Abstract： The principles of 2010 National Comprehensive Cancer Network（NCCN） clinical practice guidelines in non-small cell lung cancer address that anatomic pulmonary resection is preferred for the majority of patients with non-small cell lung cancer and video-assisted thoracic surgery (VATS) is a reasonable and acceptable approach for patients with no anatomic or surgical contraindications. By reviewing the literatures on general treatment, pulmonary segmentectomy, pulmonary function reserve, and the anatomic issue of early stage non-small cell lung cancer surgery, the feasibility and reliability of thoracoscopic pulmonary segmentectomy are showed.
ObjectiveTo explore the safety and short-term efficacy of uniportal and three-port video-assisted thoracoscopic surgery (VATS) anatomical segmentectomy for pulmonary nodules. MethodsThe clinical data of 225 patients with consecutive VATS anatomic segmentectomy by the same surgeon in Xuzhou Central Hospital between December 2019 and February 2022 was retrospectively reviewed. There were 85 males and 140 females with an average age of 57.3±11.6 years. These patients were divided into an uniportal VATS group (128 patients) and a three-port VATS group (97 patients) according to the surgical procedures. Single-direction anatomical procedure was utilized in the uniportal VATS group. The operation time, blood loss during the surgery, number of dissected lymph nodes, duration and volume of chest drainage, incidence of complications, and postoperative hospital stay of the two groups were compared. ResultsThere was no conversion to thoracotomy, addition of surgical ports, or mortality in this cohort, with tumor-negative surgical margins. The postoperative pathological staining confirmed 2 (0.9%) patients of lymph node metastasis (pN1) and 4 (1.8%) patients of adenocarcinoma with micropapillary component. As compared with the three-port VATS group, patients in the uniportal VATS group had shorter operation time (115.6±54.7 min vs. 141.5±62.8 min, P=0.001), less intraoperative blood loss (77.2±49.6 mL vs. 96.9±98.1 mL, P=0.050), less total thoracic drainage [394.0 (258.8, 580.0) mL vs. 530.0 (335.0, 817.5) mL, P=0.010], and shorter postoperative hospital stay (7.7±3.7 d vs. 8.7±3.5 d, P=0.031). Both groups showed similar stations and numbers of dissected lymph nodes, incidence of operation-related complications, duration of chest tube drainage, and the drainage volume in the first and second postoperative days (P>0.05). No tumor recurrence or metastasis was recorded in this cohort during the follow-up of 11 (1-26) months. ConclusionSingle-direction uniportal VATS anatomical segmentectomy is safe and feasible for the treatment of pulmonary nodules, with better short-term efficacy as compared with the three-port VATS procedure, including shorter operation time, less intraoperative blood loss and thoracic drainage. However, further studies are needed to elucidate the precise indications of segmentectomy for lung cancer.
ObjectiveTo investigate the application effect of digital chest drainage system in patients with air leak after lung resection and evaluate its efficacy and safety. MethodsClinical data of patients who underwent lung resection and received closed thoracic drainage postoperatively in the Department of Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2024 to November 2025 were collected. Patients with air leak graded Ⅰ to Ⅲ were divided into an experimental group (digital chest drainage system) and a control group (traditional closed thoracic drainage) according to different drainage devices used. Baseline characteristics and perioperative data were retrospectively analyzed and compared between the two groups. ResultsA total of 170 patients were included, with 81 in the experimental group (59 males, 22 females; median age 68 years) and 89 in the control group (60 males, 29 females; median age 68 years). There were no statistically significant differences between the two groups in terms of age, gender, body mass index, surgical type, pleural adhesions, surgical site, lesion nature, comorbidities, smoking index, or air leak grade (P>0.05). The experimental group had significantly less median total drainage volume [490 (883) mL vs. 740 (958) mL, P=0.023], shorter air leak duration [5 (2) d vs. 5 (4) d, P=0.005] and postoperative hospital stay [5 (1) d vs. 6 (4) d, P=0.029]. However, there were no statistically significant differences in hospitalization costs or drainage volume within the first 7 postoperative days between the two groups (P>0.05). The incidence of subcutaneous emphysema was significantly lower in the experimental group (27.16% vs. 41.57%, P=0.049). No significant differences were found between the groups in the incidence of pulmonary infection, atelectasis, pleural effusion, skin incision issues, secondary tube placement, or pain scores (P>0.05). Subgroup analysis revealed that for patients with grade Ⅰ air leak, the experimental group showed shorter air leak duration [5 (2) d vs. 5 (5) d, P=0.006] and postoperative hospital stay [5 (2) d vs. 6 (4) d, P=0.010] compared to the control group, with no significant difference in total drainage volume (P=0.055). For patients with grade Ⅱ air leak, there were no significant differences in total drainage volume, air leak duration, or postoperative hospital stay between the two groups (P>0.05). For patients undergoing wedge resection, the experimental group had less total drainage volume [289 (707) mL vs. 880 (1074) mL, P=0.035] compared to the control group, while no significant differences were found in air leak duration or postoperative hospital stay (P>0.05). For patients undergoing segmentectomy, there were no significant differences in total drainage volume, air leak duration, or postoperative hospital stay between the two groups (P>0.05). For patients undergoing lobectomy, the experimental group had shorter air leak duration [5 (2) d vs. 6 (4) d, P=0.029] compared to the control group, while no significant differences were found in total drainage volume or postoperative hospital stay (P>0.05). ConclusionCompared with traditional closed thoracic drainage, the digital chest drainage system effectively shortens the duration of postoperative air leak and hospital stay, reduces total drainage volume, and lowers the incidence of subcutaneous emphysema without increasing total hospitalization costs. It is a safe and effective drainage method for pulmonary resection patients, particularly those with grade Ⅰ air leak following lobectomy.