Clinical practice specification of split pulmonary segmentectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Guobing ¹ , ZHENG Bin ¹ , HONG Ruopeng ¹ , WU Weibing ² , LIU Chengwu ³ , SHEN Yaxing ⁴ , ZHANG Fan ⁵ , HAN Dingpei ⁶ ,  CHEN Chun ¹

1. Department of Thoracic Surgery, Fujian Medical University Union Hospital, Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Clinical Research Center for Thoracic Tumors of Fujian Province, National Key Clinical Specialty of Thoracic Surgery, Fuzhou, 350001, P. R. China;
2. Department of Thoracic Surgery, Jiangsu Province Hospital, Nanjing, 210029, P. R. China;
3. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
4. Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, 200032, P. R. China;
5. Department of Thoracic Surgery, The Cancer Hospital of the Chinese Academy of Medical Sciences, Beijing, 100021, P. R. China;
6. Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China;

Corresponding?author：

CHEN Chun, Email: chenchun0209@fjmu.edu.cn

Keywords：

Split segmentectomy; anatomical segmentectomy; early-stage lung cancer; pulmonary nodules; pulmonary function preservation; sublobar resection; clinical practice specification

DOI：

10.7507/1007-4848.202607019

Video：

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In recent years, segmentectomy has been widely adopted across centers nationwide and has gained consistent recognition for its efficacy in treating early-stage lung cancer. However, in clinical practice, solitary or multiple nodules located in challenging anatomical positions are frequently encountered, for which conventional segmentectomy may fail to ensure complete resection or achieve adequate tumor-free margins, often necessitating lobectomy and thereby compromising the preservation of pulmonary function. The split-segmentectomy technique removes the target segment in the central portion of a lobe by combining adjacent segments or subsegments, leaving the remaining lung tissue on both sides as two seemingly "disconnected" parts. This approach enables complete resection of pulmonary nodules while avoiding extensive lobectomy, thereby preserving as much normal lung tissue as possible. Preliminary clinical outcomes have been satisfactory, establishing it as a viable surgical option for pulmonary nodules in difficult locations. To standardize the application of this technique, promote its wider adoption, improve surgical quality, enhance procedural homogeneity, and reduce associated complications, this specification was developed on the basis of relevant literature and expert opinions from China. After thorough discussion and revision at an expert consensus meeting, a unified agreement was reached and formalized into the present specification.

1.	Hong R, Chen C, Zheng W, et al. "Split" combined subsegmentectomy: a case series[J]. Thorac Cancer, 2022, 13(3): 423-429.
2.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial[J]. Lancet, 2022, 399(10335): 1607-1617.
3.	Altorki N, et al. Lobar or sub-lobar resection for peripheral clinical stage ⅠA ≤ 2 cm non-small cell lung cancer (NSCLC): results from an international randomized phaseⅢtrial (CALGB 140503 [Alliance])[C]. Vienna, Austria: International Association for the Study of Lung Cancer, 2022.
4.	Wang K, Wei X, Fang Q. Split-lobe for tumor between left S3 and S4 by uniportal video-assisted thoracoscopy[J/OL]. Thorac Cardiovasc Surg Rep, 2023, 12(1): e10-e13. DOI: 10.1055/s-0043-1761957.
5.	NCCN. NCCN clinical practice guidelines in oncology: non-small cell lung cancer (version 5.2025)[EB/OL]. 2025. NSCL-B2.
6.	中國臨床腫瘤學會指南工作委員會. 中國臨床腫瘤學會(CSCO)非小細胞肺癌診療指南(2025年版)[M]. 北京: 人民衛生出版社, 2025: 18.Chinese Society of Clinical Oncology Guidelines Working Committee. CSCO guidelines for the diagnosis and treatment of non-small cell lung cancer (2025 edition)[M]. Beijing: People’s Medical Publishing House, 2025, 18.
7.	Chen K, Niu Z, Jin R, et al. Three-dimensional reconstruction computed tomography in thoracoscopic segmentectomy: a randomized controlled trial[J/OL]. Eur J Cardiothorac Surg, 2024, 66(1): ezae250. DOI: 10.1093/ejcts/ezae250.
8.	Vervoorn MT, Wulfse M, Mohamed Hoesein FAA, et al. Application of three-dimensional computed tomography imaging and reconstructive techniques in lung surgery: a mini-review[J/OL]. Front Surg, 2022, 9: 1079857.DOI: DOI10.3389/fsurg.2022.1079857.
9.	Browne IL, Patel YS, Hanna NM, et al. Three-dimensional virtual lung reconstruction in robotic segmentectomy: a safety and feasibility trial[J/OL]. JTCVS Tech, 2024, 29: 150-160. DOI: 10.1016/j.xjtc.2024.01.005.
10.	Mariolo AV, Vieira T, Stern JB, et al. Electromagnetic navigation bronchoscopy localization of lung nodules for thoracoscopic resection[J]. J Thorac Dis, 2021, 13(7): 4371-4377.
11.	陳香, 張亞杰, 韓丁培, 等. 電磁導航支氣管鏡引導下肺結節術前定位183例的單中心臨床分析[J]. 中國胸心血管外科臨床雜志, 2023, 30(11): 1539-1544.Chen X, Zhang YJ, Han DP, et al. Electromagnetic navigation bronchoscopy-guided preoperative localization of pulmonary nodules: a single-center clinical analysis of 183 cases[J]. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(11): 1539-1544.
12.	Hui H, Miao H, Qiu F, et al. Noninferiority comparison of electromagnetic navigation-guided versus computed tomography-guided percutaneous localization of multiple small pulmonary nodules: a prospective randomized clinical trial[J]. World J Surg Oncol, 2024, 22(1): 323.
13.	Tsai TM, Chiang XH, Liao HC, et al. Computed tomography-guided dye localization for deeply situated pulmonary nodules in thoracoscopic surgery[J]. Ann Transl Med, 2019, 7(2): 31.
14.	Zheng B, Xu G, Fu X, et al. Management of the inter-segmental plane using the "Combined Dimensional Reduction Method" is safe and viable in uniport video-assisted thoracoscopic pulmonary segmentectomy[J]. Transl Lung Cancer Res, 2019, 8(5): 658-666.
15.	Wu F, Tao X, Wang A, et al. Contribution of fluorescence imaging to thoracoscopic anatomical segmentectomy: a multicenter propensity matching analysis[J]. J Thorac Dis, 2024, 16(8): 5299-5313.
16.	Zhao G, Tong L, Dong X, et al. An innovative and safe method to manage the inter-segmental plane using the "Inserted Multilateral Cutting Method" in pulmonary segmentectomy[J]. J Thorac Dis, 2024, 16(11): 7675-7685.
17.	Libor L, Pécsy B, Sz?cs E, et al. Effect of transbronchial or intravenous administration of indocyanine green on resection margins during near-infrared-guided segmentectomy: a review[J/OL]. Front Surg, 2024, 11: 1430100. DOI: 10.3389/fsurg.2024.1430100.
18.	Wada H, Yamamoto T, Morimoto J, et al. Near-infrared-guided pulmonary segmentectomy after endobronchial indocyanine green injection[J]. Ann Thorac Surg, 2020, 109(2): 396-403.
19.	張成龍, 王瑞堯, 肖闊, 等. 吲哚菁綠熒光法與改良膨脹萎陷法在胸腔鏡肺段切除術中有效性及安全性的系統評價[J]. 中國胸心血管外科臨床雜志, 2024, 31(10): 1486-1495.Zhang CL, Wang RY, Xiao K, et al. Effectiveness and safety of indocyanine green fluorescence method versus modified inflation-deflation method in thoracoscopic pulmonary segmentectomy: a systematic review[J]. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(10): 1486-1495.
20.	黃可南, 丁新宇, 陳昱, 等. 吲哚菁綠熒光胸腔鏡技術在單孔胸腔鏡下肺段切除術段間平面的識別[J]. 中國胸心血管外科臨床雜志, 2019, 26(6): 623-624.Huang KN, Ding XY, Chen Y, et al. Application of indocyanine green fluorescence thoracoscopy in intersegmental plane identification during uniportal thoracoscopic pulmonary segmentectomy[J]. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(6): 623-624.
21.	Nakayama T, Kohno M, Izumi Y, et al. Innovative segmentectomy to remove the posterior segment of the lower lobe (S10) of the lung[J]. Surg Today, 2012, 42(1): 104-106.
22.	Miyata Y, Okada M. Hybrid video-assisted thoracic surgery basilar (S9-10) segmentectomy[J]. Semin Thorac Cardiovasc Surg, 2011, 23(1): 73-77.
23.	Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures[J]. Eur J Anaesthesiol, 2015, 32(2): 88-105.

1. Hong R, Chen C, Zheng W, et al. "Split" combined subsegmentectomy: a case series[J]. Thorac Cancer, 2022, 13(3): 423-429.
2. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial[J]. Lancet, 2022, 399(10335): 1607-1617.
3. Altorki N, et al. Lobar or sub-lobar resection for peripheral clinical stage ⅠA ≤ 2 cm non-small cell lung cancer (NSCLC): results from an international randomized phaseⅢtrial (CALGB 140503 [Alliance])[C]. Vienna, Austria: International Association for the Study of Lung Cancer, 2022.
4. Wang K, Wei X, Fang Q. Split-lobe for tumor between left S3 and S4 by uniportal video-assisted thoracoscopy[J/OL]. Thorac Cardiovasc Surg Rep, 2023, 12(1): e10-e13. DOI: 10.1055/s-0043-1761957.
5. NCCN. NCCN clinical practice guidelines in oncology: non-small cell lung cancer (version 5.2025)[EB/OL]. 2025. NSCL-B2.
6. 中國臨床腫瘤學會指南工作委員會. 中國臨床腫瘤學會(CSCO)非小細胞肺癌診療指南(2025年版)[M]. 北京: 人民衛生出版社, 2025: 18.Chinese Society of Clinical Oncology Guidelines Working Committee. CSCO guidelines for the diagnosis and treatment of non-small cell lung cancer (2025 edition)[M]. Beijing: People’s Medical Publishing House, 2025, 18.
7. Chen K, Niu Z, Jin R, et al. Three-dimensional reconstruction computed tomography in thoracoscopic segmentectomy: a randomized controlled trial[J/OL]. Eur J Cardiothorac Surg, 2024, 66(1): ezae250. DOI: 10.1093/ejcts/ezae250.
8. Vervoorn MT, Wulfse M, Mohamed Hoesein FAA, et al. Application of three-dimensional computed tomography imaging and reconstructive techniques in lung surgery: a mini-review[J/OL]. Front Surg, 2022, 9: 1079857.DOI: DOI10.3389/fsurg.2022.1079857.
9. Browne IL, Patel YS, Hanna NM, et al. Three-dimensional virtual lung reconstruction in robotic segmentectomy: a safety and feasibility trial[J/OL]. JTCVS Tech, 2024, 29: 150-160. DOI: 10.1016/j.xjtc.2024.01.005.
10. Mariolo AV, Vieira T, Stern JB, et al. Electromagnetic navigation bronchoscopy localization of lung nodules for thoracoscopic resection[J]. J Thorac Dis, 2021, 13(7): 4371-4377.
11. 陳香, 張亞杰, 韓丁培, 等. 電磁導航支氣管鏡引導下肺結節術前定位183例的單中心臨床分析[J]. 中國胸心血管外科臨床雜志, 2023, 30(11): 1539-1544.Chen X, Zhang YJ, Han DP, et al. Electromagnetic navigation bronchoscopy-guided preoperative localization of pulmonary nodules: a single-center clinical analysis of 183 cases[J]. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(11): 1539-1544.
12. Hui H, Miao H, Qiu F, et al. Noninferiority comparison of electromagnetic navigation-guided versus computed tomography-guided percutaneous localization of multiple small pulmonary nodules: a prospective randomized clinical trial[J]. World J Surg Oncol, 2024, 22(1): 323.
13. Tsai TM, Chiang XH, Liao HC, et al. Computed tomography-guided dye localization for deeply situated pulmonary nodules in thoracoscopic surgery[J]. Ann Transl Med, 2019, 7(2): 31.
14. Zheng B, Xu G, Fu X, et al. Management of the inter-segmental plane using the "Combined Dimensional Reduction Method" is safe and viable in uniport video-assisted thoracoscopic pulmonary segmentectomy[J]. Transl Lung Cancer Res, 2019, 8(5): 658-666.
15. Wu F, Tao X, Wang A, et al. Contribution of fluorescence imaging to thoracoscopic anatomical segmentectomy: a multicenter propensity matching analysis[J]. J Thorac Dis, 2024, 16(8): 5299-5313.
16. Zhao G, Tong L, Dong X, et al. An innovative and safe method to manage the inter-segmental plane using the "Inserted Multilateral Cutting Method" in pulmonary segmentectomy[J]. J Thorac Dis, 2024, 16(11): 7675-7685.
17. Libor L, Pécsy B, Sz?cs E, et al. Effect of transbronchial or intravenous administration of indocyanine green on resection margins during near-infrared-guided segmentectomy: a review[J/OL]. Front Surg, 2024, 11: 1430100. DOI: 10.3389/fsurg.2024.1430100.
18. Wada H, Yamamoto T, Morimoto J, et al. Near-infrared-guided pulmonary segmentectomy after endobronchial indocyanine green injection[J]. Ann Thorac Surg, 2020, 109(2): 396-403.
19. 張成龍, 王瑞堯, 肖闊, 等. 吲哚菁綠熒光法與改良膨脹萎陷法在胸腔鏡肺段切除術中有效性及安全性的系統評價[J]. 中國胸心血管外科臨床雜志, 2024, 31(10): 1486-1495.Zhang CL, Wang RY, Xiao K, et al. Effectiveness and safety of indocyanine green fluorescence method versus modified inflation-deflation method in thoracoscopic pulmonary segmentectomy: a systematic review[J]. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(10): 1486-1495.
20. 黃可南, 丁新宇, 陳昱, 等. 吲哚菁綠熒光胸腔鏡技術在單孔胸腔鏡下肺段切除術段間平面的識別[J]. 中國胸心血管外科臨床雜志, 2019, 26(6): 623-624.Huang KN, Ding XY, Chen Y, et al. Application of indocyanine green fluorescence thoracoscopy in intersegmental plane identification during uniportal thoracoscopic pulmonary segmentectomy[J]. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(6): 623-624.
21. Nakayama T, Kohno M, Izumi Y, et al. Innovative segmentectomy to remove the posterior segment of the lower lobe (S10) of the lung[J]. Surg Today, 2012, 42(1): 104-106.
22. Miyata Y, Okada M. Hybrid video-assisted thoracic surgery basilar (S9-10) segmentectomy[J]. Semin Thorac Cardiovasc Surg, 2011, 23(1): 73-77.
23. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures[J]. Eur J Anaesthesiol, 2015, 32(2): 88-105.

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