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Dai Z, Li Y, Mi X, Yang Z, Gao J, Liu C, Mei J, Liu L, Pu Q. Comparison of uniport versus triport thoracoscopic single or combined basal segmentectomy for stage IA lung cancer. J Thorac Dis 2023; 15:4216-4228. [PMID: 37691649 PMCID: PMC10482630 DOI: 10.21037/jtd-23-477] [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: 03/23/2023] [Accepted: 07/07/2023] [Indexed: 09/12/2023]
Abstract
Background Single or combined basal segmentectomy (CBS), excluding common basal segmentectomy, is the most difficult of all types of segmentectomies. The purpose of this study was to compare the perioperative outcomes and oncological prognosis between uniport thoracoscopic basal segmentectomy (UTBS) and triport thoracoscopic basal segmentectomy (TTBS). Methods This study retrospectively collected 300 patients who underwent thoracoscopic single or CBS at the West China Hospital of Sichuan University from April 2015 to May 2022, including 67 and 233 patients in the UTBS and TTBS groups, respectively. Propensity score matching (PSM) was used to reduce confounding bias between the two groups. The primary outcome was recurrence-free survival (RFS). The secondary outcomes were overall survival (OS) and perioperative outcomes. Results After PSM, the UTBS group (n=64) had significantly less intraoperative blood loss than the TTBS group (n=64) (20 vs. 30 mL, P=0.001). Other perioperative outcomes, including the operation time, number of lymph nodes and lymph node stations harvested, duration of chest tube drainage, postoperative hospital stay, and postoperative complications, were comparable. Subgroup analysis demonstrated that the operative time in the group underwent single basal segmentectomy (SBS) was significantly shorter compared to the group underwent CBS (110 vs. 120 min, P=0.002). There were 5 cases of recurrence in the overall cohort and no recurrence in the matched cohort. No deaths were observed in the overall cohort. Therefore, a survival analysis was conducted only for RFS in the overall cohort. The RFS rate and OS rate of the overall cohort were 98.3% and 100%, respectively. The surgical approach (UTBS vs. TTBS) was not an independent risk factor for RFS (HR: 1.120, 95% CI: 0.342-13.051, P=0.879). Conclusions UTBS provided similar perioperative outcomes and oncological prognoses compared to TTBS.
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Affiliation(s)
- Zhangyi Dai
- Department of Thoracic Surgery, Sichuan University West China Medical Center, Chengdu, China
| | - Yiming Li
- Department of Thoracic Surgery, Sichuan University West China Medical Center, Chengdu, China
| | - Xingqi Mi
- Department of Thoracic Surgery, Sichuan University West China Medical Center, Chengdu, China
| | - Zhenyu Yang
- Department of Thoracic Surgery, Sichuan University West China Medical Center, Chengdu, China
| | - Jiayi Gao
- Department of Thoracic Surgery, Sichuan University West China Medical Center, Chengdu, China
| | - Chengwu Liu
- Department of Thoracic Surgery, Sichuan University West China Medical Center, Chengdu, China
| | - Jiandong Mei
- Department of Thoracic Surgery, Sichuan University West China Medical Center, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, Sichuan University West China Medical Center, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, Sichuan University West China Medical Center, Chengdu, China
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Tang Y, Liu C, Guo C, Pu Q, Mei J, Zhu Y, Ma L, Zardo P, Ferrari PA, Hirai K, Igai H, AlGhamdi ZM, Liu L. Uniportal video-assisted thoracic surgery basal segmentectomy: a single-center retrospective cohort study. Transl Lung Cancer Res 2022; 11:2125-2135. [PMID: 36386453 PMCID: PMC9641035 DOI: 10.21037/tlcr-22-651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/30/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Uniportal video-assisted thoracic surgery (VATS) basal segmentectomy is technically challenging and requires a deep understanding of the segmental anatomy of the lung. This report describes the uniportal VATS segmentectomy of basal segments using a single-direction approach. METHODS A total of 49 patients who underwent uniportal VATS basal segmentectomy between April 2019 and April 2021 were included in this retrospective study. All the surgeries were conducted using a single-direction approach. The resections of segments 7-8 were mainly performed using the interlobar fissure approach, while the resections of segments 9-10 were performed using the inferior pulmonary ligament approach. RESULTS A total of 33 patients underwent a single basal segmentectomy and 16 patients underwent combined basal segmentectomy/sub-segmentectomy. The median operative time was 120 min (range, 60-180 min), and the median blood loss was 20 mL (range, 10-100 mL). The median chest tube duration was 2 days (range, 1-5 days), and the median hospital stay after surgery was 4 days (range, 2-15 days). The morbidity rate after surgery was 6.1% (3/49). There were no perioperative deaths. The pathological examinations revealed 3 cases of adenocarcinoma in situ (AIS), 33 cases of minimally invasive adenocarcinoma, and 13 cases of lepidic-predominant invasive adenocarcinoma. No recrudescence or mortality was reported during the median follow-up time of 7 months (range, 2-25 months). CONCLUSIONS Uniportal VATS basal segmentectomy is a feasible and reliable technique based on our experience. This single-direction method allows the uniportal VATS basal segmentectomy to be performed in an easy manner with the targeted segmental bronchi and vessels exposed from superficial to deep in order of their appearance while avoiding the repeated turnover of the lung.
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Affiliation(s)
- Yudong Tang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China;,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China;,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Chenglin Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China;,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China;,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China;,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Yunke Zhu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China;,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lin Ma
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China;,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Patrick Zardo
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Paolo A. Ferrari
- Division of Thoracic Surgery, Oncology Hospital “A. Businco”, A.R.N.A.S. “G. Brotzu”, Cagliari, Italy
| | - Kyoji Hirai
- Division of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Zeead M. AlGhamdi
- Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China;,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
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