Objective To compare the perioperative outcomes of atypical segmentectomy between robotic-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) in early-stage non-small cell lung cancer (NSCLC). MethodsThe data of patients who underwent minimally invasive anatomic atypical segmentectomy in our hospital from October 2016 to December 2021 were collected. These patients were divided into a RATS group and a VATS group according to the operation method. Propensity score (PS) matching was used to select patients with close clinical baseline characteristics, and the perioperative results of the two groups were compared. ResultsA total of 1 048 patients were enrolled, including 320 males and 728 females, with a mean age of 53.51±11.13 years. There were 277 patients in the RATS group and 771 patients in the VATS group. After 1∶1 PS matching, 277 pairs were selected. Both groups were well balanced for age, sex, smoking history, body mass index, Charlson comorbidity index, pulmonary function, tumor size, tumor location, and histological type. All patients were R0 resection, and there were no deaths within 30 days after surgery. The RATS group had shorter operative time [85 (75, 105) min vs. 115 (95, 140) min, P<0.001] and less blood loss [50 (30, 100) mL vs. 60 (50, 100) mL, P=0.001]. There were no statistical differences between the two groups in lymph node resection, conversion to thoracotomy, thoracic drainage time, total amount of thoracic drainage or postoperative complications (P>0.05). ConclusionBoth RATS and VATS atypical segmentectomies are safe and feasible for early-stage NSCLC. RATS can effectively shorten the operative time, and reduce blood loss.
Lung cancer, as one of the malignant tumors with the fastest increasing morbidity and mortality in the world, has a serious impact on people's health. With the continuous advancement of medical technology, more and more medical methods are applied to lung cancer screening, which has gradually increased the detection rate of early lung cancer. At present, the standard operation for the treatment of early non-small cell lung cancer (NSCLC) is still lobectomy and mediastinal lymph node dissection. There is a growing trend to use segmentectomy for the treatment of early stage lung cancer. Anatomical segmentectomy not only removes the lesions to the maximum extent, but also preserves the lung function to the greatest extent, and its advantages are also obvious. This article reviews the progress of anatomical segmentectomy in the treatment of early NSCLC.
ObjectiveTo analyze the feasibility, advantages and disadvantages of the fluorescence method and the inflation-deflation method in defining the intersegmental plane during thoracoscopic lung segmental resection.MethodsFrom February to October 2018, 60 patients underwent thoracoscopic anatomical segmentectomy in Thoracic Surgery Department of Nanjing Chest Hospital, with 28 males and 32 females, aged from 25 to 82 years. Three-dimension computed tomography bronchography and angiography was used to reconstruct pulmonary vessels, bronchus and virtual intersegmental plane. Among them, 20 patients used the fluorescence method to define the intersegmental plane, and the other 40 patients used the traditional inflation-deflation method to define the intersegmental plane.ResultsFluorescent injection of indocyanine green (ICG) showed a clear intersegmental line with a duration sufficient to complete the label. With the fluorescence method, the intersegmental plane occurrence time was significantly shortened (10.75±3.78 s vs. 988.00±314.24 s, P<0.001) and had satisfactory repeatability. The lungs did not need to be inflated, which was convenient for the operation. And the operation time was shortened (108.75±31.28 min vs 138.00±32.47 min, P=0.002). No obvious ICG injection-related concurrency symptoms was found.ConclusionCompared with the traditional inflation-deflation method, the fluorescence method can display the intersegmental line quickly, accurately and clearly, reduce the difficulty of surgery, shorten the operation time, and provide reliable technical support for thoracoscopic anatomical segmentectomy. The fluorescence is a safe and effective method that is worthy of clinical application.
ObjectiveTo compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections.MethodsThe patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed.ResultsThere was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041).ConclusionSegmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.
Objective To evaluate the effectiveness and safety of indocyanine green fluorescence method versus modified inflation-deflation method for thoracoscopic anatomic segmentectomy. Methods CNKI, Wanfang Database, China Biomedical Literature Database, Web of Science, Cochrane Library, EMbase, PubMed, Clinicaltrials.gov, were searched from 1 January 2000 to 1 May 2023, and controlled studies between indocyanine green fluorescence and modified inflation deflation method in thoracoscopic segmentectomy were collected. Meta-analysis was performed using Stata14MP and RevMan5.4. Results A total of 10 articles, including 1 156 patients, were identified. In thoracoscopic anatomic segmentectomy, indocyanine green fluorescence method had an advantage over modified inflation deflation method. The total incidence of postoperative complications decreased (OR=0.51, 95%CI 0.36 to 0.71, P<0.0001). The incidence of air leaks decreased (OR=0.50, 95%CI 0.31 to 0.80, P=0.004), the operation time shortened (MD=?25.81, 95%CI ?29.78 to ?21.84, P<0.00001), the length of postoperative hospital stays shortened (MD=?0.98, 95%CI ?1.57 to ?0.39, P=0.001), the rate of clear displaying for intersegmental boundary line increased (OR=5.79, 95%CI 2.76 to 12.15, P<0.00001). The difference was statistically significant. Conclusion Compared with modified inflation deflation method, indocyanine green fluorescence method can quickly and clearly display the intersegmental boundary line, reduce the difficulty of surgery, shorten the operation time, reduce the length of postoperative hospital stay, and provide reliably technical support for thoracoscopic anatomic segmentectomy. It is an effective and safe method, which is worthy of extensive application.
ObjectiveTo analyze the risk factors for complications after robotic segmentectomy.MethodsClinical data of 207 patients undergoing robot-assisted anatomical segmentectomy in our hospital from June 2015 to July 2019 were retrospectively analyzed, including 69 males and 138 females with a median age of 54.0 years. The relationship between clinicopathological factors and prolonged air leakage, pleural effusion, and pulmonary infection after surgery was analyzed.ResultsAfter robot-assisted segmentectomy, 20 (9.7%) patients developed prolonged air leakage (>5 d), 17 (8.2%) patients developed pleural effusion, and 4 (1.9%) patients developed pulmonary infection. Univariate logistic regression showed that body mass index (BMI, P=0.018), FEV1% (P=0.024), number of N1 lymph nodes resection (P=0.008) were related to prolonged air leakage after robot-assisted segmentectomy. Benign lesion was a risk factor for pleural effusion (P=0.013). The number of lymph node sampling stations was significantly related to the incidence of pulmonary infection (P=0.035). Multivariate logistic analysis showed that the BMI (OR=0.73, P=0.012) and N1 lymph node sampling (OR=1.38, P=0.001) had a negative and positive relationship with prolonged air leakage after robot-assisted segmentectomy, respectively.ConclusionThe incidence of pulmonary complications after robot-assisted segmentectomy is low. The lower BMI and more N1 lymph node sampling is, the greater probability of prolonged air leakage is. Benign lesions and more lymph node sampling stations are risk factors for pleural effusion and lung infection, respectively. Attention should be paid to the prevention and treatment of perioperative complications for patients with such risk factors.
Abstract： Objective To evaluate the safety and efficacy of total thoracoscopic anatomic pulmonary segmentectomy for the treatment of early-stage peripheral lung carcinoma, pulmonary metastases and benign pulmonary diseases. Methods We retrospectively analyzed 20 patients who received total thoracoscopic anatomic pulmonary segmentectomy in Zhongshan Hospital of Fudan University from March 2008 to November 2011. There were ten male and ten female patients with a mean age of 58.0（14-86）years. Three ports were used. The pulmonary artery and vein of the segment were dealt with Hem-o-lok or stapler. The bronchi of the segment were dealt with staplers. Staplers were used in peripheral lung of intersegmental plane. Results All the twenty patients underwent total thoracoscopic anatomic segmentectomy successfully without any conversion to thoracoctomy or lobectomy. No perioperative morbidity or mortality occurred. Postoperative pathological examinations showed lung cancer in 10 patients, pulmonary metastases in 3 patients and benign pulmonary diseases in 7 patients. The mean operative time was 133.0（90-240）min. The mean blood loss was 85.0（50-200）ml. The chest tubes were maintained in position for 3.2 （2-7） d. The mean postoperative hospitalization time was 6.7 （4-11）d. Conclusion Total thoracoscopic anatomic pulmonary segmentectomy is a feasible and safe technique to be used selectively for Ⅰa stage lung cancer, pulmonary metastases and benign pulmonary diseases that are not appropriate for wedge resection.