Clinical efficacy of single-port thoracoscopic anatomical segmentectomy for stageⅠA non-small-cell lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DUAN Yuzhou ¹ , SUN Jianyong ¹ , ZHANG Nian ² , LI Yan ¹ ,  ZHENG Chunlong ¹

1. Department of Thoracic Surgery, The Second Affiliated Hospital, Air Force Military Medical University, Xi'an, 710038, P. R. China;
2. Department of Anesthesiology, The Second Affiliated Hospital, Air Force Military Medical University, Xi'an, 710038, P. R. China;

Corresponding author：

ZHENG Chunlong, Email: zmcsls@163.com

Keywords：

Non-small cell lung cancer; single-port; thoracoscopy; anatomical segmentectomy

DOI：

10.7507/1007-4848.202502070

Video：

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Objective To explore the efficacy of single-port thoracoscopic anatomical lung segmentectomy in treating Stage IA non-small-cell lung cancer (NSCLC) and to analyze its impact on the body's stress response and lung function. Methods A retrospective analysis was conducted on the clinical data of patients with stageⅠA NSCLC admitted to the Second Affiliated Hospital, Air Force Military Medical University, from January 2021 to June 2022. Patients were divided into two groups based on their treatment plans: those who underwent single-port thoracoscopic lobectomy were in the lobe group, and those who underwent single-port thoracoscopic anatomical lung segmentectomy were in the segment group. The surgical-related indicators, complication rates, survival rates of the two groups were compared, as well as the body's stress response indicators before and after surgery [C-reactive protein (CRP), interleukin-6 (IL-6), cortisol (Cor), creatine kinase (CK)], prognostic lung function indicators [forced vital capacity (FVC), maximal voluntary ventilation (MVV), forced expiratory volume in one second (FEV₁), FEV₁/FVC ratio], and auxiliary tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), CA724, cyto-keratin 21-1 fragment (CYFRA21-1)]. Results Each group included 53 patients, with 29 males and 24 females in the segment group, with an average age of (70.38±3.67) years; and 26 males and 27 females in the lobe group, averaging an age of (71.09±3.80) years. The intraoperative blood loss in the segment group was less than that in the lobe group [(118.41±14.58) mL vs. (130.36±10.61) mL, P＜0.001], and the hospital stay was shorter in the segment group [(7.13±1.14) d vs. (8.52±1.33) d, P＜0.001]. One day and three days post-surgery, the serum levels of CRP, IL-6, Cor, and CK in the segment group were lower those in the lobe group, while the levels of FVC, FEV₁, FEV₁/FVC ratio, and MVV were higher (P＜0.05). One month and three months post-surgery, the serum levels of CEA, CA125, CA724, and CYFRA21-1 in the segment group showed no statistically significant difference compared to the lobe group (P＞0.05); the incidence of postoperative complications and survival rates in the segment group were 3.77% and 80.39%, respectively, while they were 7.55% and 76.92% in the lobe group, respectively, with no statistical difference between the two groups (P＞0.05). Conclusion Single-port thoracoscopic anatomical lung segmentectomy for stage ⅠA NSCLC has significant advantages in reducing intraoperative damage, stabilizing the body's stress response, and has less impact on lung function, which is beneficial for postoperative recovery.

1.	刘刚, 汪令伟, 董林, 等. 两孔胸腔镜下肺段切除和肺叶切除治疗早期非小细胞肺癌疗效比较. 同济大学学报(医学版), 2020, 41(2): 235-239.Liu G, Wang LW, Dong L, et al. Efficacy comparison of two-port thoracoscopic segmentectomy versus lobectomy in early-stage non-small cell lung cancer. J Tongji Univ (Med Sci), 2020, 41(2): 235-239.
2.	Zheng YX, Zhang SL, Zeng TW, et al. A novel form of precise segmentectomy-triumphal arch-like anatomical segmentectomy. Thorac Cancer, 2022, 13(18): 2650-2653.
3.	Okazaki M, Suzawa K, Shien K, et al. Surgical outcome of ipsilateral anatomical resection for lung cancer after pulmonary lobectomy. Eur J Cardiothorac Surg, 2023, 63(3): ezad048.
4.	Liu GL, Dong P, Hu HF, et al. Modified 2-cm super single port vs. the traditional 3-cm single port for video-assisted thoracoscopic surgery lobectomy. Surg Today, 2021, 51(11): 1805-1812.
5.	Yang Z, Chang XJ. A 2. 5-cm single-port video-assisted thoracoscopic surgery for stageⅢtuberculous empyema: A case report. J Cardiothorac Surg, 2023, 18(1): 15.
6.	Tosi D, Nosotti M, Bonitta G, et al. Anatomical segmentectomy versus pulmonary lobectomy for stageⅠnon-small-cell lung cancer: Patients selection and outcomes from the European Society of Thoracic Surgeons database analysis. Interact Cardiovasc Thorac Surg, 2021, 32(4): 546-551.
7.	Kagimoto A, Tsutani Y, Izaki Y, et al. Initial experience of robotic anatomical segmentectomy for non-small cell lung cancer. Jpn J Clin Oncol, 2020, 50(4): 440-445.
8.	Bertolaccini L, Prisciandaro E, Bardoni C, et al. Minimally invasive anatomical segmentectomy versus lobectomy in stage ⅠA non-small cell lung cancer: A systematic review and meta-analysis. Cancers (Basel), 2022, 14(24): 6157.
9.	Wang G, Yu ZW, Li JJ, et al. Anatomical segmentectomy under uniportal video-assisted thoracoscopic surgery for early staged non-small cell lung cancer: A case report. J Thorac Dis, 2022, 14(9): 3613-3623.
10.	Postmus PE, Kerr KM, Oudkerk M, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2017, 28(suppl_4): iv1-iv21.
11.	Wang SH, Mu CC, Zhang FX, et al. Acupuncture or moxibustion adjuvant chemotherapy for advanced non-small cell lung cancer: Systematic review and network meta-analysis. Medicine (Baltimore), 2023, 102(42): e35000.
12.	Duma N, Santana-Davila R, Molina JR. Non-small cell lung cancer: Epidemiology, screening, diagnosis, and treatment. Mayo Clin Proc, 2019, 94(8): 1623-1640.
13.	刘彦军. 早期非小细胞肺癌患者经单孔全胸腔镜解剖性肺段切除术治疗疗效评价. 中国药物与临床, 2021, 21(11): 1921-1923.Liu YJ. Therapeutic evaluation of single-port thoracoscopic anatomic segmentectomy for early-stage non-small cell lung cancer. Chin J Drugs Clin, 2021, 21(11): 1921-1923.
14.	Wang J, Xu MQ, Zhang CK, et al. Clinical analysis of subxiphoid single-port thoracoscopic surgery for simultaneous bilateral lung lesion resection. BMC Surg, 2022, 22(1): 203.
15.	Bayfield NGR, Bibo L, Wang E, et al. Left upper lobe multi-segmentectomy versus lobectomy for early-stage lung cancer: A meta-analysis. Heart Lung Circ, 2023, 32(5): 596-603.
16.	Mimae T, Okada M. Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer. Gen Thorac Cardiovasc Surg, 2020, 68(7): 703-706.
17.	张五星, 喻东亮, 熊剑文, 等. 胸腔镜下肺段切除与肺叶切除治疗Ⅰ期非小细胞肺癌: 系统回顾与荟萃分析. 中华胸心血管外科杂志, 2020, 36(4): 245-253.Zhang WX, Yu DX, Xiong JW, et al. Thoracoscopic segmentectomy versus lobectomy for stage Ⅰnon-small cell lung cancer: A systematic review and meta-analysis. Chin J Thorac Cardiovasc Surg, 2020, 36(4): 245-253.
18.	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. Lancet, 2022, 399(10335): 1607-1617.
19.	Hattori A, Suzuki K, Takamochi K, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer with radiologically pure-solid appearance in Japan (JCOG0802/WJOG4607L): A post-hoc supplemental analysis of a multicentre, open-label, phase 3 trial. Lancet Respir Med, 2024, 12(2): 105-116.
20.	杨勇坡, 董小齐, 陈洁. 胸腔镜下解剖性肺段切除术治疗ⅠA期NSCLC临床疗效及远期预后影响因素分析. 实用癌症杂志, 2021, 36(6): 969-972.Yang YP, Dong XQ, Chen J. Clinical efficacy and long-term prognostic factors of thoracoscopic anatomic segmentectomy for stage ⅠA NSCLC. Pract Oncol J, 2021, 36(6): 969-972.
21.	Galanis M, Leivaditis V, Gioutsos K, et al. Segmentectomy versus lobectomy. Which factors are decisive for an optimal oncological outcome. Kardiochir Torakochirurgia Pol, 2023, 20(3): 179-186.
22.	谈海云, 姜明, 於建鹏, 等. 右美托咪定对腹腔镜下直肠癌根治术患者围术期应激反应和血循环微转移的影响. 海军医学杂志, 2021, 42(5): 592-596.Tan HY, Jiang M, Yu JP, et al. Effects of dexmedetomidine on perioperative stress response and hematogenous micrometastasis in laparoscopic radical resection of rectal cancer. J Navy Med, 2021, 42(5): 592-596.
23.	王永富, 吴远林, 解少强, 等. 电视胸腔镜解剖性肺段切除术治疗早期非小细胞肺癌疗效及对血清C-反应蛋白、白细胞介素-1β、白细胞介素-6、肿瘤坏死因子-α水平的影响分析. 临床外科杂志, 2022, 30(8): 731-734.Wang YF, Wu YL, Xie SQ, et al. Efficacy of video-assisted thoracoscopic anatomic segmentectomy in early-stage NSCLC and its impact on serum CRP, IL-1β, IL-6, and TNF-α levels. J Clin Surg, 2022, 30(8): 731-734.
24.	Liu SD, Huang HC, Zhang CF, et al. Postoperative leukocyte counts as a surrogate for surgical stress response in matched robot- and video-assisted thoracoscopic surgery cohorts of patients: A preliminary report. J Robot Surg, 2024, 18(1): 176.
25.	王孝彬, 郭一泽, 马骏. 单孔全胸腔镜下解剖性肺段切除术在早期NSCLC患者中的应用及其对肺功能指标和术后应激指标的影响. 检验医学与临床, 2024, 21(23): 3499-3503.Wang XB, Guo YZ, Ma J. Application of single-port thoracoscopic anatomic segmentectomy in early NSCLC and its effects on pulmonary function and postoperative stress markers. Lab Med Clin, 2024, 21(23): 3499-3503.
26.	Wang S, Shi Y, Chen H, et al. Pulmonary function protection by single-port thoracoscopic segmental lung resection in elderly patients with IA non-small cell lung cancer: A differential matched analysis. Medicine (Baltimore), 2023, 102(17): e33648.
27.	Wang XW, Li LJ, Huan C, et al. Uniportal video-assisted thoracic S9+10 segmentectomy using a single-direction approach is good for pulmonary function. Surgery, 2022, 172(5): 1516-1521.
28.	Kato H. Thoracoscopic anatomical segmentectomy for early-stage non-small cell lung cancer: Minimally invasive surgery involving various approaches. J Thorac Dis, 2023, 15(2): 242-245.

1. 刘刚, 汪令伟, 董林, 等. 两孔胸腔镜下肺段切除和肺叶切除治疗早期非小细胞肺癌疗效比较. 同济大学学报(医学版), 2020, 41(2): 235-239.Liu G, Wang LW, Dong L, et al. Efficacy comparison of two-port thoracoscopic segmentectomy versus lobectomy in early-stage non-small cell lung cancer. J Tongji Univ (Med Sci), 2020, 41(2): 235-239.
2. Zheng YX, Zhang SL, Zeng TW, et al. A novel form of precise segmentectomy-triumphal arch-like anatomical segmentectomy. Thorac Cancer, 2022, 13(18): 2650-2653.
3. Okazaki M, Suzawa K, Shien K, et al. Surgical outcome of ipsilateral anatomical resection for lung cancer after pulmonary lobectomy. Eur J Cardiothorac Surg, 2023, 63(3): ezad048.
4. Liu GL, Dong P, Hu HF, et al. Modified 2-cm super single port vs. the traditional 3-cm single port for video-assisted thoracoscopic surgery lobectomy. Surg Today, 2021, 51(11): 1805-1812.
5. Yang Z, Chang XJ. A 2. 5-cm single-port video-assisted thoracoscopic surgery for stageⅢtuberculous empyema: A case report. J Cardiothorac Surg, 2023, 18(1): 15.
6. Tosi D, Nosotti M, Bonitta G, et al. Anatomical segmentectomy versus pulmonary lobectomy for stageⅠnon-small-cell lung cancer: Patients selection and outcomes from the European Society of Thoracic Surgeons database analysis. Interact Cardiovasc Thorac Surg, 2021, 32(4): 546-551.
7. Kagimoto A, Tsutani Y, Izaki Y, et al. Initial experience of robotic anatomical segmentectomy for non-small cell lung cancer. Jpn J Clin Oncol, 2020, 50(4): 440-445.
8. Bertolaccini L, Prisciandaro E, Bardoni C, et al. Minimally invasive anatomical segmentectomy versus lobectomy in stage ⅠA non-small cell lung cancer: A systematic review and meta-analysis. Cancers (Basel), 2022, 14(24): 6157.
9. Wang G, Yu ZW, Li JJ, et al. Anatomical segmentectomy under uniportal video-assisted thoracoscopic surgery for early staged non-small cell lung cancer: A case report. J Thorac Dis, 2022, 14(9): 3613-3623.
10. Postmus PE, Kerr KM, Oudkerk M, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2017, 28(suppl_4): iv1-iv21.
11. Wang SH, Mu CC, Zhang FX, et al. Acupuncture or moxibustion adjuvant chemotherapy for advanced non-small cell lung cancer: Systematic review and network meta-analysis. Medicine (Baltimore), 2023, 102(42): e35000.
12. Duma N, Santana-Davila R, Molina JR. Non-small cell lung cancer: Epidemiology, screening, diagnosis, and treatment. Mayo Clin Proc, 2019, 94(8): 1623-1640.
13. 刘彦军. 早期非小细胞肺癌患者经单孔全胸腔镜解剖性肺段切除术治疗疗效评价. 中国药物与临床, 2021, 21(11): 1921-1923.Liu YJ. Therapeutic evaluation of single-port thoracoscopic anatomic segmentectomy for early-stage non-small cell lung cancer. Chin J Drugs Clin, 2021, 21(11): 1921-1923.
14. Wang J, Xu MQ, Zhang CK, et al. Clinical analysis of subxiphoid single-port thoracoscopic surgery for simultaneous bilateral lung lesion resection. BMC Surg, 2022, 22(1): 203.
15. Bayfield NGR, Bibo L, Wang E, et al. Left upper lobe multi-segmentectomy versus lobectomy for early-stage lung cancer: A meta-analysis. Heart Lung Circ, 2023, 32(5): 596-603.
16. Mimae T, Okada M. Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer. Gen Thorac Cardiovasc Surg, 2020, 68(7): 703-706.
17. 张五星, 喻东亮, 熊剑文, 等. 胸腔镜下肺段切除与肺叶切除治疗Ⅰ期非小细胞肺癌: 系统回顾与荟萃分析. 中华胸心血管外科杂志, 2020, 36(4): 245-253.Zhang WX, Yu DX, Xiong JW, et al. Thoracoscopic segmentectomy versus lobectomy for stage Ⅰnon-small cell lung cancer: A systematic review and meta-analysis. Chin J Thorac Cardiovasc Surg, 2020, 36(4): 245-253.
18. 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. Lancet, 2022, 399(10335): 1607-1617.
19. Hattori A, Suzuki K, Takamochi K, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer with radiologically pure-solid appearance in Japan (JCOG0802/WJOG4607L): A post-hoc supplemental analysis of a multicentre, open-label, phase 3 trial. Lancet Respir Med, 2024, 12(2): 105-116.
20. 杨勇坡, 董小齐, 陈洁. 胸腔镜下解剖性肺段切除术治疗ⅠA期NSCLC临床疗效及远期预后影响因素分析. 实用癌症杂志, 2021, 36(6): 969-972.Yang YP, Dong XQ, Chen J. Clinical efficacy and long-term prognostic factors of thoracoscopic anatomic segmentectomy for stage ⅠA NSCLC. Pract Oncol J, 2021, 36(6): 969-972.
21. Galanis M, Leivaditis V, Gioutsos K, et al. Segmentectomy versus lobectomy. Which factors are decisive for an optimal oncological outcome. Kardiochir Torakochirurgia Pol, 2023, 20(3): 179-186.
22. 谈海云, 姜明, 於建鹏, 等. 右美托咪定对腹腔镜下直肠癌根治术患者围术期应激反应和血循环微转移的影响. 海军医学杂志, 2021, 42(5): 592-596.Tan HY, Jiang M, Yu JP, et al. Effects of dexmedetomidine on perioperative stress response and hematogenous micrometastasis in laparoscopic radical resection of rectal cancer. J Navy Med, 2021, 42(5): 592-596.
23. 王永富, 吴远林, 解少强, 等. 电视胸腔镜解剖性肺段切除术治疗早期非小细胞肺癌疗效及对血清C-反应蛋白、白细胞介素-1β、白细胞介素-6、肿瘤坏死因子-α水平的影响分析. 临床外科杂志, 2022, 30(8): 731-734.Wang YF, Wu YL, Xie SQ, et al. Efficacy of video-assisted thoracoscopic anatomic segmentectomy in early-stage NSCLC and its impact on serum CRP, IL-1β, IL-6, and TNF-α levels. J Clin Surg, 2022, 30(8): 731-734.
24. Liu SD, Huang HC, Zhang CF, et al. Postoperative leukocyte counts as a surrogate for surgical stress response in matched robot- and video-assisted thoracoscopic surgery cohorts of patients: A preliminary report. J Robot Surg, 2024, 18(1): 176.
25. 王孝彬, 郭一泽, 马骏. 单孔全胸腔镜下解剖性肺段切除术在早期NSCLC患者中的应用及其对肺功能指标和术后应激指标的影响. 检验医学与临床, 2024, 21(23): 3499-3503.Wang XB, Guo YZ, Ma J. Application of single-port thoracoscopic anatomic segmentectomy in early NSCLC and its effects on pulmonary function and postoperative stress markers. Lab Med Clin, 2024, 21(23): 3499-3503.
26. Wang S, Shi Y, Chen H, et al. Pulmonary function protection by single-port thoracoscopic segmental lung resection in elderly patients with IA non-small cell lung cancer: A differential matched analysis. Medicine (Baltimore), 2023, 102(17): e33648.
27. Wang XW, Li LJ, Huan C, et al. Uniportal video-assisted thoracic S9+10 segmentectomy using a single-direction approach is good for pulmonary function. Surgery, 2022, 172(5): 1516-1521.
28. Kato H. Thoracoscopic anatomical segmentectomy for early-stage non-small cell lung cancer: Minimally invasive surgery involving various approaches. J Thorac Dis, 2023, 15(2): 242-245.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesClinical efficacy of single-port thoracoscopic anatomical segmentectomy for stageⅠA non-small-cell lung cancer

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