. Changes in Pulmonary Function After 3 Surgical Methods of Pulmonary Nodules Resection by Uniportal Video-Assisted Thoracoscopic Surgery. Technol Cancer Res Treat 2020. [PMCID: PMC7436791 DOI: 10.1177/1533033820941994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the changes in pulmonary function after wedge resection, segmentectomy, and lobectomy. Methods: The patients were divided into 4 groups: lobectomy group, segmentectomy group, wedge resection group, and mediastinal surgery group. The pulmonary function was evaluated at various time points: 3 days before surgery, 1 month, 6 months, 12 months, and then 24 months after surgery. Results: The analysis results of forced expiratory volume in one second difference and breath-holding tests difference were consistent: Lobectomy group was higher than segmentectomy group, wedge resection group, and mediastinal surgery group at 4 postoperative time points (P < .05); segmentectomy group was higher than the wedge resection group and mediastinal surgery group (P < .05), and there was no statistical difference between the wedge resection group and the mediastinal surgery group (P > .05). Analysis results of tidal volume difference: Lobectomy group was higher than segmentectomy group, wedge resection group, and mediastinal surgery group at 4 postoperative time points (P < .05); segmentectomy group was higher than wedge resection group and mediastinal surgery group at 1 month after surgery (P < .05). Analysis results of the diffusion capacity of the lung for carbon monoxide difference: lobectomy group and segmentectomy group were higher than wedge resection group and mediastinal surgery group at 4 postoperative time points (P < .05). Analysis results of the stair-climbing test difference: lobectomy group and segmentectomy group were higher than the wedge resection group and mediastinal surgery group at 4 postoperative time points (P < .05). Conclusion: Segmentectomy was superior to lobectomy in the protection of pulmonary function, while wedge resection was superior to segmentectomy. The recovery process of the pulmonary function was the fastest during the first 6 months after surgery.
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Affiliation(s)
- Jinyou Li
- Department of Thoracic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haitao Ma
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhenyu Sun
- Department of Thoracic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Qi Sun
- Department of Thoracic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
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27
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Rao S, Ye L, Min L, Zhao G, Chen Y, Huang Y, Yang J, Xiao S, Cao R. Meta-analysis of segmentectomy versus lobectomy for radiologically pure solid or solid-dominant stage IA non-small cell lung cancer. J Cardiothorac Surg 2019; 14:197. [PMID: 31722726 PMCID: PMC6854787 DOI: 10.1186/s13019-019-0996-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/16/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Whether segmentectomy can be used to treat radiologically determined pure solid or solid-dominant lung cancer remains controversial owing to the invasive pathologic characteristics of these tumors despite their small size. This meta-analysis compared the oncologic outcomes after lobectomy and segmentectomy regarding relapse-free survival (RFS) and overall survival (OS) in patients with radiologically determined pure solid or solid-dominant clinical stage IA non-small cell lung cancer (NSCLC). METHODS A literature search was performed in the MEDLINE, EMBASE, and Cochrane Central databases for information from the date of database inception to March 2019. Studies were selected according to predefined eligibility criteria. The hazard ratio (HR) and associated 95% confidence interval (CI) were extracted or calculated as the outcome measure for data combining. RESULTS Seven eligible studies published between 2014 and 2018 enrolling 1428 patients were included in the current meta-analysis. Compared with lobectomy, segmentectomy had a significant benefit on the RFS of radiologically determined pure solid or solid-dominant clinical stage IA NSCLC patients (combined HR: 1.46; 95% CI, 1.05-2.03; P = 0.024) and there were no significant differences on the OS of these patients (HR: 1.52; 95% CI, 0.95-2.43; P = 0.08). CONCLUSIONS Segmentectomy leads to lower survival than lobectomy for clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors. Moreover, applying lobectomy to clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors (≤2 cm) could lead to an even bigger survival advantage. However, there are some limitations in the present study, and more evidence is needed to support the conclusion.
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Affiliation(s)
- Sunyin Rao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lianhua Ye
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China.
| | - Li Min
- Department of Respiratory Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guangqiang Zhao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ya Chen
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yunchao Huang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jichen Yang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shouyong Xiao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Run Cao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
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Wakamatsu I, Matsuguma H, Nakahara R, Chida M. Factors associated with compensatory lung growth after pulmonary lobectomy for lung malignancy: an analysis of lung weight and lung volume changes based on computed tomography findings. Surg Today 2019; 50:144-152. [PMID: 31440912 DOI: 10.1007/s00595-019-01863-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/15/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To establish the factors associated with compensatory lung growth (CLG) in human adults. METHODS The subjects of this study were 216 patients who underwent pulmonary lobectomy between January 2008 and March 2015 and had computed tomography (CT) scans done before and 2 years after surgery with no signs of recurrence. The predicted postoperative values of lung volume and lung weight, based on the preoperative CT data, were compared with those 2 years after surgery. RESULTS When the predicted postoperative values were considered to be 100%, the mean lung volume and lung weight 2 years after surgery were 116 ± 16% and 115 ± 19%, respectively. CLG was defined as both lung volume ≥ 110% and lung weight ≥ 106% (CLG group; n = 108). Both univariate and multivariate analyses showed that younger age (≤ 60 years), a larger number of resected subsegments (≥ 10), and a light- (< 20 pack-years) or non-smoking history were significantly associated with CLG. CONCLUSIONS This study identified younger age, a light- or non-smoking history, and a large resection volume as the predictors of CLG in patients who underwent pulmonary lobectomy for lung malignancy. All of these three factors may be reasonably connected to CLG.
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Affiliation(s)
- Ikuma Wakamatsu
- Division of Thoracic Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, 320-0834, Tochigi, Japan.
| | - Haruhisa Matsuguma
- Division of Thoracic Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, 320-0834, Tochigi, Japan
| | - Rie Nakahara
- Division of Thoracic Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, 320-0834, Tochigi, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
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29
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Ju S, Gao Y. [Advances in the Study of the Effects of Video-assisted Thoracoscopic Segmentectomy
on Pulmonary Function]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:537-540. [PMID: 31451146 PMCID: PMC6717867 DOI: 10.3779/j.issn.1009-3419.2019.08.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
2018年美国国立综合癌症网络关于非小细胞肺癌(non-small cell lung cancer, NSCLC)指南指出,对于早期NSCLC,解剖性肺叶切除为首选方案。随着电视胸腔镜技术的发展,以胸腔镜为代表的胸外科微创手术在临床得到了广泛应用。胸腔镜肺段切除术已经成为早期NSCLC的治疗方案之一。临床研究发现相较于肺叶切除,亚肺叶切除在早期NSCLC治疗中也可取得相似的结果并保留更多的肺功能,但肺段切除术后患者肺功能的改变尚存争议。本文将重点对胸腔镜肺段切除术后患者肺功能改变的研究进展做一综述。
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Affiliation(s)
- Shaolong Ju
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yushun Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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30
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Chen L, Fang W. [A Review on Comparison of Lobectomy and Segmentectomy in the Treatment of
Early Stage Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:526-531. [PMID: 31451144 PMCID: PMC6717873 DOI: 10.3779/j.issn.1009-3419.2019.08.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lung cancer is a worldwide malignancy with high morbidity and mortality in the world. With the application of low-dose spiral computed tomography in the screening and diagnosis of lung cancer, more lung cancers are detected at an early stage and cured by surgical treatment. Anatomical lobectomy has long been the standard procedure for the treatment of early stage non-small cell lung cancer. However, whether intentional segmentectomy can be more used remains controversial. And this paper focuses on the question.
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Affiliation(s)
- Liang Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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31
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Bilgi Z, Swanson SJ. Current indications and outcomes for thoracoscopic segmentectomy for early stage lung cancer. J Thorac Dis 2019; 11:S1662-S1669. [PMID: 31516739 DOI: 10.21037/jtd.2019.07.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Management of early stage non-small cell lung cancer (NSCLC) is evolving as the epidemiology of NSCLC has changed due to decreased rates of smoking in the general population, the development of screening programs and advancements in imaging modalities. Surgical technique is also evolving as a result of changes in instrumentation. Segmentectomy for early stage NSCLC has the advantage of preservation of lung function. Video-assisted thoracic surgery (VATS) segmentectomy is a safe option for surgeons already experienced in VATS lobectomy and offers comparable oncological benefit with better quality of life in selected patients. In this article, we will examine the role of segmentectomy and VATS for early stage NSCLC.
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Affiliation(s)
- Zeynep Bilgi
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott J Swanson
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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32
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Sui T, Liu A, Jiao W. [Difference of Lung Function Retention after Segmentectomy and Lobectomy]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:178-182. [PMID: 30909999 PMCID: PMC6441122 DOI: 10.3779/j.issn.1009-3419.2019.03.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
近年来肺癌发病率和检出率逐渐升高,肺段切除术被越来越普遍应用于治疗早期非小细胞肺癌。有学者认为肺段切除术相比肺叶切除术更有利于术后肺功能的保留,也有研究得出两种手术方式在术后肺功能保留方面差异不大,本文就肺段切除术与肺叶切除术术后肺功能变化的相关研究作一综述。
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Affiliation(s)
- Tianyi Sui
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Ao Liu
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266071, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266071, China
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Nanoparticle-based CT visualization of pulmonary vasculature for minimally-invasive thoracic surgery planning. PLoS One 2019; 14:e0209501. [PMID: 30653521 PMCID: PMC6336249 DOI: 10.1371/journal.pone.0209501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/06/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate CF800, a novel lipid-based liposomal nanoparticle that co-encapsulates indocyanine green (ICG) and iohexol, for CT imaging of pulmonary vasculature in minimally-invasive thoracic surgery planning. Methods CF800 was intravenously administered to 7 healthy rabbits. In vivo CT imaging was performed 15 min post-injection, with a subset of animals imaged at 24h, 48h, and 72h post injection. Signal-to-background ratios (SBR) were calculated at the inferior vena cava and compared across time-points. A similar protocol was applied to 2 healthy pigs to evaluate the feasibility and efficacy in a large animal model. To evaluate the feasibility of clinical application, a survey was completed by 7 surgical trainees to assess pre- and post-injection CT images of rabbits and pigs. Responses on the discernibility of pulmonary vasculature sub-branches and comfort level to use the images for pre-operative planning were collected and analyzed. Results CF800 injection improved visualization of pulmonary vessels in both rabbit and pig models. The SBR of rabbit pulmonary vasculature was significantly higher after CF800 injection (range 3.7–4.4) compared to pre-injection (range 3.3–3.8, n = 7; p<0.05). SBR remained significantly different up to 24 hours after injection (range 3.7–4.3, n = 4; p<0.05). Trainees’ evaluation found the post-injection CT images had significantly higher discernibility at the second vessel branch generation in both rabbit and pig models. Trainees identified smaller vasculature branch generations in the post-injection images compared to the pre-treatment images in both rabbit (mean 6.7±1.8 vs 5.4±2.1; p<0.05) and pig (mean 6.7±1.8 vs 5.4±2.1; p<0.05). Trainees were significantly more comfortable using post-injection images for surgical planning compared to the pre-injection images (rabbit: 8.1±1.1 vs. 4.7±2.1; pig: 7.6±2.1 vs. 4.9±2.2; p<0.05). Conclusion CF800 provides SBR and contrast enhancement of pulmonary vasculature which may assist in pre-surgical CT planning of minimally invasive thoracic surgery.
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Tanvetyanon T, Keenan RJ. Recovery of lung function after segmentectomy versus lobectomy for early-stage lung cancer. J Thorac Dis 2018; 10:S2144-S2146. [PMID: 30123544 DOI: 10.21037/jtd.2018.06.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tawee Tanvetyanon
- Thoracic Oncology Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Robert J Keenan
- Thoracic Oncology Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
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Bédat B, Abdelnour-Berchtold E, Krueger T, Perentes JY, Ris HB, Triponez F, Licker MJ, Karenovics W, Gonzalez M. Clinical outcome and risk factors for complications after pulmonary segmentectomy by video-assisted thoracoscopic surgery: results of an initial experience. J Thorac Dis 2018; 10:5023-5029. [PMID: 30233876 DOI: 10.21037/jtd.2018.07.42] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Pulmonary anatomical segmentectomies are increasingly being done via video-assisted thoracoscopic surgery (VATS). We analyzed clinical outcomes and risk factors for post-operative complications after pulmonary segmentectomy by VATS was introduced in two institutions. Methods We retrospectively reviewed records of all patients who underwent anatomical pulmonary segmentectomy by VATS from 2014 to 2016 at the university hospitals of Geneva and Lausanne in Switzerland. Results One hundred twenty-nine patients (64 men; median age 68 years, range, 29-85 years) underwent anatomical VATS segmentectomy for primary lung tumors (n=100), metastases (n=16) and benign lesions (n=13). The overall 30-day mortality and morbidity rates were 0.8% and 31%, respectively. The reoperation rate was 4.7% [indications: hemothorax 2, prolonged air leak (PAL) 2, segmental torsion 1, empyema 1]. Chest drainage lasted for a median of 2 days (range, 1-33 days) and patients were discharged from the hospital after a median of 6 days (range, 2-37 days). Postoperative complications were mainly associated with chronic obstructive pulmonary disease (COPD) [odds ratio (OR) 2.54 and 95% confidence interval (95% CI), 1.18-5.47], and smoking pack-years >50 units (OR 5.27; 95% CI, 1.68-16.55). Nine patients (9%) presented with distant recurrences. Nodule size >2 cm was associated with decreased disease-free survival (DFS) (P=0.04). There was no association between surgical experience in VATS segmentectomy and DFS or postoperative complications. Conclusions Segmentectomies can be safely performed by VATS in an initial experience and result in favorable clinical outcome. COPD and smoking pack-years are associated with an increased risk of complications.
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Affiliation(s)
- Benoît Bédat
- Service of Thoracic Surgery, Hopitaux Universitaires de Genève, Genève, Switzerland
| | | | - Thorsten Krueger
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hans-Beat Ris
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Frédéric Triponez
- Service of Thoracic Surgery, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Marc-Joseph Licker
- Service of Anesthesiology, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Wolfram Karenovics
- Service of Thoracic Surgery, Hopitaux Universitaires de Genève, Genève, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Raman V, Yang CFJ, Deng JZ, D'Amico TA. Surgical treatment for early stage non-small cell lung cancer. J Thorac Dis 2018; 10:S898-S904. [PMID: 29780636 DOI: 10.21037/jtd.2018.01.172] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Surgery is the standard of care for early stage non-small cell lung cancer. There is significant debate about the type of operation most effective for lung cancer. Minimally invasive techniques like video-assisted (VATS) and robot-assisted thoracoscopic surgery (RATS) have been shown to reduce postoperative complications and shorten hospitalization. However, there remains skepticism about their oncologic effectiveness when compared to an open approach, though recent literature suggests no differences in upstaging or survival between VATS and thoracotomy. The extent of resection for early lung cancer also remains a matter of debate. Lobectomy remains the preferred operation and is associated with better survival and lower locoregional recurrence, but there is increased interest in the role of sublobar resections. Sublobar resections have similar mortality to lobar resections in small ground glass-predominant tumors. We examine the literature surrounding these controversies in this review.
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Affiliation(s)
- Vignesh Raman
- Department of Surgery, Duke University Health System, Durham, North Carolina 27710, USA
| | - Chi-Fu Jeffrey Yang
- Department of Surgery, Duke University Health System, Durham, North Carolina 27710, USA
| | - John Z Deng
- Department of Surgery, Duke University Health System, Durham, North Carolina 27710, USA
| | - Thomas A D'Amico
- Section of General Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Bertolaccini L, Solli P. COUNTERPOINT: Should Segmentectomy Rather Than Lobectomy Be the Operation of Choice for Early-Stage Non-small Cell Lung Cancer? No. Chest 2018; 153:592-595. [DOI: 10.1016/j.chest.2017.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022] Open
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Charloux A, Quoix E. Lung segmentectomy: does it offer a real functional benefit over lobectomy? Eur Respir Rev 2017; 26:26/146/170079. [DOI: 10.1183/16000617.0079-2017] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/03/2017] [Indexed: 12/23/2022] Open
Abstract
Anatomical segmentectomy has been developed to offer better pulmonary function preservation than lobectomy, in stage IA lung cancer. Despite the retrospective nature of most of the studies and the lack of randomised studies, a substantial body of literature today allows us to evaluate to what extent lung function decreases after segmentectomy and whether segmentectomy offers a real functional benefit over lobectomy. From the available series, it emerges that the mean decrease in forced expiratory volume in 1 s (FEV1) is low, ranging from −9% to −24% of the initial value within 2 months and −3 to −13% 12 months after segmentectomy. This reduction in lung function is significantly lower than that induced by lobectomy, but saves only a few per cent of pre-operative FEV1. Moreover, the published results do not firmly establish the functional benefit of segmentectomy over lobectomy in patients with poor lung function. Some issues remain to be addressed, including whether video-assisted thoracic surgery (VATS) segmentectomy may preserve lung function better than VATS lobectomy in patients with poor lung function, especially within the early days after surgery, and whether this may translate to lowering the functional limit for surgery. Eventually, trials comparing stereotactic ablative body radiotherapy, radiofrequency ablation and segmentectomy functional consequences are warranted.
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Kouritas V, Milton R. The lobar vs. sublobar "limited" resection respiratory function preservation debate: learning to speak the same language. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:169. [PMID: 28480205 PMCID: PMC5401685 DOI: 10.21037/atm.2017.03.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/06/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Vasileios Kouritas
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Richard Milton
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
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