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Wang L, Cao J, Feng Y, Jia R, Ren Y. Application of uniportal video-assisted thoracoscopic surgery for segmentectomy in early-stage non-small cell lung cancer: A narrative review. Heliyon 2024; 10:e30735. [PMID: 38742067 PMCID: PMC11089358 DOI: 10.1016/j.heliyon.2024.e30735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/26/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
Uniportal video-assisted thoracoscopic surgery (UVATS) segmentectomy has emerged as an effective approach for managing early-stage non-small-cell lung cancer (NSCLC). Compared to conventional open and thoracoscopic surgeries, this minimally invasive surgical technique offers multiple benefits, including reduced postoperative discomfort, shorter hospital stays, expedited recovery, fewer complications, and superior cosmetic outcomes. Particularly advantageous in preserving lung function, UVATS segmentectomy is a compelling option for patients with compromised lung capabilities or limited pulmonary reserve. Notably, it demonstrates promising oncological results in early-stage NSCLC, with long-term survival rates comparable to those of lobectomies. Skilled thoracic surgeons can ensure a safe and effective execution of UVATS despite the potential technical challenges posed by complex tumor locations that may hinder visibility and maneuverability within the thoracic cavity. This study provided a comprehensive review of the literature and existing studies on UVATS segmentectomies. It delves into the evolution of the technique, its current applications, and the balance between its benefits and limitations. This discussion extends the technical considerations, challenges, and prospects of UVATS segmentectomy. Furthermore, it aimed to update advancements in segmentectomy for treating early-stage NSCLC, offering in-depth insights to thoracic surgeons to inform more scientifically grounded and patient-specific surgical decisions.
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Affiliation(s)
- Linlin Wang
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
| | - Jiandong Cao
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
| | - Yong Feng
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
| | - Renxiang Jia
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
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2
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Diebels I, Dubois M, Van Schil PEY. Sublobar Resection for Early-Stage Lung Cancer: An Oncologically Valid Procedure? J Clin Med 2023; 12:jcm12072674. [PMID: 37048756 PMCID: PMC10094821 DOI: 10.3390/jcm12072674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
In the era of minimally invasive surgery, the role of sublobar resection comprising anatomical segmentectomy and wide wedge excision remains controversial [...]
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Affiliation(s)
- Ian Diebels
- Department of Thoracic and Vascular Surgery, Heilig Hart Ziekenhuis, 2500 Lier, Belgium
| | - Marc Dubois
- Department of Thoracic and Vascular Surgery, Heilig Hart Ziekenhuis, 2500 Lier, Belgium
| | - Paul E. Y. Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
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3
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Wang M, Lv H, Wu T, Gao W, Tian Y, Gai C, Tian Z. Application of three-dimensional computed tomography bronchography and angiography in thoracoscopic anatomical segmentectomy of the right upper lobe: A cohort study. Front Surg 2022; 9:975552. [PMID: 36204338 PMCID: PMC9530257 DOI: 10.3389/fsurg.2022.975552] [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] [Received: 06/27/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Objective Three-dimensional computed tomography bronchography and angiography (3D-CTBA) can provide detailed imaging information for pulmonary segmentectomy. This study aimed to investigate the safety and effectiveness of 3D-CTBA guidance of anatomical segmentectomy of the right upper lobe (RUL). Methods This was a retrospective analysis of anatomical segmentectomy of the RUL at the Thoracic Surgery Department of the Fourth Hospital of Hebei Medical University from December 9, 2013, to June 2, 2021. Preoperatively, all patients underwent contrast-enhanced CT of the chest (to determine the size of the pulmonary nodule) and a lung function test. 3D-CTBA has been performed since 2018; patients with vs. without 3D-CTBA were compared. Segmentectomy was performed according to nodule location. Results Of 139 patients (46 males and 93 females, aged 21–81 years), 93 (66.9%) completed single segmentectomy, 3 (2.2%) completed single subsegmentectomy, 29 had combined subsegmentectomy, 7 had segmentectomy combined with subsegmentectomy, and 6 had combined resection of two segments. Eighty-five (61.2%) patients underwent 3D-CTBA. 3D-CTBA cases had decreased intraoperative blood loss (67.4 ± 17.6 vs. 73.1 ± 11.0, P = 0.021) and shorter operation time (143.0 ± 10.8 vs. 133.4 ± 20.9, P = 0.001). 3D-CTBA (Beta = −7.594, 95% CI: −12.877 to −2.311, P = 0.005) and surgical procedure (Beta = 9.352, 95% CI: 3.551–15.153, P = 0.002) were independently associated with intraoperative blood loss. 3D-CTBA (Beta = −13.027, 95% CI: −18.632 to 17.422, P < 0.001) and surgical procedure (Beta = 7.072, 95% CI: 0.864–13.280, P = 0.026) were also independent factors affecting the operation time. Conclusion Preoperative use of 3D-CTBA to evaluate the pulmonary vessels and bronchial branch patterns of the RUL decreased blood loss and procedure time and so would be expected to improve the safety and effectiveness of thoracoscopic segmentectomy.
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Affiliation(s)
- Mingbo Wang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huilai Lv
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tao Wu
- Operating Room, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenda Gao
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yang Tian
- Department of Thoracic Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Chunyue Gai
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ziqiang Tian
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- Correspondence: Ziqiang Tian
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Sun K, Wu Z, Wang Q, Wu M. Three-port single-intercostal versus uniportal thoracoscopic segmentectomy for the treatment of lung cancer: a propensity score matching analysis. World J Surg Oncol 2022; 20:181. [PMID: 35659244 PMCID: PMC9167546 DOI: 10.1186/s12957-022-02626-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this retrospective study was to demonstrate the safety and feasibility of three-port single-intercostal video-assisted thoracoscopic surgery (SIC-VATS) segmentectomy compared to uniportal video-assisted thoracoscopic surgery (UVATS) segmentectomy. Methods We included 544 patients diagnosed with cT1N0M0 non-small-cell lung cancer (NSCLC) who underwent thoracoscopic segmentectomy between January 2020 and August 2021, including 147 and 397 patients who underwent three-port SIC-VATS and UVATS, respectively. After incorporating preoperative clinical variables, we compared surgical outcomes and perioperative indicators between the two groups by propensity score matching analysis. Results After 1:1 propensity score matching, each group comprised 143 patients with no significant differences in baseline demographics and characteristics. There was no significant difference in operative time (p = 0.469), blood loss (p = 0.501), number of dissected lymph nodes (p = 0.228), dwell time of the main chest drain (p = 0.065), hospital stay (p = 0.243), or major complication rate (p = 0.295) between the three-port SIC-VATS and UVATS groups. Conclusions The three-port SIC-VATS was as safe and feasible as UVATS for patients who are diagnosed with early-stage NSCLC. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02626-x.
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Affiliation(s)
- Keyi Sun
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou City, Zhejiang Province, China
| | - Zixiang Wu
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou City, Zhejiang Province, China
| | - Qi Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou City, Zhejiang Province, China
| | - Ming Wu
- Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou City, Zhejiang Province, China.
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5
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Xie X, Gu L, Guo Z, Tao H, Zhou Y, Shen W, Zhou Z. DCE‐MRI
for early evaluation of therapeutic response in esophageal cancer after concurrent chemoradiotherapy and its values in predicting
HIF
‐1α expression. PRECISION MEDICAL SCIENCES 2021. [DOI: 10.1002/prm2.12049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Xiaodong Xie
- Department of Radiology Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research Nanjing China
- Department of Radiology Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University Nanjing China
| | - Lingling Gu
- Department of Radiology Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research Nanjing China
| | - Zhen Guo
- Department of Radiology Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research Nanjing China
| | - Hua Tao
- Department of Radiation Oncology Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research Nanjing China
| | - Yiqin Zhou
- Department of Radiation Oncology Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research Nanjing China
| | - Wenrong Shen
- Department of Radiology Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research Nanjing China
| | - Zhengyang Zhou
- Department of Radiology Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University Nanjing China
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Fan X, Liang Y, Bai Y, Yang C, Xu S. Conditional survival rate estimates of lobectomy, segmentectomy and wedge resection for stage IA1 non-small cell lung cancer: A population-based study. Oncol Lett 2020; 20:1607-1618. [PMID: 32724402 PMCID: PMC7377117 DOI: 10.3892/ol.2020.11713] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/27/2020] [Indexed: 11/06/2022] Open
Abstract
Conditional survival rate (CSR) is defined as the dynamic possibility of survival, considering the changes in the survival risk over time. The present study aimed to compare the CSR of the surgical procedures for stage IA1 non-small cell lung cancer (NSCLC). Overall, data for 2,535 patients with stage IA1 NSCLC after lobectomy, segmentectomy or wedge resection were obtained from the Surveillance, Epidemiology and End Results database, and the overall survival (OS) rates were subsequently compared. CSR estimates, the possibility of patients who had already survived × years, to survive further y years, was calculated as CSR=S(x+y)/S(x), where S is the survival rate at a particular point in time. A Cox regression model and propensity-score matching were used to adjust confounding factors. There were no statistical differences in the OS among the three surgical procedures, except that OS of patients who underwent a lobectomy was improved compared with the wedge resection. The CSR of surviving to the 5th year after operation improved gradually over time. The 3-year CSR of lobectomy or segmentectomy was higher compared with that of the wedge resection. Moreover, the 3-year CSR of segmentectomy was higher compared with that of lobectomy from the 3rd year after surgery, particularly in some specific situations, such as female sex, patients ≥66 years old, patients with squamous cell carcinoma or patients with poor tumor differentiation. The present study is the first report to compare CSR following lobectomy, segmentectomy and wedge resection for patients with stage IA1 NSCLC, to the best of our knowledge. These findings indicated that lobectomy is the most conservative surgical procedure for stage IA1 NSCLC and raises questions regarding improved long-term prognosis of segmentectomy in some subsets of patients.
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Affiliation(s)
- Xiaoxi Fan
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yicheng Liang
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yunpeng Bai
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Chunlu Yang
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Shun Xu
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Wang Y, Zhou L, Wang M, Shao C, Shi L, Yang S, Zhang Z, Feng M, Shan F, Liu L. Combination of generative adversarial network and convolutional neural network for automatic subcentimeter pulmonary adenocarcinoma classification. Quant Imaging Med Surg 2020; 10:1249-1264. [PMID: 32550134 DOI: 10.21037/qims-19-982] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The efficient and accurate diagnosis of pulmonary adenocarcinoma before surgery is of considerable significance to clinicians. Although computed tomography (CT) examinations are widely used in practice, it is still challenging and time-consuming for radiologists to distinguish between different types of subcentimeter pulmonary nodules. Although there have been many deep learning algorithms proposed, their performance largely depends on vast amounts of data, which is difficult to collect in the medical imaging area. Therefore, we propose an automatic classification system for subcentimeter pulmonary adenocarcinoma, combining a convolutional neural network (CNN) and a generative adversarial network (GAN) to optimize clinical decision-making and to provide small dataset algorithm design ideas. Methods A total of 206 nodules with postoperative pathological labels were analyzed. Among them were 30 adenocarcinomas in situ (AISs), 119 minimally invasive adenocarcinomas (MIAs), and 57 invasive adenocarcinomas (IACs). Our system consisted of two parts, a GAN-based image synthesis, and a CNN classification. First, several popular existing GAN techniques were employed to augment the datasets, and comprehensive experiments were conducted to evaluate the quality of the GAN synthesis. Additionally, our classification system processes were based on two-dimensional (2D) nodule-centered CT patches without the need of manual labeling information. Results For GAN-based image synthesis, the visual Turing test showed that even radiologists could not tell the GAN-synthesized from the raw images (accuracy: primary radiologist 56%, senior radiologist 65%). For CNN classification, our progressive growing wGAN improved the performance of CNN most effectively (area under the curve =0.83). The experiments indicated that the proposed GAN augmentation method improved the classification accuracy by 23.5% (from 37.0% to 60.5%) and 7.3% (from 53.2% to 60.5%) in comparison with training methods using raw and common augmented images respectively. The performance of this combined GAN and CNN method (accuracy: 60.5%±2.6%) was comparable to the state-of-the-art methods, and our CNN was also more lightweight. Conclusions The experiments revealed that GAN synthesis techniques could effectively alleviate the problem of insufficient data in medical imaging. The proposed GAN plus CNN framework can be generalized for use in building other computer-aided detection (CADx) algorithms and thus assist in diagnosis.
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Affiliation(s)
- Yunpeng Wang
- Shanghai Public Health Clinical Center and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Lingxiao Zhou
- Shanghai Public Health Clinical Center and Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,Department of Respiratory Medicine, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - Mingming Wang
- School of Computer Science, Fudan University, Shanghai, China
| | - Cheng Shao
- School of Computer Science, Fudan University, Shanghai, China
| | - Lili Shi
- Shanghai Public Health Clinical Center and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Shuyi Yang
- Shanghai Public Health Clinical Center and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Zhiyong Zhang
- Shanghai Public Health Clinical Center and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Mingxiang Feng
- Chest Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fei Shan
- Shanghai Public Health Clinical Center and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Lei Liu
- Shanghai Public Health Clinical Center and Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,Shanghai University of Medicine & Health Sciences, Shanghai China
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8
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Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
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Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
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9
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Zhou Q, Huang J, Pan F, Li J, Liu Y, Hou Y, Song W, Luo Q. Operative outcomes and long-term survival of robotic-assisted segmentectomy for stage IA lung cancer compared with video-assisted thoracoscopic segmentectomy. Transl Lung Cancer Res 2020; 9:306-315. [PMID: 32420070 PMCID: PMC7225141 DOI: 10.21037/tlcr-20-533] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Robotic anatomic segmentectomy (RATS) for early-stage lung cancer is being increasingly performed in spite of limited published evidence. To evaluate its safety and oncologic efficacy, we compared the outcomes of both RATS and video-assisted thoracoscopic (VATS) segmentectomy in patients with small-sized (<2 cm) peripheral stage IA lung cancer. Methods From November 2011 to January 2018, a total of 130 patients with resected stage IA non-small cell lung cancer (NSCLC) who underwent RATS (n=50) and VATS (n=80) pulmonary segmentectomy were included. Clinicopathologic data, recurrence rate, and survival were recorded. Results The demographics, pulmonary function, comorbidity, and tumor size were similar between RATS segmentectomy and VATS segmentectomy. The surgery time, intensive care unit stay, hospital stay, and blood loss were reduced in the RATS group compared to the VATS group. The number of totally dissected lymph nodes and postoperative complications were similar between the 2 groups. There was no operative mortality. The intensity of narcotic use during hospital stay and the time to return to routine daily activities were also reduced in the RATS group. There was no recurrence observed in the RATS group during the median 38-month follow-up period; meanwhile, during a median 85-month follow-up period in the VATS group, local recurrence and distant recurrence was observed in 2 patients (2.5%) and 3 patients (3.75%) respectively. There was no significant difference in the 5-year recurrence-free survival between the RATS and VATS groups (100% vs. 93.75%; P>0.05). Conclusions RATS can be performed safely and effectively in patients with early-stage NSCLC. The reduced narcotic use and earlier return to routine daily activities of RATS patients might reflect its less traumatic nature as compared to VATS. For stage IA disease with small tumors (<2 cm), segmentectomy performed by RATS has better oncologic efficacy when compared to VATS, although in this study, this difference did not reach statistical difference.
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Affiliation(s)
- Qianjun Zhou
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jia Huang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Feng Pan
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Jiantao Li
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Yuan Liu
- Department of Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Yucheng Hou
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Weijian Song
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
| | - Qingquan Luo
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai 200030, China
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Wang H, Weng Q, Hui J, Fang S, Wu X, Mao W, Chen M, Zheng L, Wang Z, Zhao Z, Zhou L, Tu J, Xu M, Huang Y, Ji J. Value of TSCT Features for Differentiating Preinvasive and Minimally Invasive Adenocarcinoma From Invasive Adenocarcinoma Presenting as Subsolid Nodules Smaller Than 3 cm. Acad Radiol 2020; 27:395-403. [PMID: 31201034 DOI: 10.1016/j.acra.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/28/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND To distinguish preinvasive (adenocarcinoma in situ/atypical adenomatous hyperplasia) and minimally invasive adenocarcinoma (MIA) from invasive adenocarcinoma (IA) appearing as solitary subsolid nodules (SSNs) less than 3 cm based on thin-section computed tomography (TSCT) features to guide therapeutic approaches. METHODS A total of 154 lesions that were histopathologically confirmed to have pre/minimally invasive adenocarcinoma (hereafter pre/MIA) and IA presenting as part-solid nodules (PSNs) or pure ground-glass nodules (pGGNs) were retrospectively reviewed. The TSCT features, including diameter, area, CT value, shape, air bronchogram, margins, and location, were compared and assessed. Receiver operating characteristic analyses were conducted to determine the cut-off values for the qualitative variables and their diagnostic performances. RESULTS Of 154 nodules, 89 IA, 53 MIA, eight adenocarcinoma in situ, and four atypical adenomatous hyperplasia lesions were found. Univariate and multivariate logistic regression of the pre/MIA and IA lesions were compared and analyzed among PSNs and pGGNs. Among pGGNs, a significant difference was found in the area (p = 0.004, odds ratio [OR] = 0.124, 95% confidence interval [CI] = 0.300-0.515) between the pre/MIA and IA groups. In PSNs, significant differences were found in the diameter (p = 0.001, OR = 0.171, 95% CI = 0.063-0.467) and CT value (p = 0.001, OR = 0.996, 95% CI = 0.993-0.998) between the pre/MIA and IA groups. According to the corresponding receiver operating characteristic curves, the optimal cut-off tumor area in pGGNs to differentiate pre/MIA from IA was 0.595 cm2. A higher CT value of the lesion (≥ -298.500 HU) and a larger diameter (≥1.450 cm) in PSNs were significantly associated with IA. CONCLUSION Imaging features from TSCT contribute to distinguishing pre/MIA from IA in solitary subsolid nodules and may contribute to guide the clinical management of these lesions.
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Affiliation(s)
- Hailin Wang
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Qiaoyou Weng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Junguo Hui
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Shiji Fang
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Xulu Wu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Weibo Mao
- Department of Pathology, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, China
| | - Minjiang Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Liyun Zheng
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Zufei Wang
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Zhongwei Zhao
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Limin Zhou
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Jianfei Tu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Min Xu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China
| | - Yuan Huang
- Department of Pathology, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, China.
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, School of Medicine, Lishui, Zhejiang, 323000, China.
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Vieira A, Oliveira R, de Azevedo IS, Figueroa PU. Developing the guidelines: the techniques of uniportal VATS for sublobar resection and middle lobectomy. J Thorac Dis 2019; 11:S2086-S2094. [PMID: 31637043 DOI: 10.21037/jtd.2019.04.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Arthur Vieira
- Division of Thoracic Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Ricardo Oliveira
- Division of Thoracic Surgery, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brazil
| | - Ivan Salgado de Azevedo
- Division of Thoracic Surgery, Department of Oncology Oncobeda, Doctor Beda General Hospital, Rio de Janeiro, Brazil
| | - Paula Ugalde Figueroa
- Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
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Attenuation and Morphologic Characteristics Distinguishing a Ground-Glass Nodule Measuring 5-10 mm in Diameter as Invasive Lung Adenocarcinoma on Thin-Slice CT. AJR Am J Roentgenol 2019; 213:W162-W170. [PMID: 31216199 DOI: 10.2214/ajr.18.21008] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE. The purpose of this study is to comprehensively investigate the role of multiple features seen on thin-section CT (TSCT) in the differential diagnosis of ground-glass nodules (GGNs) measuring 5-10 mm in diameter as invasive adenocarcinoma (IAC). MATERIALS AND METHODS. The TSCT features of 313 surgically diagnosed GGNs from 288 patients were retrospectively reviewed. A logistic regression model was applied, and the AUC values for the model and the size and attenuation of the lesions were compared using ROC curve analysis. RESULTS. A total of 247 lung adenocarcinomas in situ (AISs) and minimally invasive adenocarcinomas (MIAs) (hereafter referred to as the AIS-MIA group) and 66 invasive adenocarcinomas (IACs) were identified. Compared with the AIS-MIA group, the IAC groups were significantly larger in size and had higher attenuation values, a higher frequency of mixed GGNs (all p < 0.001), bubblelike appearance, spiculation, pleural indentation, different locations, and a lower frequency of clear tumor-lung interface (all p < 0.05). The logistic model included size and attenuation (both p < 0.001; odds ratio [OR], 1.872 and 1.009, respectively) as well as tumor-lung interface (p = 0.001; OR, 0.242), bubblelike appearance (p < 0.05; OR, 2.205), and type of nodule. The AUC value for the logistic model was 0.847 (sensitivity, 80.3%; specificity, 81.0%) and was significantly higher than that for size or attenuation (both p < 0.01). CONCLUSION. Radiologic features could help in the differential diagnosis of a GGN that was 5-10 mm in diameter as IAC versus AIS or MIA. GGNs larger than 8.12 mm and with attenuation greater than -449.52 HU were more likely to be IAC.
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Lobectomy vs. segmentectomy. A propensity score matched comparison of outcomes. Eur J Surg Oncol 2018; 45:845-850. [PMID: 30409440 DOI: 10.1016/j.ejso.2018.10.534] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/26/2018] [Accepted: 10/24/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Segmentectomy has emerged as a lung parenchymal sparring alternative to the gold standard lobectomy in non-small cell lung cancer (NSCLC) patients. We hypothesized that there is parity between functional, local recurrence and survival outcomes. PATIENTS AND METHODS Parenchymal sparring procedures including anatomical segmentectomies were propensity score matched 1:1 with lobectomies (n = 64). The primary outcomes included survival, functional and oncological outcomes. The oncological outcomes were: post-operative histology, clear margins and local recurrence rates. Kaplan Meier survival curves were used to compare the survival. Oncological and functional variables were assessed by Fischer exact test and t-test. RESULTS The pre-operative performance status, ASA grade, lung function, risk factors, surgical approach and tumour histology were similar between the groups. The tumour size was significantly higher for lobectomies (32.4 ± 17 vs. 24.6 ± 12 mm, p = 0.01). The tumour staging in the segmentectomy group was similar to the lobectomy group (Ia; 50 vs. 34%; Ib: 29 vs. 37%; IIa 11 vs. 9.3%; IIb 5 vs. 14%; IIIa 5 vs. 4.6%, p = 0.83). The loco-regional recurrence was lower in the segmentectomy group (1.5 vs. 3.1%, p = 0.69). The up-staging and down-staging post-surgery was similar in both groups, while neo-adjuvant therapy was used in 5 lobectomy and 3 segmentectomy cases. The survival was similar at 1 year between the groups (88 vs. 92%, p = 0.65). Between 4 and 5 years, the survival reduced in the parenchymal sparing group to 39% vs. 68% in the lobectomy group (p = 0.04). CONCLUSION Surgical selection bias could be an important confounder in the selection of patients undergoing segmentectomy. Similar up and down staging were demonstrated in the two groups. This is one of the first studies to investigate the results of segmentectomy versus lobectomy in stage II/IIIa NSCLC tumours. No significant differences were found in functional outcomes, but the survival decreased after 4 years in the segmentectomy group, which could be explained by lower survival in the stage II/IIIa tumours treated with segmentectomy.
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Duan L, Jiang G, Yang Y. One hundred and fifty-six cases of anatomical pulmonary segmentectomy by uniportal video-assisted thoracic surgery: a 2-year learning experience. Eur J Cardiothorac Surg 2018; 54:677-682. [PMID: 29635401 DOI: 10.1093/ejcts/ezy142] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/03/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liang Duan
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Yong Yang
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
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Vieira A, Ugalde Figueroa P. Anatomic bisegmentectomy for synchronous lung adenocarcinoma. J Vis Surg 2017; 3:64. [PMID: 29078627 DOI: 10.21037/jovs.2017.03.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 01/15/2023]
Abstract
Modern thoracic surgery requires the ability to manage patients with ground glass opacities (GGO). However, due to the lack of a standardize approach in our institution these cases are discussed in the tumor board. We here present our therapeutic rationale in a case of a patient with multiple GGOs, who underwent an en-bloc anatomic bisegmentectomy as surgical treatment for a synchronous lung adenocarcinoma.
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Affiliation(s)
- Arthur Vieira
- Division of Thoracic Surgery, Institut Universitaire de Pneumologie et Cardiologie de Quebec - Université Laval 2725, chemin Sainte-Foy, Pavillon Laval, 3e étage, porte L-3513-1, Quebec (Québec) G1V 4G5, Canada
| | - Paula Ugalde Figueroa
- Division of Thoracic Surgery, Institut Universitaire de Pneumologie et Cardiologie de Quebec - Université Laval 2725, chemin Sainte-Foy, Pavillon Laval, 3e étage, porte L-3513-1, Quebec (Québec) G1V 4G5, Canada
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16
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Imaging features of TSCT predict the classification of pulmonary preinvasive lesion, minimally and invasive adenocarcinoma presented as ground glass nodules. Lung Cancer 2017. [DOI: 10.1016/j.lungcan.2017.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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17
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Brown LM, Louie BE, Jackson N, Farivar AS, Aye RW, Vallières E. Recurrence and Survival After Segmentectomy in Patients With Prior Lung Resection for Early-Stage Non-Small Cell Lung Cancer. Ann Thorac Surg 2016; 102:1110-8. [PMID: 27350237 DOI: 10.1016/j.athoracsur.2016.04.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 03/12/2016] [Accepted: 04/11/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Lobectomy is the standard of care for patients with early-stage non-small cell lung cancer (NSCLC). However, the treatment of choice for patients with prior lung resection and a second primary NSCLC has not been established. We compared rates and patterns of recurrence and survival in patients with and without prior lung resection treated by segmentectomy and determined predictors of recurrence. METHODS This was a retrospective cohort study of 90 patients who underwent 91 consecutive segmentectomies for early-stage NSCLC between April 2004 and December 2014. Logistic regression was used to determine predictors of recurrence, and Kaplan-Meier curves were used to determine survival. RESULTS Of the 91 segmentectomies, 21 (23%) had a prior lung cancer resection and 70 (77%) were primary resections. There were 18 recurrences (20%): 9 of 21 (43%) in those with prior lung resection and 9 of 70 (13%) in those without. The 90-day mortality was 0%. The recurrence-free survival and 5-year survival were 61% and 55% in those with prior lung resection (p = 0.09) and 84% and 65% in those without (p = 0.4). Close parenchymal margin and number of lymph nodes examined were significant modifiable predictors of recurrence. CONCLUSIONS Segmentectomy is a reasonable option for patients with early-stage NSCLC who have had a prior lung resection. It results in similar survival but trends toward lower recurrence-free survival compared with patients undergoing primary resection.
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Affiliation(s)
- Lisa M Brown
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of California, Davis Medical Center, Sacramento, California
| | - Brian E Louie
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
| | - Nicole Jackson
- Department of Cardiothoracic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | | | - Ralph W Aye
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
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Zhang Y, Shen Y, Qiang JW, Ye JD, Zhang J, Zhao RY. HRCT features distinguishing pre-invasive from invasive pulmonary adenocarcinomas appearing as ground-glass nodules. Eur Radiol 2015; 26:2921-8. [PMID: 26662263 DOI: 10.1007/s00330-015-4131-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 11/09/2015] [Accepted: 11/23/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the high-resolution computed tomography (HRCT) features that distinguish lung adenocarcinomas in situ (AISs) and minimally invasive adenocarcinomas (MIAs) from invasive adenocarcinomas (IACs) appearing as ground-glass nodules (GGNs), and to select candidates for sublobar resection. METHODS Two hundred and twenty-nine patients with 237 GGNs of less than 2 cm (139 AIS-MIA nodules and 98 IAC nodules) confirmed by surgery and pathology were retrospectively reviewed. The HRCT features of the AIS-MIAs and IACs were analysed and compared. Receiver operating characteristic (ROC) analyses were conducted to determine the cutoff values for the qualitative variables and their diagnostic performances. RESULTS Significant differences were found in the density, nodule and solid component diameters, CT values of the ground-glass and solid components, lobulated shape, spiculated margin, abnormal pulmonary vein and artery, air bronchogram, and pleural indentation of the GGNs between the two groups. Multivariate and ROC analyses revealed that larger diameter of nodules (≥12.2 mm) and solid components (≥6.7 mm), and higher CT values of the solid components (≥ -192 HU) in the GGNs with air bronchogram were significantly associated with IACs. CONCLUSIONS HRCT can identify distinguishing morphological features between AIS-MIAs and IACs, and is helpful for selecting candidates for sublobar resection. KEY POINTS • IACs appearing as GGNs were often ≥ 12.2 mm in diameter. • IACs were often ≥ 6.7 mm in solid component diameter. • The solid components of the IACs often exhibited ≥ -192 HU. • IACs exhibited air bronchogram more frequently than AIS-MIAs.
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Affiliation(s)
- Yu Zhang
- Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, 201508, China
| | - Yan Shen
- Department of Radiology, Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, 201508, China.
| | - Jian Ding Ye
- Department of Radiology, Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China.
| | - Jie Zhang
- Department of Pathology, Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Rui Ying Zhao
- Department of Pathology, Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, China
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Abstract
BACKGROUND The relationship between the free margin distance and the recurrence rate and overall survival after R0 wedge resection for non-small cell lung cancer (NSCLC) is still not clear. We retrospectively evaluated the long-term oncologic outcome of patients who had undergone wedge resection for NSCLC to assess the prognostic effect of margin distance in this setting. METHODS Between 2003 and 2013, 243 consecutive patients with a functional contraindication to major lung resection underwent wedge resection with systematic lymph node dissection for clinical stage I NSCLC. The study enrolled 182 patients with pathologic stage I and R0 resection and divided them into three subgroups according to margin distance of less than 1 cm (n = 30), 1 to 2 cm (n = 80), and more than 2 cm (n = 72). RESULTS The histologic assessment was adenocarcinoma in 112 patients, squamous cell in 30, and other in 40. Postoperative morbidity was 18.7%, and postoperative mortality was 1.1%. The median follow-up was 31 months (range, 2 to 133 months). The locoregional (lung parenchyma, hilum, mediastinum) recurrence rate was 26.4% (n = 48). The distant recurrence rate was 11% (n = 20). Overall 5-year survival was 70.4%. Disease-free 5-year survival was 51.7%. There was no statistical difference in locoregional (p = 0.9) and distant (p = 0.3) recurrence rate and no difference in overall survival (p = 0.07) when the three groups were compared. CONCLUSIONS Wedge resection is a viable option for the surgical treatment of stage I NSCLC when lobectomy is contraindicated. The distance between the tumor and the parenchymal suture margin does not influence recurrence or the survival rate when an R0 resection is achieved.
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Kidane B, Toyooka S, Yasufuku K. MDT lung cancer care: Input from the Surgical Oncologist. Respirology 2015; 20:1023-33. [DOI: 10.1111/resp.12567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/12/2015] [Accepted: 04/15/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Biniam Kidane
- Division of Thoracic Surgery; University of Toronto; Toronto Ontario Canada
- Division of Thoracic Surgery; Toronto General Hospital; University Health Network; Toronto Ontario Canada
| | - Shinichi Toyooka
- Department of Thoracic Surgery; Okayama University Hospital; Okayama Japan
- Department of Clinical Genomic Medicine; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery; University of Toronto; Toronto Ontario Canada
- Division of Thoracic Surgery; Toronto General Hospital; University Health Network; Toronto Ontario Canada
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Sakurai H, Asamura H. Sublobar resection for early-stage lung cancer. Transl Lung Cancer Res 2015; 3:164-72. [PMID: 25806296 DOI: 10.3978/j.issn.2218-6751.2014.06.11] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/14/2022]
Abstract
Since the 1995 report of the prospective randomized trial of lobectomy versus sublobar resection for stage I non-small cell lung cancer (NSCLC) performed by the the Lung Cancer Study Group, lobectomy remains the standard of care for the surgical management of stage I NSCLC. Sublobar resection has been typically used for high-risk patients who are operative candidates but for whom a lobectomy is contraindicated. Recent advances in imaging and staging modalities and improved spatial resolution of computed tomography (CT) scan have refined the presentation and diagnosis of early-stage NSCLC. The detection of small tumors and ground-glass opacity (GGO) appearance associated with a favorable histology have led to the increased use of sublobar resection in many institutes to include good-risk patients. There is an increasing body of evidence that sublobar resection may achieve oncological outcomes similar to those with lobectomy in early-stage NSCLC, especially that 2 cm or less in size. However, whether or not sublobar resection constitutes adequate treatment for small-sized lung cancer or for the radiographic "early" lung cancer such as a GGO-dominant lesion is still being prospectively investigated. Sublobar resection will be expected to play an important role as a primary treatment option for patients with small stage IA NSCLC, based on an anatomical functional advantage over lobectomy as well as comparable prognostic outcomes between sublobar resection and lobectomy.
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Affiliation(s)
- Hiroyuki Sakurai
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Non-small cell lung cancer: when to offer sublobar resection. Lung Cancer 2014; 86:115-20. [PMID: 25249427 DOI: 10.1016/j.lungcan.2014.09.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/07/2014] [Indexed: 11/20/2022]
Abstract
Sublobar resection for lung cancer--whether non-anatomic wedge resection or anatomic segmentectomy--has emerged as a credible alternative to lobectomy for the surgical treatment of selected patients with lung cancer. Sublobar resection promises to cause less pulmonary compromise in such patients. Emerging evidence suggests that sublobar resection may offer survival outcomes approaching that of lobectomy for lung cancer patients whose disease meets the following criteria: stage IA disease only; tumor up to 2-3 cm diameter; peripheral location of tumor in the lung; and predominantly ground-glass (non-solid) appearance on CT imaging. The best results are obtained with segmentectomy (as opposed to wedge resection) and complete lymph node dissection. Nevertheless, the evidence is currently still limited, and the above criteria are met only in a minority of patients. Large randomized trials are underway to define the clinical role of sublobar resections, and results are eagerly anticipated. Until that time, lobectomy should still be regarded as the mainstay of surgical therapy for patients with early stage lung cancer at present.
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High pathologic complete remission rate from induction docetaxel, platinum and fluorouracil (DCF) combination chemotherapy for locally advanced esophageal and junctional cancer. Med Oncol 2014; 31:188. [PMID: 25148898 DOI: 10.1007/s12032-014-0188-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/13/2014] [Indexed: 12/26/2022]
Abstract
Adding docetaxel to the cisplatin/5-fluorouracil induction regimen for locally advanced esophageal and GEJ cancer may increase the pathologic complete remission (pCR) rate, leading to an improved outcome. Institutional ethics committee approved the protocol of retrospective analysis of patients with locally advanced esophageal and GEJ carcinoma, who received 2-3 cycles of docetaxel, cisplatin and 5-fluorouracil (DCF) induction chemotherapy with primary growth factors and prophylactic antibiotics. Following chemotherapy, a restaging scan was performed. If disease was deemed resectable, surgery was performed. Between February 2010 and October 2013, 31 patients received induction DCF. Ninety-four percent patients had squamous histology. Response rate was 81 %: complete remission (CR)-23 % and partial remission-58 %. Eighty-seven percent patients underwent surgery; R0 resection rate was 67 %. pCR occurred in 26 %. Common grade 3/4 toxicities included anemia-23 %, neutropenia-42 %, febrile neutropenia-39 %, diarrhea-39 %, hyponatremia-55 % and hypokalemia-39 %. There were no toxic deaths. At a median follow-up of 34 months (95 % CI 31.3-36.6), estimated median progression-free survival (PFS) was 27 months (95 % CI 11-39) and the overall survival (OS) at 1 year, 2 years and 3 years was 80, 68 and 55 %, respectively. Patients who attained pCR had a significant longer PFS and OS; median PFS and OS were not reached in patients with pCR and were 15 months (95 %CI 8.4-21.5 months), P = 0.012 and 25 months (95 %CI 10.3-39.7), P = 0.023, respectively, in patients who did not attain a pCR. DCF induction chemotherapy leads to pCR of 26 %, which rivals that obtained from chemoradiotherapy. Toxicity is substantial but manageable with adequate supportive care.
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Ozeki N, Iwano S, Taniguchi T, Kawaguchi K, Fukui T, Ishiguro F, Fukumoto K, Nakamura S, Hirakawa A, Yokoi K. Therapeutic surgery without a definitive diagnosis can be an option in selected patients with suspected lung cancer. Interact Cardiovasc Thorac Surg 2014; 19:830-7. [PMID: 25038121 DOI: 10.1093/icvts/ivu233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES With the recent improvements in the diagnostic accuracy of radiographic modalities, it might be an option to perform therapeutic surgery without a definitive diagnosis for selected patients with suspected lung cancer based on the findings of diagnostic imaging. METHODS Between April 2008 and December 2012, all nodules without a definitive diagnosis were classified into five categories according to the probability of lung cancer based on the diagnostic imaging: Category 1 (Benign), Category 2 (Probably benign), Category 3 (Intermediate), Category 4 (Suspected malignancy) and Category 5 (Highly suggestive of malignancy). In this study, the 232 surgical candidates for suspected clinical stage I lung cancer without a preoperative definitive diagnosis were considered to be Category 3 (n = 29), Category 4 (n = 46) and Category 5 (n = 157). Eighty-two patients (72% of Category 3, 46% of Category 4 and 25% of Category 5) had an intraoperative diagnosis during surgery, whereas the remaining 150 patients did not. The final pathological diagnosis and surgical outcomes were analysed. RESULTS The final pathological diagnosis of the 232 suspicious nodules revealed 214 lung cancers (52% of Category 3, 93% of Category 4 and 99% of Category 5). Wedge resection was performed for all seven benign tumours. In the multiple regression analysis, intraoperative diagnosis was a significant factor for the length of the operation. In the multivariate logistic regression analysis, the length of the operation was a significant factor predicting both the postoperative morbidity and a prolonged hospital stay. CONCLUSIONS Based on a careful clinical decision made using the current diagnostic imaging strategies, patients with a high probability of lung cancer are good candidates for therapeutic surgery, even without a preoperative or intraoperative definitive diagnosis.
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Affiliation(s)
- Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuo Taniguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Kawaguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Futoshi Ishiguro
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koichi Fukumoto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Hirakawa
- Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Landreneau RJ, Normolle DP, Christie NA, Awais O, Wizorek JJ, Abbas G, Pennathur A, Shende M, Weksler B, Luketich JD, Schuchert MJ. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis. J Clin Oncol 2014; 32:2449-55. [PMID: 24982447 DOI: 10.1200/jco.2013.50.8762] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Although anatomic segmentectomy has been considered a compromised procedure by many surgeons, recent retrospective, single-institution series have demonstrated tumor recurrence and patient survival rates that approximate those achieved by lobectomy. The primary objective of this study was to use propensity score matching to compare outcomes after these anatomic resection approaches for stage I non-small-cell lung cancer. PATIENTS AND METHODS A retrospective data set including 392 segmentectomy patients and 800 lobectomy patients was used to identify matched segmentectomy and lobectomy cohorts (n = 312 patients per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed by Cox regression analysis and Kaplan-Meier estimates. RESULTS Perioperative mortality was 1.2% in the segmentectomy group and 2.5% in the lobectomy group (P = .38). At a mean follow-up of 5.4 years, comparing segmentectomy with lobectomy, no differences were noted in locoregional (5.5% v 5.1%, respectively; P = 1.00), distant (14.8% v 11.6%, respectively; P = .29), or overall recurrence rates (20.2% v 16.7%, respectively; P = .30). Furthermore, when comparing segmentectomy with lobectomy, no significant differences were noted in 5-year freedom from recurrence (70% v 71%, respectively; P = .467) or 5-year survival (54% v 60%, respectively; P = .258). Segmentectomy was not found to be an independent predictor of recurrence (hazard ratio, 1.11; 95% CI, 0.87 to 1.40) or overall survival (hazard ratio, 1.17; 95% CI, 0.89 to 1.52). CONCLUSION In this large propensity-matched comparison, lobectomy was associated with modestly increased freedom from recurrence and overall survival, but the differences were not statistically significant. These results will need further validation by prospective, randomized trials (eg, Cancer and Leukemia Group B 140503 trial).
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Affiliation(s)
- Rodney J Landreneau
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
| | - Daniel P Normolle
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Neil A Christie
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Omar Awais
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Joseph J Wizorek
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Ghulam Abbas
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Arjun Pennathur
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Manisha Shende
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Benny Weksler
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - James D Luketich
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Matthew J Schuchert
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
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Deng B, Cassivi SD, de Andrade M, Nichols FC, Trastek VF, Wang Y, Wampfler JA, Stoddard SM, Wigle DA, Shen RK, Allen MS, Deschamps C, Yang P. Clinical outcomes and changes in lung function after segmentectomy versus lobectomy for lung cancer cases. J Thorac Cardiovasc Surg 2014; 148:1186-1192.e3. [PMID: 24746994 DOI: 10.1016/j.jtcvs.2014.03.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 03/06/2014] [Accepted: 03/12/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We compared the clinical outcomes and changes in pulmonary function test (PFT) results after segmentectomy or lobectomy for non-small cell lung cancer. METHODS The retrospective study included 212 patients who had undergone segmentectomy (group S) and 2336 patients who had undergone lobectomy (group L) from 1997 to 2012. The follow-up and medical record data were collected. We used all the longitudinal PFT data within 24 months postoperatively and performed linear mixed modeling. We analyzed the 5-year overall and disease-free survival in stage IA patients. We used propensity score case matching to minimize the bias due to imbalanced group comparisons. RESULTS During the perioperative period, 1 death (0.4%) in group S and 7 (0.3%) in group L occurred. The hospital stay for the 2 groups was similar (median, 5.0 vs 5.0 days; range, 2-99 vs 2-58). The mean overall and disease-free survival period of those with T1a after segmentectomy or lobectomy seemed to be similar (4.2 vs 4.5 years, P=.06; and 4.1 vs 4.4 years, P=.07, respectively). Compared with segmentectomy, lobectomy yielded marginally significantly better overall (4.4 vs 3.9 years, P=.05) and disease-free (4.1 vs 3.6 years; P=.05) survival in those with T1b. We did not find a significantly different effect on the PFTs after segmentectomy or lobectomy. CONCLUSIONS Both surgical types were safe. We would advocate lobectomy for patients with stage IA disease, especially those with T1b. A retrospective study with a large sample size and more detailed information should be conducted for PFT evaluation, with additional stratification by lobe and laterality.
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Affiliation(s)
- Bo Deng
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minn; Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Stephen D Cassivi
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn
| | - Mariza de Andrade
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minn
| | - Francis C Nichols
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn
| | - Victor F Trastek
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn
| | - Yi Wang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minn; School of Environmental Science and Public Health, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Jason A Wampfler
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minn
| | - Shawn M Stoddard
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minn
| | - Dennis A Wigle
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn
| | - Robert K Shen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn
| | - Mark S Allen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn
| | - Claude Deschamps
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn
| | - Ping Yang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minn.
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Guo Z, Shao W, Yin W, Chen H, Zhang X, Dong Q, Liang L, Wang W, Peng G, He J. Analysis of feasibility and safety of complete video-assisted thoracoscopic resection of anatomic pulmonary segments under non-intubated anesthesia. J Thorac Dis 2014; 6:37-44. [PMID: 24455174 DOI: 10.3978/j.issn.2072-1439.2014.01.06] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 01/06/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To explore the feasibility and safety of complete video-assisted thoracoscopic surgery (C-VATS) under non-intubated anesthesia for the resection of anatomic pulmonary segments in the treatment of early lung cancer (T1N0M0), benign lung diseases and lung metastases. METHODS The clinical data of patients undergoing resection of anatomic pulmonary segments using C-VATS under non-intubated anesthesia in the First Affiliated Hospital of Guangzhou Medical University from July 2011 to November 2013 were retrospectively analyzed to evaluate the feasibility and safety of this technique. RESULTS The procedures were successfully completed in 15 patients, including four men and eleven women. The average age was 47 [21-74] years. There were ten patients with adenocarcinoma, one with pulmonary metastases, and four with benign lung lesions. The resected sites included: right upper apical segment, two; right lower dorsal segment, one; right lower basal segment, two; left upper lingular segment, three; left upper apical segment, one; left upper anterior apical segment, two; left upper posterior segment, one; left lower basal segment, one; left upper posterior and apical segments, one; and left upper anterior and apical segments plus wedge resection of the posterior segment, one. One case had intraoperative bleeding, which was controlled with thoracoscopic operation and no blood transfusion was required. No thoracotomy or perioperative death was noted. Two patients had postoperative bleeding without the need for blood transfusions, and were cured and discharged. The pathologic stage for all patients with primary lung cancer was IA. After 4-19 months of follow-up, no tumor recurrence and metastasis was found. The overall mean operative length was 166 minutes (range 65-285 minutes), mean blood loss 75 mL (range 5-1,450 mL), mean postoperative chest drainage 294 mL (range 0-1,165 mL), mean chest drainage time 2 days (range 0-5 days), and mean postoperative hospital stay 5 days (range 3-8 days). CONCLUSIONS Complete video-assisted throacoscopic segmentectomy under anesthesia without endotracheal intubation is a safe and feasible technique that can be used to treat a selected group of IA patients with primary lung cancer, lung metastases and benign diseases.
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Affiliation(s)
- Zhihua Guo
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Wenlong Shao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Weiqiang Yin
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Hanzhang Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Xin Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Qinglong Dong
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Lixia Liang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Wei Wang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Guilin Peng
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
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Powell CA, Halmos B, Nana-Sinkam SP. Update in lung cancer and mesothelioma 2012. Am J Respir Crit Care Med 2013; 188:157-66. [PMID: 23855692 PMCID: PMC3778761 DOI: 10.1164/rccm.201304-0716up] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/01/2013] [Indexed: 12/21/2022] Open
Affiliation(s)
- Charles A Powell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Shiono S, Abiko M, Sato T. Limited resection for clinical Stage IA non-small-cell lung cancers based on a standardized-uptake value index. Eur J Cardiothorac Surg 2012; 43:e7-e12. [DOI: 10.1093/ejcts/ezs573] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Locoregional recurrence after pulmonary sublobar resection of non-small cell lung cancer: can it be reduced by considering cancer cells at the surgical margin? Gen Thorac Cardiovasc Surg 2012; 61:9-16. [DOI: 10.1007/s11748-012-0156-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Indexed: 10/27/2022]
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Stapleford LJ, Curran WJ. Optimal management of patients with stage I non-small-cell lung cancer and compromised cardiopulmonary function. Lung Cancer Manag 2012. [DOI: 10.2217/lmt.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Lobectomy with systematic lymph node evaluation is the standard of care for medically fit patients with stage I non-small-cell lung cancer. The definition of ‘medically inoperable’ has evolved over time as technological advances have reduced the morbidity and mortality associated with surgery. Operability is currently more appropriately described as a gradient of risk, rather than a strict characterization of inoperable versus operable. For patients who cannot tolerate a lobectomy, multiple treatment options exist: sublobar resection, fractionated radiation, stereotactic body radiation therapy (SBRT) and radiofrequency ablation. Ongoing randomized studies will provide direct comparisons of surgery versus SBRT for both standard- and high-risk operable patients. For medically inoperable patients, radiation is the standard of care, and SBRT offers high rates of local control with limited morbidity. Prospective trials will continue to inform, but in the meantime, the best approach is a multidisciplinary one in which treatment is optimized for individual patients.
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Affiliation(s)
- Liza J Stapleford
- Department of Radiation Oncology & Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Walter J Curran
- Department of Radiation Oncology & Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
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