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Jiang L, Zhang X, Ding SA, Tang M, Ding F, Mei J, Liu H. Simultaneous thoracoscopic surgery in patients with atrial fibrillation and early-stage lung cancer. Int J Cardiol 2024; 414:132422. [PMID: 39098610 DOI: 10.1016/j.ijcard.2024.132422] [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: 05/26/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES Atrial fibrillation (AF) and early-stage lung cancer can both be treated under thoracoscopy. This study aims to evaluate the feasibility and safety of simultaneous thoracoscopic surgery for atrial fibrillation and early-stage lung cancer. METHODS This was a single-center, retrospective study of 865 patients with paroxysmal or non-paroxysmal AF who underwent surgical ablation between October 2014 and December 2021. Patients were divided into two groups according to whether they have undergone simultaneous thoracoscopic early-stage lung cancer surgery and resulting in 24 pairs of patients. RESULTS In total, 48 patients (24 matched pairs) were analyzed. The age was 63.71 ± 8.43 years. Procedure time and postoperative mechanical ventilation time were significantly lower in the group AF than group AFLC (Atrial fibrillation and lung cancer) (140.38 ± 27.53 vs. 230.79 ± 59.06 min, P<0.001; 5 vs 6.5 h, P = 0.002). There was no significant difference between the groups in terms of operative bleeding volume (90.00 ± 29.78 vs 85.83 ± 53.56 ml, P = 0.741), total postoperative drainage volume (1020.83 ± 516.5 vs 1406.25 ± 840.33 ml, P = 0.067), ICU (intensive care unit) length of stay (LOS) (43.5 vs 44 h, P = 0.33), hospitalization LOS (9.29 ± 1.92 vs 8.58 ± 1.98 days, P = 0.214) and incidence of freedom from AF or complications. CONCLUSIONS Simultaneous thoracoscopic surgical AF ablation and early-stage lung cancer is safe and feasible. It can be used as an alternative method for coexisting atrial fibrillation and lung cancer with acceptable operative risks.
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Affiliation(s)
- Lianyong Jiang
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Xuefeng Zhang
- Department of Radiology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Shi-Ao Ding
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Ming Tang
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Fangbao Ding
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Ju Mei
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Hao Liu
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China.
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Motono N, Mizoguchi T, Ishikawa M, Iwai S, Iijima Y, Uramoto H. Accurate Selection of Sublobar Resection for Small Non-small Cell Lung Cancer. Ann Surg Oncol 2024:10.1245/s10434-024-16027-9. [PMID: 39138778 DOI: 10.1245/s10434-024-16027-9] [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: 03/22/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Although sublobar resection (wedge resection [Wed] or segmentectomy [Seg]) has become a standard operative procedure for clinical stages IA1 and IA2 non-small cell lung cancer (NSCLC) in Japan, the impact of this procedure on the prognosis and postoperative complications in real-world clinical practice is unknown. METHODS This study retrospectively analyzed risk factors for a poor prognosis and postoperative complications of 470 patients with clinical stage ≤ IA2 NSCLC who underwent surgery from 2012 to 2021. RESULTS Among the patients with a consolidation-to-tumor ratio (CTR) higher than 0.5, the 5-year relapse-free survival (RFS) rate was significantly lower in the Wed group (72.1%) than in the Seg (85.8%) and Lob (86.8%) groups (p < 0.01), but the difference between the Seg and Lob groups was not significant. Among patients with a CTR of 0.5 or lower, the 5-year RFS rate did not differ significantly among the three groups. Multivariable analysis of RFS showed that the prognosis was significantly worse in the Wed group than in the Lob group (hazard ratio, 2.83; p < 0.01), but the difference between the Wed and Seg groups or the between Seg and Lob groups was not significant. Multivariable analysis of postoperative complications showed a significantly lower risk in the Wed group than in the Seg group (odds ratio, 0.31; p < 0.01). CONCLUSIONS Seg could become the standard operative procedure for clinical stages IA1 and IA2 NSCLC patients. Wed is suggested to be an option for patients with a CTR of 0.5 or lower and has the advantage of avoiding postoperative complications.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan.
| | - Takaki Mizoguchi
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
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Ventura L, Fiorelli A, Rossi M, Gnetti L, Natale G, Wang Y, Carbognani P, Fang W, Waller D. Is Lobectomy Actually Worse Than Segmentectomy for All Stage I Non-Small Cell Lung Cancer? J Surg Res 2024; 300:298-308. [PMID: 38838427 DOI: 10.1016/j.jss.2024.04.041] [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: 04/22/2023] [Revised: 03/24/2024] [Accepted: 04/20/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The recent results of the JCOG 0802 and CALGB 140503 studies suggest that segmentectomy should be considered instead of lobectomy for patients with peripheral <2 cm node-negative non-small cell lung cancer (NSCLC). This study aimed to test this hypothesis in a retrospective analysis of a larger dataset of patients with stage I NSCLC recorded in the Surveillance, Epidemiology, and End Results database. METHODS Patients with all stage I NSCLC (≤4 cm in size) who underwent either segmentectomy or lobectomy from 2000 to 2017 were analyzed. The primary endpoints were overall survival and lung cancer-specific survival, while the secondary endpoints were the 30-day and 90-day mortality. RESULTS Overall, 32,673 patients treated by lobectomy and 2166 patients treated by segmentectomy were included in the initial data collection. After 1:1 propensity score matching (PSM), 2016 patients in each group were enrolled in the final analysis with well-balanced baseline characteristics. After PSM, there was no difference between segmentectomy and lobectomy for all stage IA NSCLC (≤3 cm in size) in both overall survival and lung cancer-specific survival (hazard ratio: 0.87 [0.74-1.02], P value: 0.09 and hazard ratio: 0.81 [0.4-1.03], P value: 0.09, respectively). Furthermore, lobectomy had higher 30-day mortality than segmentectomy: 1.1% versus 2.1%, P value: 0.01. However, this difference was not significant for 90-day mortality, even after PSM (3.9% versus 3.0%, P value: 0.17). CONCLUSIONS We found no evidence to support the use of lobectomy rather than segmentectomy in stage IA NSCLC in terms of either overall or lung cancer-specific long-term survival. The choice of lobectomy may also be detrimental to early postoperative recovery.
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Affiliation(s)
- Luigi Ventura
- Cardiothoracic Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Rossi
- Department of Clinical and Experimental Medicine, University Hospital of Parma, Parma, Italy
| | - Letizia Gnetti
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - Paolo Carbognani
- Thoracic Surgery Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - David Waller
- Barts Thorax Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Gu C, Yuan H, Yang C, Xie F, Chen J, Zhu L, Jiang Y, Sun J. Transbronchial cryoablation in peripheral lung parenchyma with a novel thin cryoprobe and initial clinical testing. Thorax 2024; 79:633-643. [PMID: 38242710 PMCID: PMC11187365 DOI: 10.1136/thorax-2023-220227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/23/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Transbronchial cryoablation shows potential as a local therapy for inoperable peripheral lung cancer. However, its clinical application for peripheral pulmonary lesions has not been reported yet. METHODS An improved cryoprobe with an 8-mm-long, 1.9-mm-wide cryotip was used. Initially, the safety and effectiveness of this cryoprobe were assessed in an in vivo porcine model. Transbronchial cryoablation with 2 or 3 freeze-thaw cycles (10 min or 15 min in each freezing time) was performed in 18 pigs under CT monitoring. Radiological and pathological examinations were performed to evaluate the extent of cryoablation. Subsequently, nine patients with stage IA peripheral lung cancer or metastases underwent transbronchial cryoablation with this cryoprobe under the guidance of navigation bronchoscopy and cone-beam CT. Technical success, safety and outcomes were assessed. RESULTS 36 cryoablation procedures were performed successfully without any major complications in the porcine model. The extent of cryoablation increased with freezing time and the number of freeze-thaw cycles, which peaked at 24 hours and then gradually decreased. Pathological results showed a change from massive haemorrhage at 24 hours to fibrous hyperplasia with chronic inflammation after 4 weeks. In the clinical trial, 10 cryoablations were performed on 9 tumours with a technical success rate of 100%. One mild treatment-related complication occurred. Of the nine tumours, seven achieved complete ablation, while two exhibited incomplete ablation and subsequent local progression at 6 months. CONCLUSION Our initial experience indicated that transbronchial cryoablation was a safe and feasible procedure for non-surgical peripheral stage IA lung cancer or pulmonary metastases. TRIAL REGISTRATION NUMBER ChiCTR2200061544.
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Affiliation(s)
- Chuanjia Gu
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Haibin Yuan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chi Yang
- Research and Development Department, AccuTarget MediPharma (Shanghai) Co., Ltd, Shanghai, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Junxiang Chen
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yifeng Jiang
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
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de Ruiter JC, van der Noort V, van Diessen JNA, Smit EF, Damhuis RAM, Hartemink KJ. The optimal treatment for patients with stage I non-small cell lung cancer: minimally invasive lobectomy versus stereotactic ablative radiotherapy - a nationwide cohort study. Lung Cancer 2024; 191:107792. [PMID: 38621343 DOI: 10.1016/j.lungcan.2024.107792] [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: 11/19/2023] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES The aim of the Early-Stage LUNG cancer (ESLUNG) study was to compare outcomes after minimally invasive lobectomy (MIL) and stereotactic ablative radiotherapy (SABR) in patients with stage I non-small cell lung cancer (NSCLC). MATERIALS AND METHODS In this retrospective cohort study, patients with clinical stage I NSCLC (according to TNM7), treated in 2014-2016 with MIL or SABR, were included. 5-year overall survival (OS) and recurrence-free survival (RFS) were calculated and compared between patients treated with MIL and a propensity score (PS)-weighted SABR population with characteristics comparable to those of the MIL group. RESULTS 1211 MIL and 972 SABR patients were included. Nodal upstaging occurred in 13.0 % of operated patients. 30-day mortality was 1.0 % after MIL and 0.2 % after SABR. After SABR, the 5-year regional recurrence rate (18.1 versus 14.2 %; HR 0.74, 95 % CI 0.58-0.94) and distant metastasis rate (26.2 versus 20.2 %; HR 0.72, 95 % CI 0.59-0.88) were significantly higher than after MIL, with similar local recurrence rate (13.1 versus 12.1 %; HR 0.90, 95 % CI 0.68-1.19). Unadjusted 5-year OS and RFS were 70.2 versus 40.3 % and 58.0 versus 25.1 % after MIL and SABR, respectively. PS-weighted, multivariable analyses showed no significant difference in OS (HR 0.89, 95 % CI 0.65-1.20) and better RFS after MIL (HR 0.70, 95 % CI 0.49-0.99). CONCLUSION OS was not significantly different between stage I NSCLC patients treated with MIL and the PS-weighted population of patients treated with SABR. For operable patients with stage I NSCLC, SABR could therefore be an alternative treatment option with comparable OS outcome. However, RFS was better after MIL due to fewer regional recurrences and distant metastases. Future studies should focus on optimization of patient selection for MIL or SABR to further reduce postoperative mortality and morbidity after MIL and nodal failures after SABR.
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Affiliation(s)
- Julianne Cynthia de Ruiter
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Pulmonary Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Vincent van der Noort
- Department of Statistics, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Judi Nani Annet van Diessen
- Department of Radiotherapy, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Egbert Frederik Smit
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Ronald Alphons Maria Damhuis
- Department of Research, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands
| | - Koen Johan Hartemink
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
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Yu KR, Julliard WA. Sublobar Resection of Non-Small-Cell Lung Cancer: Wedge Resection vs. Segmentectomy. Curr Oncol 2024; 31:2497-2507. [PMID: 38785468 PMCID: PMC11120128 DOI: 10.3390/curroncol31050187] [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: 03/23/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Lung cancer is the most common cause of cancer death. The mainstay treatment for non-small-cell lung cancer (NSCLC), particularly in the early stages, is surgical resection. Traditionally, lobectomy has been considered the gold-standard technique. Sublobar resection includes segmentectomy and wedge resection. Compared to lobectomy, these procedures have been viewed as a compromise procedure, reserved for those with poor cardiopulmonary function or who are poor surgical candidates for other reasons. However, with the advances in imaging and surgical techniques, the subject of sublobar resection as a curative treatment is being revisited. Many studies have now shown segmentectomy to be equivalent to lobectomy in patients with small (<2.0 cm), peripheral NSCLC. However, there is a mix of evidence when it comes to wedge resection and its suitability as a curative procedure. At this time, until more data can be found, segmentectomy should be considered before wedge resection for patients with early-stage NSCLC.
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Affiliation(s)
| | - Walker A. Julliard
- Section of Thoracic & Foregut Surgery, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA 23298, USA
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Tankel J, Spicer J, Chu Q, Fiset PO, Kidane B, Leighl NB, Joubert P, Maziak D, Palma D, McGuire A, Melosky B, Snow S, Bahig H, Blais N. Canadian Consensus Recommendations for the Management of Operable Stage II/III Non-Small-Cell Lung Cancer: Results of a Modified Delphi Process. Curr Oncol 2023; 30:10363-10384. [PMID: 38132389 PMCID: PMC10742991 DOI: 10.3390/curroncol30120755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
The treatment paradigm for patients with stage II/III non-small-cell lung cancer (NSCLC) is rapidly evolving. We performed a modified Delphi process culminating at the Early-stage Lung cancer International eXpert Retreat (ELIXR23) meeting held in Montreal, Canada, in June 2023. Participants included medical and radiation oncologists, thoracic surgeons and pathologists from across Quebec. Statements relating to diagnosis and treatment paradigms in the preoperative, operative and postoperative time periods were generated and modified until all held a high level of consensus. These statements are aimed to help guide clinicians involved in the treatment of patients with stage II/III NSCLC.
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Affiliation(s)
- James Tankel
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Jonathan Spicer
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Quincy Chu
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada
| | - Pierre Olivier Fiset
- Department of Pathology, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba & Cancer Care Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Natasha B. Leighl
- Division of Medical Oncology, Princess Margaret Cancer Center, Toronto, ON M5G 2C4, Canada
| | - Philippe Joubert
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université, Laval, QC G1V 4G5, Canada
| | - Donna Maziak
- Department of Thoracic Surgery, Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - David Palma
- Department of Radiation Oncology, London Health Services Center, London, ON N6A 5A5, Canada
| | - Anna McGuire
- Department of Thoracic Surgery, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Barbara Melosky
- Department of Medical Oncology, BCCA, Vancouver, BC V5Z 4E6, Canada
| | - Stephanie Snow
- Department of Medical Oncology, Queen Elizabeth II Health Sciences Center, Halifax, NS B3H 3A7, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
| | - Normand Blais
- Department of Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
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Fong KY, Chan YH, Chia CML, Agasthian T, Lee P. Sublobar resection versus lobectomy for stage IA non-small-cell lung cancer ≤ 2 cm: a systematic review and patient-level meta-analysis. Updates Surg 2023; 75:2343-2354. [PMID: 37563486 DOI: 10.1007/s13304-023-01627-z] [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: 07/03/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
Despite lobectomy being the standard of care for early-stage non-small-cell lung cancer (NSCLC), sublobar resection (segmentectomy or wedge resection) has recently been suggested to achieve similar outcomes. An electronic literature search was conducted to retrieve randomized controlled trials (RCTs) or propensity score-matched studies (PSMs) comparing lobectomy to sublobar resection in stage IA NSCLC ≤ 2 cm in size, with provision of Kaplan-Meier curves for overall survival (OS) and disease-free survival (DFS). A graphical reconstructive algorithm was used to obtain OS and DFS of individual patients, which was then pooled under random-effects individual patient data meta-analysis using Cox models to determine hazard ratios (HRs). Sensitivity analyses for OS and DFS were also performed, restricting to results from RCTs only. Seven studies (2528 patients) were retrieved. There were no significant differences in OS (shared-frailty HR = 0.92, 95% CI = 0.77-1.11, p = 0.378) or DFS (shared-frailty HR = 1.06, 95% CI = 0.90-1.24, p = 0.476) between lobectomy and sublobar resection. This comparison remained non-significant even when restricted to RCTs only. Pooled Kaplan-Meier curves of OS appeared to diverge over time, in favor of sublobar resection. This was confirmed on analysis of restricted mean survival time curves. This patient-level meta-analysis of high-quality studies demonstrates that sublobar resection is equivalent to lobectomy in patients with small stage IA NSCLC. Sublobar resection offers greater down-the-road benefits in patients who experience recurrence or a second primary tumor since the lung-sparing index surgery allows patients to receive further treatment safely. This heralds sublobar resection as the new standard of care in carefully selected early-stage patients.Trial registration: PROSPERO CRD42023385358.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cynthia Ming Li Chia
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore, Singapore
| | | | - Pyng Lee
- Department of Respiratory and Critical Care Medicine, National University Hospital, Singapore, Singapore
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Hao X, Xiaoyan C, Linyou Z. Robot-assisted segmentectomy with improved modified inflation-deflation combined with the intravenous indocyanine green method. J Robot Surg 2023; 17:2195-2203. [PMID: 37273113 DOI: 10.1007/s11701-023-01639-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
To investigate the perioperative outcomes of patients who underwent robot-assisted thoracoscopic (RATS) segmentectomy for identifying the intersegmental plane (ISP) by improved modified inflation-deflation (MID) combined with near-infrared fluorescence imaging with the intravenous indocyanine green (ICG) method and to assess the feasibility of this method in a large-scale cohort according to the type of segmentectomy performed. We retrospectively analysed the perioperative data of a total of 155 consecutive patients who underwent RATS segmentectomy between April 2020 and December 2021. Data from the operation, including the demarcation status of the intersegmental plane, were analysed retrospectively. The mean operative time and estimated blood loss were 125.56 ± 36.32 min and 41.81 ± 49.18 mL, respectively. Good demarcation of the intersegmental plane was observed in 150 (96.77%) patients, with no correlation with the type of resected segments or the surgical method. Postoperative complications of Clavien-Dindo classification grade 3 or more were observed in 4 patients (2.58%), and no ICG-related adverse events were noted. Demarcation of the intersegmental plane by improved MID combined with ICG is feasible regardless of the type of segmentectomy and can be commonly applied in robot-assisted segmentectomy.
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Affiliation(s)
- Xu Hao
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, #148 Baojian Road, Harbin, 150001, China
| | - Chang Xiaoyan
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, #148 Baojian Road, Harbin, 150001, China
| | - Zhang Linyou
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, #148 Baojian Road, Harbin, 150001, China.
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10
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Moret A, Madelaine L, Hanna HA, Bernard A, Pagès PB. [Complications after pulmonary segmentectomy: Impact of the surgical approach]. Rev Mal Respir 2023; 40:666-674. [PMID: 37798174 DOI: 10.1016/j.rmr.2023.06.008] [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: 09/02/2022] [Accepted: 06/14/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Pulmonary segmentectomy is becoming increasingly widespread but remains technically challenging. The aim of this study was to evaluate the impact of the surgical approach applied on postoperative complications after pulmonary segmentectomy. METHODS All patients having undergone pulmonary segmentectomy by thoracotomy, videothoracoscopy or robot-assisted surgery from 1st January 2018 to 31st December 2021 were included. The primary endpoint was the occurrence of postoperative complications. Secondary endpoints were operative time, length of hospital stay, 30-day readmission rate, 30-day and 90-day mortality. RESULTS Two hundred and twenty-three patients were included, 30% (n=67) in the thoracotomy group, 9.4% (n=21) in the videothoracoscopy group and 60.5% (n=135) in the robot-assisted surgery group. There was no difference in the occurrence of postoperative complications according to type of approach (P=0.564), 26.9% of patients (n=60) had at least one postoperative complication. There was no significant difference between the groups in terms of operative time (P=0.385), length of hospital stay (P=0.107), 30 and 90-day mortality (P=0.124 and P=0.249, respectively). Mini-invasive surgery significantly reduced the 30-day readmission rate (P=0.049). CONCLUSION The surgical approach applied does not influence the postoperative complications of pulmonary segmentectomy.
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Affiliation(s)
- A Moret
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Service de chirurgie thoracique, centre hospitalier Métropole Savoie, Chambéry, France
| | - L Madelaine
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - H Abou Hanna
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - A Bernard
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - P-B Pagès
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Inserm, UMR 1231, CHU de Dijon, université de Bourgogne, Dijon, France.
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11
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Kidane B, Bott M, Spicer J, Backhus L, Chaft J, Chudgar N, Colson Y, D'Amico TA, David E, Lee J, Najmeh S, Sepesi B, Shu C, Yang J, Swanson S, Stiles B. The American Association for Thoracic Surgery (AATS) 2023 Expert Consensus Document: Staging and multidisciplinary management of patients with early-stage non-small cell lung cancer. J Thorac Cardiovasc Surg 2023; 166:637-654. [PMID: 37306641 DOI: 10.1016/j.jtcvs.2023.04.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/27/2023] [Indexed: 06/13/2023]
Abstract
Novel targeted therapy and immunotherapy drugs have recently been approved for use in patients with surgically resectable lung cancer. Accurate staging, early molecular testing, and knowledge of recent trials are critical to optimize oncologic outcomes in these patients.
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Affiliation(s)
| | - Matthew Bott
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Jamie Chaft
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | | | - Jay Lee
- University of California, Los Angeles, Los Angeles, Calif
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12
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Ding C, Jia Q, Wu Z, Zhang Y, Hu Y, Wang J, Wei D. Efficacy of thoracoscopic segmentectomy versus lobectomy in the treatment of early invasive lung adenocarcinoma: a propensity score matching study. Front Oncol 2023; 13:1186991. [PMID: 37719018 PMCID: PMC10502230 DOI: 10.3389/fonc.2023.1186991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Objective This study aimed to investigate and analyze the clinical application value of thoracoscopic segmentectomy and lobectomy in patients with invasive pulmonary adenocarcinoma. Methods 286 patients with invasive pulmonary adenocarcinoma who underwent segmentectomy or lobectomy at the First Hospital of Jiaxing City from January 2018 to June 2020 were retrospectively analyzed. Patients were divided into a thoracoscopic segmentectomy group(n=97) and a lobectomy group (n=189). Patients were compared after obtaining 1:1 propensity score-matched cohorts. Outcome indicators included surgery-related indicators, immune-inflammation-related indicators, postoperative complications, recurrence, and metastasis. Results After 1:1 propensity score matching, 93 patients were included in each group. We found that the volume of intraoperative blood loss in the segmentectomy group was significantly less than in the lobectomy group (P=0.014). The duration of postoperative drainage (P = 0.005) and hospitalization (P=0.002) in the segmentectomy group were significantly shorter than in the lobectomy group. In terms of immunoinflammatory response, compared with the lobectomy group, white blood cells, neutrophils, SII, and NLR in the segmentectomy group were significantly lower than in the lobectomy group (P< 0.05). The recurrence-free survival (RFS) rates in the segmentectomy and lobectomy were 80.5% and 88.2% at 1 year and 35.1% and 52.6% at 3 years, respectively, and the difference was statistically significant (P<0.05). The segmentectomy group achieved similar outcomes to the lobectomy group at 1 year and 3 years (P > 0.05). Multivariate COX regression analysis showed that CAR was an independent risk factor for RFS in patients undergoing invasive adenocarcinoma surgery. Conclusion Compared with lobectomy, thoracoscopic segmentectomy can effectively reduce the postoperative inflammatory response in patients with early invasive lung adenocarcinoma and promote patient recovery. Although segmentectomy is associated with a higher recurrence rate in the short term for patients with early invasive lung adenocarcinoma, the associated survival rate is similar to the lobectomy group. Segmentectomy should be considered in the treatment of early invasive lung adenocarcinoma. Meanwhile, postoperative CAR represents an independent risk factor for early postoperative recurrence in patients with IAC.
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Affiliation(s)
- Congyi Ding
- Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Jiaxing, Zhejiang, China
| | - Qiyu Jia
- Department of Trauma Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhongjie Wu
- Department of Cardiothoracic Surgery, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Yanfei Zhang
- Department of Cardiothoracic Surgery, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Yi Hu
- Department of Cardiothoracic Surgery, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Jingyu Wang
- Department of Cardiothoracic Surgery, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Dahai Wei
- Department of Cardiothoracic Surgery, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
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13
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Bottet B, Piton N, Selim J, Sarsam M, Guisier F, Baste JM. Beyond the Frontline: A Triple-Line Approach of Thoracic Surgeons in Lung Cancer Management-State of the Art. Cancers (Basel) 2023; 15:4039. [PMID: 37627067 PMCID: PMC10452134 DOI: 10.3390/cancers15164039] [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: 07/07/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is now described as an extremely heterogeneous disease in its clinical presentation, histology, molecular characteristics, and patient conditions. Over the past 20 years, the management of lung cancer has evolved with positive results. Immune checkpoint inhibitors have revolutionized the treatment landscape for NSCLC in both metastatic and locally advanced stages. The identification of molecular alterations in NSCLC has also allowed the development of targeted therapies, which provide better outcomes than chemotherapy in selected patients. However, patients usually develop acquired resistance to these treatments. On the other hand, thoracic surgery has progressed thanks to minimally invasive procedures, pre-habilitation and enhanced recovery after surgery. Moreover, within thoracic surgery, precision surgery considers the patient and his/her disease in their entirety to offer the best oncologic strategy. Surgeons support patients from pre-operative rehabilitation to surgery and beyond. They are involved in post-treatment follow-up and lung cancer recurrence. When conventional therapies are no longer effective, salvage surgery can be performed on selected patients.
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Affiliation(s)
- Benjamin Bottet
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
| | - Nicolas Piton
- Department of Pathology, UNIROUEN, INSERM U1245, CHU Rouen, Normandy University, F-76000 Rouen, France;
| | - Jean Selim
- Department of Anaesthesiology and Critical Care, CHU Rouen, F-76000 Rouen, France;
- INSERM EnVI UMR 1096, University of Rouen Normandy, F-76000 Rouen, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
| | - Florian Guisier
- Department of Pneumology, CHU Rouen, 1 Rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 Rue de Germont, F-76000 Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Hospital Center University De Rouen, 1 Rue de Germont, F-76000 Rouen, France; (B.B.); (M.S.)
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14
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Meershoek AJA, Loonen TGJ, Maal TJJ, Hekma EJ, Hugen N. Three Dimensional Printing as a Tool For Anatomical Training in Lung Surgery. MEDICAL SCIENCE EDUCATOR 2023; 33:873-878. [PMID: 37546186 PMCID: PMC10403471 DOI: 10.1007/s40670-023-01807-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 08/08/2023]
Abstract
Objective Pulmonary anatomy is challenging, due to the high variability and its three-dimensional (3D) shape. While demands in thoracic oncologic surgery are increasing, the transition from open to thoracoscopic surgery is hampering anatomical understanding. This study analyzed the value of a 3D printed lung model in understanding and teaching anatomy. Methods A 3D pulmonary model was created and tested among different levels of proficiency: 10 experienced surgeons, 10 fellow surgeons and 10 junior residents. They were tested in interpretation of anatomy based on thoracic CT-scans, either using the 3D model or a 2D anatomical atlas. Accuracy of the given answers, time to complete the task and the self-reported level of certainty were scored in each group. Results In the experienced surgeons group there was no difference in between the 2D-model or 3D-model with a high rate of correct answers in both groups, and no differences in time or certainty. Fellow surgeons highly benefitted from the 3D-model with an improved accuracy from 26.6% to 70.0% (p = 0.001). Time to complete the task was shorter (207 versus 122 s, p < 0.0001) and participants were more secure (median of 4 versus 3, p = 0.007). For junior residents time to complete the task was shorter, the level of certainty was higher, but there was no improvement in accuracy. Conclusions 3D printing may benefit in understanding anatomical relations in the complex anatomy of the bronchiopulmonary tree, especially for surgeons in training and could benefit in teaching anatomy. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01807-x.
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Affiliation(s)
| | - Tom G. J. Loonen
- 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas J. J. Maal
- 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edo J. Hekma
- Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - Niek Hugen
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
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15
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Gioutsos K, Hayoz YJ, Dorn P. Clinical and Oncological Outcomes after Uniportal Anatomical Segmentectomy for Stage IA Non-Small Cell Lung Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1064. [PMID: 37374269 DOI: 10.3390/medicina59061064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The existing literature comparing sublobar and lobar resection in the treatment of stage IA lung cancer highlights the trend and overall need for further evaluation of minimally invasive, parenchymal-sparing techniques. The role of uniportal minimally invasive segmentectomy in the oncological therapy of early-stage non-small cell lung cancer (NSCLC) remains controversial. The aim of this study was to evaluate the clinical and midterm oncological outcomes of patients who underwent uniportal video-assisted anatomical segmentectomy for pathological stage IA lung cancer. Materials and Methods: We retrospectively analyzed all patients with pathological stage IA lung cancer (8th edition UICC) who underwent uniportal minimally invasive anatomical segmentectomy at our institution from January 2015 to December 2018. Results: 85 patients, 54 of whom were men, were included. The median length of hospital stay was 3 days (1.-3. IQR 3-5), whereas 30-day morbidity was 15.3% (13 patients), and the in-hospital mortality rate was 1.2% (1 patient). The 3-year overall survival rate was 87.9% for the total population. It was 90.5% in the IA1 group, 93.3% in the IA2 group, and 70.1% in the IA3 group, respectively. Conclusions: There were satisfactory short-term clinical outcomes with low 30-day morbidity and mortality and promising midterm oncological survival results following uniportal minimally invasive anatomical segmentectomy for pathological stage IA non-small cell lung cancer.
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Affiliation(s)
- Konstantinos Gioutsos
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Yves J Hayoz
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
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16
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Salvicchi A, Tombelli S, Mugnaini G, Gonfiotti A. Lung Segmentectomy in NSCLC Surgery. Life (Basel) 2023; 13:1284. [PMID: 37374067 DOI: 10.3390/life13061284] [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: 05/18/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Current guidelines recommend surgery for early-stage non-small cell lung cancer (NSCLC). The standard treatment for patients with cT1N0 NSCLC has been lobectomy with lymph-node dissection, with sublobar resection used only in patients with inadequate cardio-respiratory reserve, with poor performance status, or who are elderly. In 1995, the Lung Cancer Study Group published the results of a randomized, prospective trial demonstrating the superiority of lobectomy compared with sublobar resection. From then on, wedge resection and segmentectomy were reserved exclusively for patients with poor functional reserve who could not tolerate lobectomy. Therefore, the exact role of segmentectomy has been controversial over the past 20 years. Recently, the randomized controlled trial JCOG0802/WJOG4607L demonstrated that segmentectomy was superior to lobectomy in patients with stage IA NSCLC (<2 cm and CTR < 0.5) in terms of both overall-survival and post-operative lung function. Based on these results, segmentectomy should be considered the standard surgical procedure for this patient group. In 2023, the randomized phase III CALGB 140503 (Alliance) trial demonstrated the efficacy and non-inferiority of sublobar resection, including wedge resection, for clinical stage IA NSCLC with tumor diameter of < 2 cm. This article is a narrative review of the current role of segmentectomy in lung cancer treatment and summarizes the most relevant studies in this context.
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Affiliation(s)
- Alberto Salvicchi
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Simone Tombelli
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Giovanni Mugnaini
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alessandro Gonfiotti
- Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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17
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Righi I, Maiorca S, Diotti C, Bonitta G, Mendogni P, Tosi D, Nosotti M, Rosso L. Oncological Outcomes of Segmentectomy versus Lobectomy in Clinical Stage I Non-Small Cell Lung Cancer up to Two Centimeters: Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:life13040947. [PMID: 37109476 PMCID: PMC10146149 DOI: 10.3390/life13040947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/09/2023] Open
Abstract
Objective. In recent years, pulmonary segmentectomy has emerged as an alternative to lobectomy for the treatment of patients with clinical stage I non-small cell lung cancer. Considering the conflicting results reported in the literature, the oncological effectiveness of segmentectomy remains controversial. To provide new insight into oncological results, we reviewed the literature, including recent randomized trials. Methods. We performed a systematic review for surgical treatment of stage I NSCLC up to 2 cm using MEDLINE and the Cochrane Database from 1990 to December 2022. Primary outcomes for pooled analysis were overall and disease-free survival; secondary outcomes were postoperative complications and 30-day mortality. Results. Eleven studies were considered for the meta-analysis. The pooled analysis included 3074 and 2278 patients who received lobectomy and segmentectomy, respectively. The estimated pooled hazard ratio showed a similar hazard for segmentectomy compared to lobectomy in terms of overall and disease-free survival. The restricted mean survival time difference between the two procedures was statistically and clinically not significant for overall and disease-free survival. Nevertheless, the overall survival hazard ratio was time-dependent: segmentectomy was at a disadvantage starting from 40 months after surgery. Six papers reported 30-day mortality: there were no events on 1766 procedures. The overall relative risk showed that the postoperative complication rate was higher in segmentectomy compared to lobectomy, without statistical significance. Conclusions. Our results suggest that segmentectomy might be a useful alternative to lobectomy for stage I NSCLC up to 2 cm. However, this appears to be time-dependent; in fact, the risk ratio for overall mortality becomes unfavorable for segmentectomy starting at 40 months after surgery. This last observation, together with some still undefined questions (solid/non-solid ratio, depth of the lesion, modest functional savings, etc.), leave room for further investigations on the real oncological effectiveness of segmentectomy.
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Affiliation(s)
- Ilaria Righi
- Department of Cardio-Thoracic and Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sebastiano Maiorca
- Department of Patho-Physiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Cristina Diotti
- Department of Thoracic Surgery, European Institute of Oncology, 20141 Milan, Italy
| | - Gianluca Bonitta
- Department of Patho-Physiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Paolo Mendogni
- Department of Cardio-Thoracic and Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Davide Tosi
- Department of Cardio-Thoracic and Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mario Nosotti
- Department of Cardio-Thoracic and Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Patho-Physiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Lorenzo Rosso
- Department of Cardio-Thoracic and Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Patho-Physiology and Transplantation, University of Milan, 20122 Milan, Italy
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18
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Bayfield NGR, Bibo L, Wang E, Edelman J. Left Upper Lobe Multi-Segmentectomy Vs Lobectomy for Early-Stage Lung Cancer: A Meta-Analysis. Heart Lung Circ 2023; 32:596-603. [PMID: 36959019 DOI: 10.1016/j.hlc.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION The left upper lobe (LUL) has unique hilar anatomy, and LUL multi-segmentectomy (apical trisegmentectomy and lingulectomy) may result in different outcomes than both single anatomical segmentectomy and left upper lobectomy in the management of early-stage primary lung cancer; however no meta-analyses have been performed. The aim of this meta-analysis is to determine if LUL multi-segmentectomy is non-inferior to left upper lobectomy for long-term survival outcomes, or superior for in-hospital outcomes. METHODS Electronic databases searches were performed on PubMed, Embase, and the Cochrane Library to identify studies comparing outcomes in LUL multi-segmentectomy vs left upper lobectomy in early-stage lung cancer (clinical stage T2 N0 or less). Long-term postoperative overall and disease-free survival were assessed via reconstruction of Kaplan-Meier survival curves. In-hospital complications and length of stay, as well as long term recurrence were analysed via random effects models. RESULTS Five relevant studies were identified, including 1,196 patients. Overall survival did not differ at 5 years (multi-segmentectomy 92.6% vs lobectomy 89.3%, P=0.188), but patients undergoing LUL multi-segmentectomy had better disease-free survival at 5 years (93.1% vs 88.4%, P=0.041). Patients undergoing LUL multi-segmentectomy had a shorter mean length of hospital stay (mean difference -0.26 days, 95% CI; -0.39 to 0.14, P<0.01, I2=0.00%). There was no difference in combined in-hospital complications (P=0.14), local recurrence (P=0.35), distant recurrence (P=0.23), or overall recurrence (P=0.39). CONCLUSION LUL multi-segmentectomy is associated with reduced hospital length of stay, but no difference in long-term overall survival compared with left upper lobectomy in the management of early-stage primary lung cancer.
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Affiliation(s)
- Nicholas G R Bayfield
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia.
| | - Liam Bibo
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
| | - Edward Wang
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
| | - James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
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Perez Holguin RA, Olecki EJ, Wong WG, Stahl KA, Go PH, Taylor MD, Reed MF, Shen C. Outcomes after sublobar resection versus lobectomy in non-small cell carcinoma in situ. J Thorac Cardiovasc Surg 2023; 165:853-861.e3. [PMID: 35760619 DOI: 10.1016/j.jtcvs.2022.05.032] [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: 09/28/2021] [Revised: 04/13/2022] [Accepted: 05/07/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Guidelines for treatment of non-small cell lung cancer identify patients with tumors ≤2 cm and pure carcinoma in situ histology as candidates for sublobar resection. Although the merits of lobectomy, sublobar resection, and lymphoid (LN) sampling, have been investigated in early-stage non-small cell lung cancer, evaluation of these modalities in patients with IS disease can provide meaningful clinical information. This study aims to compare these operations and their relationship with regional LN sampling in this population. METHODS The National Cancer Database was used to identify patients diagnosed with non-small cell lung cancer clinical Tis N0 M0 with a tumor size ≤2 cm from 2004 to 2017. The χ2 tests were used to examine subgroup differences by type of surgery. Kaplan-Meier method and Cox proportional hazard model were used to compare overall survival. RESULTS Of 707 patients, 56.7% (401 out of 707) underwent sublobar resection and 43.3% (306 out of 707) underwent lobectomy. There was no difference in 5-year overall survival in the sublobar resection group (85.1%) compared with the lobectomy group (88.9%; P = .341). Multivariable survival analyses showed no difference in overall survival (hazard ratio, 1.044; P = .885) in the treatment groups. LN sampling was performed in 50.9% of patients treated with sublobar resection. In this group, LN sampling was not associated with improved survival (84.9% vs 85.0%; P = .741). CONCLUSIONS We observed no difference in overall survival between sublobar resection and lobectomy in patients with cTis N0 M0 non-small cell lung cancer with tumors ≤2 cm. Sublobar resection may be an appropriate surgical option for this population. LN sampling was not associated with improved survival in patients treated with sublobar resection.
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Affiliation(s)
- Rolfy A Perez Holguin
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - Elizabeth J Olecki
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - William G Wong
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - Kelly A Stahl
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - Pauline H Go
- Division of Thoracic Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa
| | - Matthew D Taylor
- Division of Thoracic Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa
| | - Michael F Reed
- Division of Thoracic Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa
| | - Chan Shen
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa; Division of Health Services and Behavioral Research, Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pa.
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20
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Bongiolatti S, Salvicchi A, Indino R, Vokrri E, Gonfiotti A, Borgianni S, Viggiano D, Voltolini L. Post-operative and early oncological results of simple and complex full thoracoscopic segmentectomies for non-small-cell lung cancer. Asian Cardiovasc Thorac Ann 2023; 31:123-132. [PMID: 36384308 DOI: 10.1177/02184923221138502] [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: 11/18/2022]
Abstract
BACKGROUND The role of video-assisted thoracoscopic segmentectomy in the treatment of clinical IA non-small-cell lung cancer is not well established. The aim of our retrospective analysis was to evaluate the oncological results of complex and simple video-assisted thoracoscopic segmentectomy. METHODS From 2015 to June 2020, data of n = 163 consecutive patients undergoing video-assisted thoracoscopic segmentectomy for solitary pulmonary nodule were analysed. The Kaplan-Meier method, log-rank test and Cox regression were used to estimate, compare survivals and identify risk factors of worse oncological outcomes. RESULTS In this period, n = 123 patients underwent video-assisted thoracoscopic segmentectomy for non-small-cell lung cancer: we performed n = 65 simple and n = 58 complex video-assisted thoracoscopic segmentectomy; n = 99 (80.5%) had a solid appearance on computed tomography scan and n = 78 (63.4%) a moderate-to-high [18F]-2-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomographic computed tomography scan avidity. Mortality was 0%, and complications occurred in n = 14 (21.5%) and 9 (15.5%) patients. The median follow-up was 24 (range: 6-60) months and the 5-year overall survival was 96% without difference between video-assisted thoracoscopic segmentectomies (p = 0.16). Local recurrence developed in n = 2 (3.1%) and n = 3 (5.2%) patients; regional in n = 2 (3.1%) and 1 (1.8%) and distant in 8 (12.3%) and 2 (3.4%), without difference between video-assisted thoracoscopic segmentectomies (p = 0.51). The overall 5-year disease-free survival rate was 78%. Pathological upstaging was observed in n = 13 patients (nodal in n = 6, tumour in n = 7) and it was the only significant factor for worse disease-free survival at the multivariable analysis (hazard ratio: 2.43, 95% CI: 1.04-8.68, p = 0.049), value confirmed also in the group of intended video-assisted thoracoscopic segmentectomy (p = 0.047). CONCLUSIONS Pathological upstaging after simple or complex video-assisted thoracoscopic segmentectomy is a risk factor for recurrence and then video-assisted thoracoscopic segmentectomy should be considered an appropriate therapeutic option for selected stage IA non-small-cell lung cancer patients.
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Affiliation(s)
| | - Alberto Salvicchi
- Thoracic Surgery Unit, 18561Careggi University Hospital, Florence, Italy
| | - Rossella Indino
- Thoracic Surgery Unit, 18561Careggi University Hospital, Florence, Italy
| | - Eduart Vokrri
- Thoracic Surgery Unit, 18561Careggi University Hospital, Florence, Italy
| | - Alessandro Gonfiotti
- Thoracic Surgery Unit, 18561Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Sara Borgianni
- Thoracic Surgery Unit, 18561Careggi University Hospital, Florence, Italy
| | - Domenico Viggiano
- Thoracic Surgery Unit, 18561Careggi University Hospital, Florence, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, 18561Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
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21
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Wang K, Wei X, Fang Q. Split-Lobe for Tumor between Left S3 and S4 by Uniportal Video-Assisted Thoracoscopy. Thorac Cardiovasc Surg Rep 2023; 12:e10-e13. [PMID: 36851993 PMCID: PMC9966163 DOI: 10.1055/s-0043-1760749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 11/08/2022] [Indexed: 02/27/2023] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) segmentectomy is an optimal treatment for malignant pulmonary ground glass nodules (GGNs). However, this surgery is complicated when tumors are located between more than two adjacent segments, although combined subsegmentectomy ensures sufficient margin under uniportal approach. Lobectomy might be inevitable, especially when resecting deep nodules in the central left upper lung lobe. Here, we present cases wherein we performed uniportal VATS (UVATS) resection for GGNs located between borders of left S3 and S4, with three-dimensional reconstruction conducted before surgery. The strategy of resecting central tumors in the left upper lung lobe between left S3 and S4 via UVATS is simple and feasible.
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Affiliation(s)
- KangNing Wang
- Sichuan Cancer Hospital and Institute, Chengdu, Sichuan, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu, Sichuan, China
| | - Qiang Fang
- Department of Thoracic Surgery, University of Electronic Science and Technology of China, Sichuan Cancer Hospital and Research Institute, Cancer Hospital Affiliated to School of Medicine, Wuhou District, Chengdu, China
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22
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Vervoorn MT, Wulfse M, Mohamed Hoesein FAA, Stellingwerf M, van der Kaaij NP, de Heer LM. Application of three-dimensional computed tomography imaging and reconstructive techniques in lung surgery: A mini-review. Front Surg 2022; 9:1079857. [PMID: 36632523 PMCID: PMC9826793 DOI: 10.3389/fsurg.2022.1079857] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022] Open
Abstract
Background Pulmonary surgery is an innovative discipline with increasing demands for minimally invasive techniques in complicated anatomical resections, warranting adequate preoperative imaging of relevant surgical anatomy to ensure safe and radical resection of target lesions. Over the recent years, the emergence of imaging techniques enabling three-dimensional reconstruction has exerted promising influence on pulmonary surgery, facilitating optimal surgical planning and easier identification of the spatial relationship between bronchovascular structures in the individual patient and aiding the safe resection of target pulmonary lesions. The goal of this mini-review is to provide an overview of three-dimensional computed tomography imaging within pulmonary surgery. Methods The authors performed a targeted qualitative review of the literature to identify current trends and to provide better understanding of three-dimensional reconstruction within the boundaries of pulmonary surgery. Results Three-dimensional reconstructive techniques can be used for resectability assessment, identification of surgically relevant interindividual anatomic variance and may improve perioperative outcomes. Discussion Three-dimensional reconstruction using computed tomography imaging improves surgical planning and there is evidence that it results in shorter operative times, less intraoperative blood loss and lower rates of surgical conversion, as it can be applied both pre- and intraoperatively.
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Affiliation(s)
- Mats T. Vervoorn
- Department of Cardiothoracic Surgery, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, Netherlands,Correspondence: Mats T. Vervoorn
| | - Maaike Wulfse
- Department of Cardiothoracic Surgery, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Margriet Stellingwerf
- Department of Pulmonology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Niels P. van der Kaaij
- Department of Cardiothoracic Surgery, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Linda M. de Heer
- Department of Cardiothoracic Surgery, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, Netherlands
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Bakhuis W, Kersten CM, Sadeghi AH, Mank QJ, Wijnen RMH, Ciet P, Bogers AJJC, Schnater JM, Mahtab EAF. Preoperative visualization of congenital lung abnormalities: hybridizing artificial intelligence and virtual reality. Eur J Cardiothorac Surg 2022; 63:ezad014. [PMID: 36645240 PMCID: PMC10481780 DOI: 10.1093/ejcts/ezad014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/16/2022] [Accepted: 01/15/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES When surgical resection is indicated for a congenital lung abnormality (CLA), lobectomy is often preferred over segmentectomy, mostly because the latter is associated with more residual disease. Presumably, this occurs in children because sublobar surgery often does not adhere to anatomical borders (wedge resection instead of segmentectomy), thus increasing the risk of residual disease. This study investigated the feasibility of identifying eligible cases for anatomical segmentectomy by combining virtual reality (VR) and artificial intelligence (AI). METHODS Semi-automated segmentation of bronchovascular structures and lesions were visualized with VR and AI technology. Two specialists independently evaluated via a questionnaire the informative value of regular computed tomography versus three-dimensional (3D) VR images. RESULTS Five asymptomatic, non-operated cases were selected. Bronchovascular segmentation, volume calculation and image visualization in the VR environment were successful in all cases. Based on the computed tomography images, assignment of the CLA lesion to specific lung segments matched between the consulted specialists in only 1 out of the cases. Based on the three 3D VR images, however, the localization matched in 3 of the 5 cases. If the patients would have been operated, adding the 3D VR tool to the preoperative workup would have resulted in changing the surgical strategy (i.e. lobectomy versus segmentectomy) in 4 cases. CONCLUSIONS This study demonstrated the technical feasibility of a hybridized AI-VR visualization of segment-level lung anatomy in patients with CLA. Further exploration of the value of 3D VR in identifying eligible cases for anatomical segmentectomy is therefore warranted.
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Affiliation(s)
- Wouter Bakhuis
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
| | - Casper M Kersten
- Department of Pediatric Surgery, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Amir H Sadeghi
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
| | - Quinten J Mank
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
- Technical Medicine, Delft University of Technology, Delft, Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Pierluigi Ciet
- Department of Radiology and Nuclear Medicine, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
| | - J Marco Schnater
- Department of Pediatric Surgery, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Edris A F Mahtab
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
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Motono N, Mizoguchi T, Ishikawa M, Iwai S, Iijima Y, Uramoto H. Adaptation criterion for segmentectomy in small-sized early stage non-small cell lung cancer. Thorac Cancer 2022; 13:2985-2991. [PMID: 36165084 PMCID: PMC9626306 DOI: 10.1111/1759-7714.14647] [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: 08/12/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although the utility of segmentectomy for early-stage non-small cell lung cancer (NSCLC) has been reported, the adaptation criterion for segmentectomy is unclear. METHODS In total, 171 NSCLC patients who underwent segmentectomy or lobectomy with a consolidation tumor diameter on computed tomography of ≤20 mm were analyzed. RESULTS Consolidation diameter (p = 0.01), consolidation to tumor ratio (CTR) (p < 0.01), maximum standardized uptake value (SUVmax ) (p < 0.01), and segmentectomy (p = 0.01) were significantly different upon univariate analysis among patients stratified by recurrence. Positive correlations were observed between the consolidation diameter on CT and CEA (correlation coefficient; r = 0.19, p = 0.01), SUVmax (r = 0.48, p < 0.01), and CTR (r = 0.83, p < 0.01). Because there was a significant correlation among the consolidation diameter of tumors on CT, CTR, and SUVmax in this study, we integrated these factors into one. Consolidation, CTR, and SUVmax (hazard ratio [HR]: 3.77, 95% confidence interval [CI]: 1.35-11.29, p = 0.01) and segmentectomy (HR: 0.24, 95% CI: 0.03-0.90, p = 0.03) were risk factors for recurrence in a multivariate analysis. There was a significant difference between the segmentectomy and lobectomy groups (5-year relapse-free survival [RFS] 96.5% vs. 80.7%, p = 0.02). CONCLUSIONS Consolidation tumor diameter on CT, CTR, and SUVmax is a risk factor for recurrence. These results suggest that for patients with small-sized early stage NSCLC, this combined factor is important for determining the indication for segmentectomy.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Takaki Mizoguchi
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Masahito Ishikawa
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Shun Iwai
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Yoshihito Iijima
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Hidetaka Uramoto
- Department of Thoracic SurgeryKanazawa Medical UniversityUchinadaJapan
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Zhao J, Wang WB, Ding H, Fu HJ, Jiang YA. Prevention of Dexmedetomidine on Postoperative Delirium and Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Thoracoscopic Lobectomy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:5263021. [PMID: 36276865 PMCID: PMC9586721 DOI: 10.1155/2022/5263021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 09/17/2022] [Indexed: 11/18/2022]
Abstract
Objective To investigate the effect of dexmedetomidine on postoperative cognitive function and delirium in elderly patients undergoing thoracoscopic lobectomy. Methods 109 elderly patients (age is more than 65 years) who underwent thoracoscopic lobectomy in our hospital from June 2020 to Feb 2022 were randomly divided into the dexmedetomidine (DEX) group (n = 54) and the control group (n = 55). The patients in the experimental group were given dexmedetomidine by intravenous pump, intravenous pump 0.5 μg/kg within 10 minutes, and maintained the speed of 0.5 μg/(kg. h) to 30 min before the operation was ended. The control group was given the same amount of normal saline. Delirium assessment-severity (CAM-S) assessment and Mini-Cog were used to assess the severity levels of POD and POCD 24 h before, 6 hours after, one day after the operation, three days after the operation, and 1 week after the operation. Serum TNF-αα and NSE levels were assessed by using enzyme-linked immunosorbent assay. NRS pain marks were assessed in the DEX group at postanesthesia care unit (PACU) and 24 postoperation. Surgical pierhysmographic index (SPI) evaluation was performed at five time points. Results The Mini-Cog scores in the DEX group were markedly enhanced compared with those in the saline group 6 and 24 hours after the operation. The SPI values in the DEX group were markedly reduced within 2 min after intubation and at surgical sutures. Moreover, the CAM scores in the DEX group were markedly reduced 24 hours after the operation. Tumor necrosis factor-α (TNF-α) and neuron-specific enolase (NSE) levels were significantly decreased in the DEX group at T1∼T3. Conclusion The use of dexmedetomidine in the thoracoscopic lobectomy in elderly patients could reduce the occurrence and severity of postoperative cognitive dysfunction and delirium.
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Affiliation(s)
- Jing Zhao
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China
| | - Wei-Bo Wang
- Department of Anesthesiology, Shaanxi Provincial Pucheng Country Hospital, Weinan 715500, Shaanxi, China
| | - Hui Ding
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China
| | - Hua-Jun Fu
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China
| | - Yan-An Jiang
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China
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Dai SY, Tseng YL, Chang CC, Huang WL, Yen YT, Lai WW, Chen YY. Pulmonary function changes after uniportal video-assisted thoracoscopic anatomical lung resection. Asian J Surg 2022; 46:1571-1576. [PMID: 36210308 DOI: 10.1016/j.asjsur.2022.09.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The superiority of segmentectomy over lobectomy with regard to preservation of pulmonary function is controversial. This study aimed to examine changes in pulmonary function after uniportal video-assisted thoracoscopic surgery (VATS) according to the number of resected segments. METHODS We retrospectively reviewed 135 consecutive patients who underwent anatomical lung resection via uniportal VATS from April 2015 to December 2020. Pulmonary function loss was evaluated using forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). Patients were grouped according to number of resected segments: one-segment (n = 33), two segments (n = 22), three segments (n = 40), four segments (n = 15), and five segments (n = 25). RESULTS Clinical characteristics did not significantly differ between groups, except for tumor size. Mean follow-up was 8.96 ± 3.16 months. FVC loss was significantly greater in five-segment resection (10.8%) than one-segment (0.97%, p = 0.008) and two-segment resections (2.44%, p = 0.040). FEV1 loss was significantly greater in five-segment resection (15.02%) than one-segment (3.83%, p < 0.001), two-segment (4.63%, p = 0.001), and three-segment resections (7.63%, p = 0.007). Mean FVC loss and FEV1 loss increased linearly from one-segment resection to five-segment resection. Mean loss in FVC and FEV1 per segment resected was 2.16% and 3.00%, respectively. CONCLUSIONS Anatomical lung resection of fewer segments was associated with better preservation of pulmonary function in patients undergoing uniportal VATS, and function loss was approximately 2%-3% per segment resected with linear relationship.
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Affiliation(s)
- Shuo-Ying Dai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan; Division of Thoracic Surgery, Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.
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Lung Cancer Recurrence Risk Prediction through Integrated Deep Learning Evaluation. Cancers (Basel) 2022; 14:cancers14174150. [PMID: 36077686 PMCID: PMC9454871 DOI: 10.3390/cancers14174150] [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: 07/29/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Prognostic risk factors for completely resected stage IA non-small-cell lung cancers (NSCLCs) have advanced minimally over recent decades. Although several biomarkers have been found to be associated with cancer recurrence, their added value to TNM staging and tumor grade are unclear. Methods: Features of preoperative low-dose CT image and histologic findings of hematoxylin- and eosin-stained tissue sections of resected lung tumor specimens were extracted from 182 stage IA NSCLC patients in the National Lung Screening Trial. These features were combined to predict the risk of tumor recurrence or progression through integrated deep learning evaluation (IDLE). Added values of IDLE to TNM staging and tumor grade in progression risk prediction and risk stratification were evaluated. Results: The 5-year AUC of IDLE was 0.817 ± 0.037 as compared to the AUC = 0.561 ± 0.042 and 0.573 ± 0.044 from the TNM stage and tumor grade, respectively. The IDLE score was significantly associated with cancer recurrence (p < 0.0001) even after adjusting for TNM staging and tumor grade. Synergy between chest CT image markers and histological markers was the driving force of the deep learning algorithm to produce a stronger prognostic predictor. Conclusions: Integrating markers from preoperative CT images and pathologist’s readings of resected lung specimens through deep learning can improve risk stratification of stage 1A NSCLC patients over TNM staging and tumor grade alone. Our study suggests that combining markers from nonoverlapping platforms can increase the cancer risk prediction accuracy.
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Computed Tomography-Guided Localization and Extended Segmentectomy for Non-Small Cell Lung Cancer. Diagnostics (Basel) 2022; 12:diagnostics12092043. [PMID: 36140445 PMCID: PMC9497850 DOI: 10.3390/diagnostics12092043] [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: 07/19/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Lung cancer is one of the most devastating cancers. Low-dose computed tomography (LDCT) can detect lung cancer at an early stage of the disease when a minimally invasive surgical procedure using video-assisted thoracoscopic surgery is the best strategy. Herein, we discuss the treatment of deep lung tumors between segments or lesions located near the margin of a segment. Patients and Methods: This was a retrospective study conducted from January 2013 to January 2020 using the National Taiwan University Hospital data bank. We included early-stage non-small cell lung cancer (NSCLC) patients who underwent lung surgery and screened out those who received CT-guided localization for extended segmentectomy. Outcome measurements were safety margin, complication rate, and postoperative course. Results: During the study period, 68 patients with early-stage NSCLC received CT-guided localization followed by extended segmentectomy. The mean surgery time was 92.1 ± 30.3 min, and the mean blood loss was 32.8 mL. Mean drainage time was 2.3 ± 1 days, and the total hospital stay was 4.9 ± 1.1 days. Pathological reports showed tumor-free resection margins >2 cm. Sixty-one patients had adenocarcinoma at stage IA and two patients at stage IB. One patient had squamous cell carcinoma at stage IA. Conclusion: CT-guided localization followed by extended segmentectomy allows lung volume preservation with clean safety margins and good clinical outcomes.
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Hashinokuchi A, Haratake N, Takenaka T, Matsudo K, Nagano T, Watanabe K, Kosai K, Oku Y, Ono Y, Takamori S, Kohno M, Baba S, Ishigami K, Yoshizumi T. Clinical significance of the combination of preoperative SUVmax and CEA in patients with clinical stage IA lung adenocarcinoma. Thorac Cancer 2022; 13:2624-2632. [PMID: 35962578 PMCID: PMC9475234 DOI: 10.1111/1759-7714.14599] [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: 06/09/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Preoperative maximum standardized uptake value (SUVmax) of 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography and serum carcinoembryonic antigen (CEA) have been reported as prognostic factors for lung adenocarcinoma. However, the significance of combined SUVmax and CEA in early-stage lung adenocarcinoma is not well known. METHODS We retrospectively evaluated the relationship between the combination of SUVmax and CEA and the prognosis of 410 patients with clinical stage IA lung adenocarcinoma who underwent resection. The cutoff values for SUVmax and CEA were determined by receiver operating characteristic curve analysis, and patients were categorized into high SC (SUVmax and CEA) group (SUVmax ≥2.96 and CEA ≥5.3), moderate SC group (either SUVmax <2.96 and CEA ≥5.3 or SUVmax ≥2.96 and CEA <5.3) and low SC group (SUVmax <2.96 and CEA <5.3). RESULTS Kaplan-Meier curve analysis showed that patients with clinical stage IA lung adenocarcinoma in the high SC group had significantly shorter overall survival (OS) and recurrence-free survival (RFS) than the other groups (p = 0.011 and p < 0.0001, respectively). Multivariate analysis showed that high SC was an independent prognostic factor of OS (p = 0.029) and RFS (p < 0.0001). CONCLUSIONS High values of SUVmax and CEA were associated with poor OS and RFS in patients with stage IA lung adenocarcinoma. Simultaneous evaluation of SUVmax and CEA may be an effective prognostic marker to determine the optimal treatment strategy of early-stage lung adenocarcinoma.
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Affiliation(s)
- Asato Hashinokuchi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Haratake
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyoshi Takenaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kyoto Matsudo
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taichi Nagano
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Watanabe
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keisuke Kosai
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuka Oku
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuki Ono
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinkichi Takamori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mikihiro Kohno
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shingo Baba
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Soh J, Toyooka S, Shintani Y, Okami J, Ito H, Ohtsuka T, Mori T, Watanabe SI, Asamura H, Chida M, Endo S, Nakanishi R, Kadokura M, Suzuki H, Miyaoka E, Yoshino I, Date H. Limited resection for stage IA radiologically invasive lung cancer: a real-world nationwide database study. Eur J Cardiothorac Surg 2022; 62:6604739. [PMID: 35678584 DOI: 10.1093/ejcts/ezac342] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/12/2022] [Accepted: 06/03/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Radiologically invasive non-small cell lung cancer, defined as consolidation size to maximum tumour diameter ratio of over 0.5, is associated with pathological invasiveness and worse prognosis. However, there are no real-world, nationwide database studies on limited resections that consider radiological invasiveness. This study aimed to investigate the prognostic validity of limited resection, such as segmentectomy and wedge resection, in cStage IA (TNM 8th edition) radiologically invasive lung cancer. METHODS We conducted a retrospective analysis of patients who underwent complete resection according to the Japanese Joint Committee of Lung Cancer Registry Database. The relationship between surgical procedures and prognosis was examined using stratification by cT factor and radiological invasiveness. RESULTS Among the 5,692 patients enrolled, lobectomy, segmentectomy, and wedge resection were performed in 4,323 (80.0%), 657 (11.5%), and 712 (12.5%) patients, respectively. Multivariable analysis with or without propensity score matching indicated that older age, poor performance status, and wedge resection were significantly associated with worse prognosis and that patients who underwent segmentectomy showed an equivalent prognosis to those who underwent lobectomy. Subset analyses revealed that segmentectomy showed an equivalent prognosis to lobectomy in patients with cT1b or less, but not in those with cT1c, especially for non-pure radiological invasive cT1c; 5-year overall survival rates were 91.4% vs 90.4% in cT1b with non-pure radiological invasiveness, and 80.0% vs 83.8% in cT1b with pure radiological invasiveness, respectively. CONCLUSIONS Segmentectomy can be an alternative to lobectomy in patients with radiologically invasive lung cancer with cT1b or less, but not in those with cT1c.
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Affiliation(s)
- Junichi Soh
- Department of Thoracic, Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.,Division of Thoracic Surgery, Department of Surgery, Kindai University, Faculty of Medicine, Osaka-Sayama, Japan
| | - Shinichi Toyooka
- Department of Thoracic, Breast and Endocrinological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Takashi Ohtsuka
- Division of Thoracic Surgery, Department of Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takeshi Mori
- Department of Thoracic Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Hisao Asamura
- Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, Minato-ku, Tokyo, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Shunsuke Endo
- Department of Thoracic Surgery, Jichi Medical School, Shimotsuke, Tochigi, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Mitsutaka Kadokura
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Etsuo Miyaoka
- Department of Mathematics, Tokyo University of Science, Shinjuku-ku, Tokyo, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, Kyoto, Kyoto, Japan
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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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Xu H, Chang X, Zhang L. A Method to Identify Intersegmental Planes for Robotic-assisted Anatomic Segmentectomy Without Waiting. Surg Laparosc Endosc Percutan Tech 2022; 32:399-400. [PMID: 35297805 DOI: 10.1097/sle.0000000000001040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022]
Abstract
Identifying intersegmental planes is considered the key step during segmentectomy. Several techniques, including modified inflation-deflation techniques, target-segment jet ventilation, and infrared-fluorescence-enhanced methods, have been reported for the identification of intersegmental planes. However, limitations of these methods have also been reported. Here, we described an improved collateral ventilation method to identify the inflation-deflation line without waiting and without any auxiliary materials needed during robotic-assisted anatomic segmentectomy. We present this handy technique of identifying the intersegmental planes and comment on its advantages, including decreased operative time and improved clarity of the inflation-deflation line.
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Affiliation(s)
- Hao Xu
- Department of Thoracic Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang Province, China
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Zhang J, Feng Q, Huang Y, Ouyang L, Luo F. Updated Evaluation of Robotic- and Video-Assisted Thoracoscopic Lobectomy or Segmentectomy for Lung Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:853530. [PMID: 35494020 PMCID: PMC9039645 DOI: 10.3389/fonc.2022.853530] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives Robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) are the two principal minimally invasive surgical approaches for patients with lung cancer. This study aimed at comparing the long-term and short-term outcomes of RATS and VATS for lung cancer. Methods A comprehensive search for studies that compared RATS versus VATS for lung cancer published until November 31, 2021, was conducted. Data on perioperative outcomes and oncologic outcomes were subjected to meta-analysis. PubMed, Web of Science, and EMBASE were searched based on a defined search strategy to identify eligible studies before November 2021. Results Twenty-six studies comparing 45,733 patients (14,271 and 31,462 patients who underwent RATS and VATS, respectively) were included. The present meta-analysis showed that there were no significant differences in operative time, any complications, tumor size, chest drain duration, R0 resection rate, lymph station, 5-year overall survival, and recurrence rate. However, compared with the VATS group, the RATS group had less blood loss, a lower conversion rate to open, a shorter length of hospital stay, more lymph node dissection, and better 5-year disease-free survival. Conclusions RATS is a safe and feasible alternative to VATS for patients with lung cancer.
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Affiliation(s)
- Jianyong Zhang
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qingbo Feng
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yanruo Huang
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Lanwei Ouyang
- Department of Thoracic Surgery, The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu, China
| | - Fengming Luo
- Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Assessment of Treatment Strategies for Stage I Non-small Cell Lung Cancer in Patients with Comorbidities. Lung Cancer 2022; 170:34-40. [PMID: 35700630 PMCID: PMC9378574 DOI: 10.1016/j.lungcan.2022.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/28/2022] [Accepted: 05/02/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Non-small cell lung cancer (NSCLC) patients frequently have major comorbidities but there is scarce data regarding the impact of these conditions on management strategies. We used simulation modeling to compare different treatments for stage I NSCLC for patients with common major comorbidities. METHODS We used data on NSCLC patinet outcomes and quality of life from: (1) the Surveillance Epidemiology and End Results (SEER) database linked to Medicare claims; (2) Kaiser Permanente Southern California electronic health records; and (3) SEER-Medical Health Outcomes Survey to parameterize a novel simulation model of management and outcomes for stage I NSCLC. Relative efficacy of treatment modalities (lobectomy, segmentectomy, wedge resection and stereotactic body radiotherapy [SBRT]) was collected from existing literature and combined using evidence synthesis methods. We then simulated multiple randomized trials comparing these treatments in a variety of scenarios, estimating quality adjusted life expectancy (QALE) according to age, tumor size, histologic subtype, and comorbidity status. RESULTS Lobectomy and segmentectomy yielded the greatest QALE gains among all simulated age, tumor size and comorbidity groups. Optimal treatment strategies differed by patient sex and age; wedge resection was among the optimal strategies for women aged 80-84 with tumors 0-2 cm in size. SBRT was included in some optimal strategies for patients aged 80-84 with multimorbidity. CONCLUSIONS In simulated comparative trials of four common treatments for stage I NSCLC, aggressive surgical management was typically associated with the greatest projected QALE gains despite the presence of comorbidities, although less aggressive strategies were predicted to be non-inferior in some older comorbid patient groups.
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Affiliation(s)
- Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense DK-5000, Denmark.
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36
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Cheng YF, Hsieh YC, Chang YJ, Cheng CY, Huang CL, Hung WH, Wang BY. Comparison of extended segmentectomy with traditional segmentectomy for stage I lung cancer. J Cardiothorac Surg 2022; 17:27. [PMID: 35246181 PMCID: PMC8895589 DOI: 10.1186/s13019-022-01771-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For stage I non-small cell lung cancer (NSCLC), lobectomy and segmentectomy are still controversial operations. Extended segmentectomy was proposed to make larger safe margins than segmentectomy. Image-guided video-assisted thoracoscopic surgery (iVATS) is useful to accomplish extended segmentectomy. We aimed to compare the effects of iVATS extended segmentectomy to the effects of traditional segmentectomy for stage I NSCLC. METHODS This study is a retrospective analysis in a single institute. Patients with stage I NSCLC who received segmentectomy between January 2017 and September 2020 were included. Patients were distributed to iVATS extended segmentectomy (group A), and traditional segmentectomy (group B). The impacts of the different surgical methods on resection margin were assessed. RESULTS There were 116 patients enrolled in this study. Sixty-two patients distributed in group A, and the other 54 patients in group B. The resection margin to a staple line was 17.94 mm in group A versus 14.15 mm in group B, p = 0.037. The margin/tumor diameter ratio was 2.08 in group A versus 1.39 in group B, p = 0.003. The enough margin rate was 75.81% and 57.41%, respectively, for group A and group B. The subgroup analysis of iVATS extended segmentectomy showed that T1a lesions had larger margin distances than did T1b lesions (19.85 mm vs. 14.83 mm, p = 0.026). CONCLUSIONS The iVATS extended segmentectomy can provide more resection margin than traditional segmentectomy. Segmentectomy is more suitable to perform when the nodule's diameter is less than 10 mm.
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Affiliation(s)
- Ya-Fu Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, No. 135 Nanxiao St., Changhua City, 500, Taiwan, ROC
| | - Yueh-Che Hsieh
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC
| | - Yu-Jun Chang
- Big Data Center, Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Ching-Yuan Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, No. 135 Nanxiao St., Changhua City, 500, Taiwan, ROC
| | - Chang-Lun Huang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, No. 135 Nanxiao St., Changhua City, 500, Taiwan, ROC
| | - Wei-Heng Hung
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, No. 135 Nanxiao St., Changhua City, 500, Taiwan, ROC
| | - Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, No. 135 Nanxiao St., Changhua City, 500, Taiwan, ROC. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC. .,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC. .,Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan, ROC. .,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC. .,Center for General Education, Ming Dao University, Changhua, Taiwan, ROC.
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Sesma J, Bolufer S, García-Valentín A, Embún R, López ÍJ, Moreno-Mata N, Jiménez U, Trancho FH, Martín-Ucar AE, Gallar J. Thoracoscopic segmentectomy versus lobectomy: A propensity score–matched analysis. JTCVS OPEN 2022; 9:268-278. [PMID: 36003470 PMCID: PMC9390783 DOI: 10.1016/j.xjon.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy. Methods From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score–matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan–Meier and competing risks method were used to compare survival. Results In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score–matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan–Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression–related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups. Conclusions Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.
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Affiliation(s)
- Julio Sesma
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
- Address for reprints: Julio Sesma, MD, Pintor Baeza 12. 03013, Alicante, Spain.
| | - Sergio Bolufer
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Antonio García-Valentín
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Raúl Embún
- Cardiac Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Íker Javier López
- Thoracic Surgery Department, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Nicolás Moreno-Mata
- Thoracic Surgery Department, Hospital Universitario de Donostia, San Sebastián-Donostia, Spain
| | - Unai Jiménez
- Thoracic Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Antonio Eduardo Martín-Ucar
- Thoracic Surgery Department, Hospital Clínico San Carlos, Madrid, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Juana Gallar
- Miguel Hernandez de Elche University, Alicante, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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Wang P, Wang S, Liu Z, Sui X, Wang X, Li X, Qiu M, Yang F. Segmentectomy and Wedge Resection for Elderly Patients with Stage I Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11020294. [PMID: 35053989 PMCID: PMC8782039 DOI: 10.3390/jcm11020294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Considerable controversies exist regarding the efficacies of segmentectomy and wedge resection for elderly patients with early-stage non-small cell lung cancer (NSCLC). This systematic review and meta-analysis aimed to solve these issues. Methods: We searched the online databases PubMed, Web of Science, EMBASE, and Cochrane Library to identify eligible studies. Elderly patients were defined as ≥65 years. Early-stage NSCLC was defined as stage I based on TNM systems. The primary endpoints were survival outcomes (overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS)) and recurrence patterns. The second endpoints were perioperative morbidities. The hazard rate (HR) and odds ratio (OR) were effect sizes. Results: Sixteen cohort studies (3140 participants) and four database studies were finally included. Segmentectomy and lobectomy showed no significant difference in OS (cohort studies HR 1.00, p = 0.98; database studies HR 1.07, p = 0.14), CSS (HR 0.91, p = 0.85), or DFS (HR 1.04, p = 0.78) in elderly patients with stage I NSCLC. In contrast, wedge resection showed inferior OS (HR 1.28, p < 0.001), CSS (HR 1.17, p = 0.001) and DFS (HR 1.44, p = 0.042) compared to lobectomy. Segmentectomy also showed comparable local recurrence risk with lobectomy (OR 0.98, p = 0.98), while wedge resection showed increased risk (OR 5.46, p < 0.001). Furthermore, sublobar resections showed a decreased risk of 30/90-day mortality, pneumonia, and leak complications compared to lobectomy. Conclusion: Segmentectomy is promising when applied to elderly patients with stage I NSCLC, while wedge resection should be limited. Randomized controlled trials are warranted to validate these findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Fan Yang
- Correspondence: ; Tel.: +86-(10)-88326657
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39
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6545819. [DOI: 10.1093/ejcts/ezac180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/01/2022] [Indexed: 11/12/2022] Open
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40
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6554916. [DOI: 10.1093/ejcts/ezac118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/24/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
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41
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Dai W, Chang S, Pompili C, Qiu B, Wei X, Mu Y, Zhang R, Shen C, Shi Q, Li Q, Wu Z, Che G. Early Postoperative Patient-Reported Outcomes After Thoracoscopic Segmentectomy Versus Lobectomy for Small-Sized Peripheral Non-small-cell Lung Cancer. Ann Surg Oncol 2021; 29:547-556. [PMID: 34743281 DOI: 10.1245/s10434-021-10946-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/04/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patient-reported outcomes are critical for obtaining valuable patient insight into different surgical treatment options with comparable clinical outcomes. This study aimed to compare early postoperative patient-reported symptoms and functioning between thoracoscopic segmentectomy and lobectomy for small-sized (≤ 2 cm) peripheral non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS This study included 110 patients who underwent thoracoscopic segmentectomy or lobectomy for peripheral NSCLC ≤ 2 cm in a multicenter prospective longitudinal study (CN-PRO-Lung 1). Symptom severity, functional status, and short-term clinical outcomes were compared between the groups. Symptom severity and functional status were measured using the MD Anderson Symptom Inventory-Lung Cancer at baseline, daily post-surgery, and weekly post-discharge for up to 4 weeks. Both the proportion of moderate-to-severe scores and mean scores on a 0-10 scale were compared between the groups. RESULTS Overall, 48 and 62 patients underwent thoracoscopic segmentectomy and lobectomy, respectively. No significant between-group differences were found in the severity of the top five symptoms (coughing, shortness of breath, pain, fatigue, and disturbed sleep) or in the impairment of all six function items (work, walking, general activity, enjoyment of life, mood, and relations with others) during both the 6-day postoperative hospitalization and the 4-week post-discharge (all p > 0.05). Short-term clinical outcomes of postoperative hospital stay, operative time, drainage time, postoperative in-hospital oral morphine equivalent dose, and complication rate were also comparable (all p > 0.05). CONCLUSIONS In patients with peripheral NSCLC ≤ 2 cm, thoracoscopic segmentectomy and lobectomy might produce comparable symptom burden and functional impairment during the early postoperative period.
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Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shuai Chang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK.,Department of Thoracic Surgery, Leeds Teaching Hospital Trust, Leeds, UK
| | - Bin Qiu
- 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, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yunfei Mu
- Department of Thoracic Surgery, Chengdu Third People's Hospital, Chengdu, China
| | - Rui Zhang
- Department of Thoracic Surgery, Chengdu Seventh People's Hospital, Chengdu, China
| | - Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuling Shi
- Center for Cancer Prevention Research, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Chaari Z, Montagne F, Sarsam M, Bottet B, Rinieri P, Gillibert A, Baste JM. Midterm survival of imaging-assisted robotic lung segmentectomy for non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2021; 34:1016-1023. [PMID: 34687546 PMCID: PMC9159455 DOI: 10.1093/icvts/ivab287] [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: 02/12/2021] [Revised: 06/07/2021] [Accepted: 09/09/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Zied Chaari
- University of Sfax-Department of Thoracic and Cardiovascular Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia.,Department of General and Thoracic Surgery, Rouen University Hospital, Normandy, France
| | - François Montagne
- Department of General and Thoracic Surgery, Rouen University Hospital, Normandy, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, Rouen University Hospital, Normandy, France
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, Normandy, France
| | - Philippe Rinieri
- Department of General and Thoracic Surgery, Rouen University Hospital, Normandy, France
| | - Andre Gillibert
- Department of Epidemiology and Public Health, Rouen University Hospital, Normandy, France
| | - Jean Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Normandy, France.,INSERM U1096, Rouen University Hospital, Normandy, France
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Li J, Wang Y, Li J, Cao S, Che G. Meta-analysis of Lobectomy and Sublobar Resection for Stage I Non-small Cell Lung Cancer With Spread Through Air Spaces. Clin Lung Cancer 2021; 23:208-213. [PMID: 34799251 DOI: 10.1016/j.cllc.2021.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/28/2021] [Accepted: 10/10/2021] [Indexed: 02/05/2023]
Abstract
Surgery is the preferred treatment for early-stage non-small cell lung cancer (NSCLC). Numerous studies have shown that spread through air spaces (STAS) can predict the survival of patients with stage I NSCLC. However, for stage I NSCLC, it is not known whether sublobar resection or lobectomy should be performed if STAS is present. In the present study, we compared the survival outcomes of patients with STAS who underwent lobectomy versus those who underwent sublobar resection. A search was performed on the PubMed, Cochrane Library and EMBASE on March 6, 2021 to identify relevant studies. Predetermined criteria were utilized to screen studies. A meta-analysis was performed using hazard ratio (HR). In total, 13 studies involving 5947 patients were included in the meta-analysis. It was found that STAS was significantly correlated with worse RFS (HR = 2.58, 95% CI: 2.16-3.07) and OS (HR = 2.41, 95% CI: 1.97-2.95) in patients with stage I NSCLC. Lobectomy resulted in a longer RFS (HR = 2.59, 95% CI: 1.99-3.37) and OS (HR = 2.78, 95% CI: 1.92-4.02) than sublobar resection in stage I NSCLC patients with STAS. STAS is an independent prognostic factor in NSCLC. Lobectomy may be more effective for stage I NSCLC patients who underwent sublobar resection previously if STAS is present.
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Affiliation(s)
- Jialong Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shangqi Cao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Dai W, Mu Y, Chang S, Wu Z, Che G. ASO Author Reflections: Using Patient-Reported Outcomes to Compare Thoracoscopic Segmentectomy and Lobectomy. Ann Surg Oncol 2021; 29:557-558. [PMID: 34671885 DOI: 10.1245/s10434-021-10948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Wei Dai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yunfei Mu
- Department of Thoracic Surgery, Chengdu Third People's Hospital, Chengdu, China
| | - Shuai Chang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Zheng X, Yuan H, Gu C, Yang C, Xie F, Zhang X, Xu B, Sun J. Transbronchial lung parenchyma cryoablation with a novel flexible cryoprobe in an in vivo porcine model. Diagn Interv Imaging 2021; 103:49-57. [PMID: 34593335 DOI: 10.1016/j.diii.2021.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/16/2021] [Accepted: 08/31/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the feasibility and safety of transbronchial cryoablation with a novel flexible cryoprobe using nitrogen as the refrigerant in an in vivo porcine model of lung parenchyma. MATERIALS AND METHODS A novel flexible cryoprobe using nitrogen as the refrigerant was used for transbronchial cryoablation of lung parenchyma in six normal female pigs. The cryoprobe was delivered to the distal bronchus in the bilateral porcine lungs via the bronchoscopic working channel under virtual bronchoscopy guidance. The position was confirmed with real-time computed tomography (CT). The whole procedure included two freeze-thaw cycles (15 min and 2 min, respectively). CT images were obtained during cryoablation and at 24 h, one week, two weeks and four weeks after the treatment to assess the effectiveness and safety of the procedure. Ablation zone tissue samples were obtained at 24 h and four weeks after the cryoablation for further histopathological analysis. RESULTS All ablation procedures (12/12; 100%) were performed successfully. No major complications occurred during the procedure or the observation period. The ablation zones were clearly depicted on CT with a maximal ablation zone volume at 24 h (21.88 ± 12.61 [SD] cm3) compared to 3.64 ± 2.06 (SD) cm3 and 10.73 ± 3.84 (SD) cm3 at the end of the 1st and 2nd freeze-thaw cycles, respectively (P < 0.001). Histopathological analysis revealed that a coagulative necrotic zone was formed along the target bronchus, with obvious vascular occlusion and hemorrhage 24 h after treatment. The lesions gradually formed fibrosis after four weeks. CONCLUSION The novel flexible bronchoscopy-guided cryoablation is a feasible, safe and effective modality in an in vivo porcine model of peripheral normal lung parenchyma, suggesting potential capabilities for the treatment of peripheral lung cancer in humans.
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Affiliation(s)
- Xiaoxuan Zheng
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Haibin Yuan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China
| | - Chuanjia Gu
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Chi Yang
- Research and Development Department, AccuTarget MediPharma (Shanghai) Co., Ltd., 201318 Shanghai, China; School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 200093 Shanghai, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Xueyan Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China
| | - Binkai Xu
- Research and Development Department, AccuTarget MediPharma (Shanghai) Co., Ltd., 201318 Shanghai, China; School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 200093 Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China.
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Montagne F, Guisier F, Venissac N, Baste JM. The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art. Cancers (Basel) 2021; 13:3711. [PMID: 34359612 PMCID: PMC8345199 DOI: 10.3390/cancers13153711] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022] Open
Abstract
Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients' characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients' comfort.
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Affiliation(s)
- François Montagne
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen, Normandie University, LITIS QuantIF EA4108, 22 Boulevard Gambetta, F-76183 Rouen, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, Calmette Hospital, University Hospital of Lille, Boulevard du Pr. J Leclercq, F-59000 Lille, France; (F.M.); (N.V.)
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, 1 rue de Germont, F-76000 Rouen, France
- Faculty of Medicine and Pharmacy of Rouen (UNIROUEN), Normandie University, INSERM U1096, 22 Boulevard Gambetta, F-76000 Rouen, France
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Lymph node metastasis and predictive factors in clinical stage IA squamous cell carcinoma of the lung based on radiological findings. Gen Thorac Cardiovasc Surg 2021; 70:52-58. [PMID: 34268663 DOI: 10.1007/s11748-021-01681-7] [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: 05/14/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to clarify the incidence of lymph node (LN) metastasis and its predictive factors in clinical stage IA squamous cell carcinoma (SqCC) based on radiological classification to provide surgical indications for segmentectomy. METHODS We retrospectively reviewed 192 patients with clinical stage IA SqCC who underwent complete resection with lobectomy and LN dissection at our institution between 2003 and 2019. To evaluate the incidence of LN metastasis from the perspective of indications for segmentectomy, we classified them into outer and inner groups based on the location of the tumor in the radiological findings. RESULTS Regarding tumor location, 123 patients had tumors in the outer location and 69 patients had tumors in the inner location. The incidence of LN metastasis was 6% in clinical stage IA SqCC, which included 6% in the outer location and 7% in the inner location (p = 0.669). In the outer location, all LN metastases were in N1 (6%); whereas in the inner location, the incidence of N1 and N2 metastasis were 6% and 1%, respectively. Only tumors sized > 2.0 cm were found to be significantly associated with LN metastasis in clinical stage IA SqCC. CONCLUSIONS We demonstrated that the incidence of LN metastasis in clinical stage IA SqCC was comparable to that of the previously reported clinical stage IA NSCLC. The incidence of LN metastasis in the outer location was similar to that in the inner location. Tumor size was only a significant factor affecting LN metastasis in clinical stage IA SqCC.
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Zhang X, Lin G, Li J. Right apical-posterior segmentectomy with abnormal anterior segmental bronchus and artery: a case report. J Cardiothorac Surg 2021; 16:189. [PMID: 34229700 PMCID: PMC8258948 DOI: 10.1186/s13019-021-01570-3] [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: 08/05/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Displaced anterior segmental bronchus and pulmonary artery is extremely rare. A keen knowledge of such variations is required in the field of pulmonary segmentectomy, for unawareness of the structural variation could lead to intra- and postoperative complications. Case presentation A 50-year-old female presented to our department with suspected lung adenocarcinoma. Preoperative 3-dimensional computed tomographic bronchography and angiography revealed anterior segmental bronchus and anterior segmental pulmonary artery variation: the anterior segmental bronchus derived from the middle lobe bronchus, accompanied by a distally distributed anterior segmental pulmonary artery branch. A right apical-posterior segmentectomy using inflation-deflation technique was performed successfully. Conclusions The keen observation and proper application of modern imaging technology and operative technique could greatly aid segmentectomy, preventing intra- and postoperative complications from happening.
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Affiliation(s)
- Xining Zhang
- Department of thoracic surgery, Peking University First Hospital, Xishiku street 8th, Beijing, 10000, China.
| | - Gang Lin
- Department of thoracic surgery, Peking University First Hospital, Xishiku street 8th, Beijing, 10000, China
| | - Jian Li
- Department of thoracic surgery, Peking University First Hospital, Xishiku street 8th, Beijing, 10000, China
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Cai JS, Dou XM, Li JB, Yang MZ, Xie CL, Hou X, Yang HX. Nomogram to Predict Cancer Specific Survival in Patients with Pathological Stage IA Non-small Cell Lung Cancer. Semin Thorac Cardiovasc Surg 2021; 34:1040-1048. [PMID: 34216749 DOI: 10.1053/j.semtcvs.2021.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/18/2022]
Abstract
We identified the prognostic factors of resected stage IA non-small cell lung cancer (NSCLC) and developed a nomogram, with purpose of defining the high-risk population who may need closer follow-up or more intensive care. Eligible stage IA NSCLC cases from the Surveillance, Epidemiology, and End Results (SEER) database and the Sun Yat-sen University Cancer Center (SYSUCC) were included. Stage IB NSCLCs were also included for evaluating the risk stratification efficacy. Cancer specific survival (CSS) was compared between groups. Statistically significant factors from multivariate analysis were entered into the nomogram. The performance of the nomogram was evaluated by concordance index (C-index) and calibration plots. A total of 23,112 NSCLC cases (SEER stage IA training cohort, N=7,777; SEER stage IA validation cohort, N=7,776; SEER stage IB cohort, N=7,559) from the SEER database were included. 1,304 NSCLC cases (SYSUCC stage IA validation cohort, N=684; SYSUCC stage IB cohort, N=620) from the SYSUCC were also included. Younger age, female, lobectomy, well differentiated, smaller size and more examined lymph nodes were identified as favorable prognostic factors. A nomogram was established. The C-index was 0.68 (95%CI, 0.67-0.69), 0.66 (95% CI, 0.64-0.68) and 0.66 (95% CI, 0.61-0.71) for the SEER training cohort, SEER validation cohort and SYSUCC validation cohort. A risk classification system was constructed to stratify stage IA NSCLC into low-risk subgroup and high-risk subgroup. The CSS curves of these two subgroups showed statistically significant distinctions. This nomogram delivered a prognostic prediction for stage IA NSCLC and may aid individual clinical practice.
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Affiliation(s)
- Jing-Sheng Cai
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Xiao-Meng Dou
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Ji-Bin Li
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China; Department of Epidemiology and Biostatistics, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Mu-Zi Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Chu-Long Xie
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Xue Hou
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
| | - Hao-Xian Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
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Roman MA, Nakas A. Comparing Outcomes of Segmentectomy and Lobectomy for Non-small Cell Lung Cancer: Is Less Truly More? Chest 2021; 159:21-22. [PMID: 33422198 DOI: 10.1016/j.chest.2020.07.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Marius A Roman
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, England.
| | - Apostolos Nakas
- Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, England
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