ObjectiveTo investigate the clinical value of 3D CT combined with CT-guided Hookwire for localizing small pulmonary nodules in thoracoscopic pulmonary segmentectomy.MethodsFrom December 2017 to February 2019, 39 patients received thoracoscopic pulmonary segmentectomy in our hospital, including 14 males and 25 females with a mean age of 51.33±11.17 years. Before operation, we used Mimics Medical 20.0 to re-establish the anatomy of lung and locate the small pulmonary nodules with Hookwire guided by CT. Based on the position of Hookwire needle, 3D CT images and simulated surgical methods, thoracoscopic pulmonary segmentectomy was performed accurately.ResultsThe surgery was successfully completed in 39 patients without a transfer to open procedure. The mean operation time, mean intraoperative blood loss, mean postoperative hospital stay, mean thoracic tube drainage time were 148.97±28.56 min, 27.95±17.57 mL, 6.95±1.68 d, 4.21±1.95 d, respectively. Postoperative complications occurred in 5 patients (12.82%), including atrial fibrillation in 1, pulmonary infection in 1, chylothorax in 1, intrathoracic hemorrhage in 1 and pneumothorax in 1. All actual surgical margins were larger than 3.0 cm.ConclusionThe application of preoperative 3D CT combined with CT-guided Hookwire to localize small pulmonary nodules is helpful for accurate anatomical segmental resection of the lung, making the operation safe .
ObjectiveTo analyze the application effects of artificial intelligence (AI) software and Mimics software in preoperative three-dimensional (3D) reconstruction for thoracoscopic anatomical pulmonary segmentectomy. MethodsA retrospective analysis was conducted on patients who underwent thoracoscopic pulmonary segmentectomy at the Second People's Hospital of Huai'an from October 2019 to March 2024. Patients who underwent AI 3D reconstruction were included in the AI group, those who underwent Mimics 3D reconstruction were included in the Mimics group, and those who did not undergo 3D reconstruction were included in the control group. Perioperative related indicators of each group were compared. ResultsA total of 168 patients were included, including 73 males and 95 females, aged 25-81 (61.61±10.55) years. There were 79 patients in the AI group, 53 patients in the Mimics group, and 36 patients in the control group. There were no statistical differences in gender, age, smoking history, nodule size, number of lymph node dissection groups, postoperative pathological results, or postoperative complications among the three groups (P>0.05). There were statistical differences in operation time (P<0.001), extubation time (P<0.001), drainage volume (P<0.001), bleeding volume (P<0.001), and postoperative hospital stay (P=0.001) among the three groups. There were no statistical differences in operation time, extubation time, bleeding volume, or postoperative hospital stay between the AI group and the Mimics group (P>0.05). There was no statistical difference in drainage volume between the AI group and the control group (P=0.494), while there were statistical differences in operation time, drainage tube retention time, bleeding volume, and postoperative hospital stay (P<0.05). ConclusionFor patients requiring thoracoscopic anatomical pulmonary segmentectomy, preoperative 3D reconstruction and preoperative planning based on 3D images can shorten the operation time, postoperative extubation time and hospital stay, and reduce intraoperative bleeding and postoperative drainage volume compared with reading CT images only. The use of AI software for 3D reconstruction is not inferior to Mimics manual 3D reconstruction in terms of surgical guidance and postoperative recovery, which can reduce the workload of clinicians and is worth promoting.
Objective To evaluate the survival outcomes of segmentectomy versus lobectomy for T1c non-small cell lung cancer (NSCLC). Methods We searched PubMed, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), CNKI (China National Knowledge Infrastructure), and Wanfang Data, with the search time limit set from the inception of the databases to February 2024. Three researchers independently screened the literature, extracted relevant information, and evaluated the risk of bias of the included literature according to the Newcastle-Ottawa Scale (NOS). Meta-analysis was conducted using STATA 15.1. Results A total of 8 retrospective cohort studies were included, involving 7 433 patients. The NOS scores of the included studies were all ≥7 points. Patients who underwent lobectomy had significantly higher five-year overall survival (OS) rates compared to those who underwent segmentectomy (adjusted HR=1.11, 95%CI 0.99-1.24, P=0.042). Compared with lobectomy, segmentectomy showed no significant difference in adjusted three-year OS rate (adjusted HR=0.88, 95%CI 0.62-1.24) and adjusted five-year lung cancer-specific survival (adjusted HR=1.10, 95%CI 0.80-1.51, P=0.556) of patients with T1c NSCLC. Moreover, there were no differences in the five-year adjusted relapse-free survival (adjusted HR=1.23, 95%CI 0.82-1.85, P=0.319), and adverse events (OR=0.57, 95%CI 0.37-0.90, P=0.015) in the segmentectomy group were significantly less than those in the lobectomy group. Subgroup analysis based on whether patients received neoadjuvant therapy showed that among studies that excluded patients who received neoadjuvant therapy, no significant difference in 5-year adjusted OS rate was observed between the segmentectomy group and lobectomy group (adjusted HR=1.02, 95%CI 0.81-1.28, P=0.870). Conclusion Segmentectomy and lobectomy show no significant difference in long-term survival in stage T1c NSCLC patients, with segmentectomy associated with fewer postoperative complications. Further high-quality research is needed to confirm the comparative efficacy and safety of lobectomy and segmentectomy for T1c NSCLC patients.
Four hundred and eighty two paients suffering from intrahepatic bile duct stone undergoing lobectomy and segmental resection (from 1975 to 1994,9) has reported. 63% of the patient in this group underwent 1-5 operations, including different types of biliary-intestinal anastomosis (21.6%). 482 cases underwent different types of hepatectomy, including left lateral-lobetomy 321 cases (66.6%),left hemihepatectomy 80 cases(16.6%), right hemihepatectomy 19 cases (3.9%), and multiple segmental resections 39 cases (8.1%, including Ⅴ+Ⅷ 11 cases, Ⅵ+Ⅶ 28 cases). Other type hepatectomy combined with guadrate lobectomy 20 cases (4.1%). Postoperative complication rate was 10.2%, including diliary fistula. hemobilia and subdiaphragmatic and resectional surface infectioin, 85% of the patients were followed up with an excellent result of 88%. The authors emphsize that hepatic lobectomy nad segmental resection is the core of treatment and selection of operative methods depends on clinical-patholigic types of the disease.
Lobectomy is the standard surgical procedure of non-small cell lung cancer (NSCLC). Based on parenchymal-sparing advantage, better postoperative lung function, rapid recovery and less invasiveness, segmentectomy has been widely used in early peripheral non-small cell carcinoma in recent years. But there was no randomized clinical trials confirming survival benefit of segmentectomy. Led by Asamura, the Japanese Clinical Oncology Group (JCOG) has conducted a series of studies on this topic. Ever since the presentation at the 101st Annual Meeting of the American Society of Thoracic Surgeons (AATS) in 2021, the results of JCOG0802/WJOG4607l have triggered massive debate. This study was aimed at determining whether segmentectomy was non-inferior to lobectomy in overall survival in patients with early peripheral NSCLC (tumor diameter≤2 cm and consolidation tumor ratio>0.5), and the results were published in The Lancet on 22 April 2022. The 5-year overall survival rate was higher in the segmentectomy group than that in the lobectomy group, despite a higher rate of local recurrence, suggesting that segmentectomy should be the standard surgical procedure for those patients. Results of this study provide high-level evidence-based medicine evidence for the safety and effectiveness of segmentectomy, and are expected to promote the application of segmentectomy in those patients or even more other patient populations. However, due to the increased local recurrence rate and unsatisfactory postoperative lung function, there are still problems to be solved to make segmentectomy a standard surgical procedure. This paper interprets this study, discusses its instructiveness in clinical practice and summarizes its limitations.
ObjectiveTo investigate the safety and efficiency of robotic lung segmentectomy.MethodsThe clinical data of 110 patients receiving robotic or thoracoscopic segmentectomy in our hospital between June 2015 and June 2019 were retrospectively analyzed. The patients were divided into a robotic group [n=50, 13 males and 37 females aged 53.0 (46.0, 60.0) years] and a thoracoscopic group [n=60, 21 males and 39 females aged 61.0 (53.0, 67.0) years]. A propensity score-matched analysis was adopted to compare the perioperative data between the two groups.ResultsAfter the propensity score-matched analysis, 34 patients were included in each group. In comparison with the thoracoscopic group, patients in the robotic group had less blood loss [40.0 (20.0, 50.0) mL vs. 60.0 (40.0, 80.0) mL, P<0.001], more stations of lymph node dissection [7.0 (6.0, 8.0) vs. 4.0 (3.0, 6.0), P<0.001], larger number of lymph node dissection [15.0 (11.0, 21.0) vs. 10.0 (6.0, 14.0), P=0.002], and a higher total cost of hospitalization [97.0 (92.0, 103.0) thousand yuan vs. 54.0 (42.0, 59.0) thousand yuan, P<0.001].ConclusionIn contrast with the thoracoscopic segmentectomy, robotic segmentectomy has a similar operative safety, but less blood loss and a thorough lymphadenectomy.
ObjectiveTo compare the perioperative outcomes between robot-assisted complex segmentectomy and simple segmentectomy for stage ⅠA non-small cell lung cancer (NSCLC). MethodsThe clinical data of 285 patients with NSCLC undergoing robot-assisted thoracic surgery (RATS) in our hospital from January 2015 to August 2021 were retrospectively analyzed. There were 105 males and 180 females aged 23-83 years. The patients were divided into a complex segmentectomy group (n=170) and a simple segmentectomy group (n=115) according to tumor location and surgical method. The clinical pathological baseline characteristics and perioperative outcomes between the two groups were compared, including operative time, blood loss volume, dissected lymph nodes, conversion rate, postoperative duration of drainage, postoperative hospital stay, the incidence of persistent air leakage and postoperative 30 d mortality. ResultsThere was no statistical difference in baseline data between the two groups (P>0.05). No postoperative 30 d death was observed. One patient in the complex segmentectomy group was transferred to thoracotomy. No statistical difference was observed between the two groups in the operative time (97.36±38.16 min vs. 94.65±31.67 min, P=0.515), postoperative duration of drainage (3.69±1.85 d vs. 3.60±1.90 d, P=0.679), postoperative hospital stay (4.07±1.85 d vs. 4.05±1.97 d, P=0.957), dissected lymph nodes (5.15±3.53 vs. 5.13±2.93, P=0.952), incidence of blood loss volume<100 mL (98.2% vs. 99.1%, P=0.650), and incidence of postoperative persistent air leakage (6.5% vs. 5.2%, P=0.661). ConclusionThe safety and effectiveness of robot-assisted complex segmentectomy and simple segmentectomy are satisfactory in the treatment of stage ⅠA NSCLC. The perioperative results of RATS complex segmentectomy and simple segmentectomy are similar.
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.
The incidence and mortality of lung cancer are increasing globally. With the spread of CT, more and more early-stage lung cancer can be detected and treated in a timely manner. As the main treatment of lung cancer, thoracoscopic anatomical segmentectomy in the treatment of non-small cell lung cancer is causing concern to the thoracic surgeons. Here, we will discuss the application of thoracoscopic anatomical segmentectomy in the treatment of early non-small cell lung cancer.
ObjectiveTo summarize the clinical experience of thoracoscopic combined subsegmentectomy (CSS). MethodsThe clinical data of 76 patients who underwent thoracoscopic CSS in Anqing Municipal Hospital from May 2018 to July 2022 were retrospectively analyzed, including 22 males and 54 females, aged 27.0-76.0 (54.3±10.5) years. All patients underwent preoperative three-dimensional computed tomography bronchography and angiography using dual source CT. The modified inflation-deflation technique or indocyanine green was used to identify the intersubsegmental border. ResultsA total of 86 pulmonary nodules were resected in 76 patients. One patient of left upper lobe S1+2c+S4a, 1 patient of right upper lobe S2b+S3a and 1 patient of right upper lobe S1b+S3b were further performed lobectomy due to insufficient margin. One patient of left upper lobe S1+2+S3a was further performed left upper division segmentectomy due to residual atelectasis. One patient of left upper lobe S1+2c+S3a was further performed left upper division segmentectomy due to B3b+c injury, and the rest completed planned surgeries successfully. The operative time was 90.0-350.0 (174.9±53.2) min. The operative hemorrhage volume was 50.0 (20.0, 50.0) mL. The postoperative hospital stay time was 6.0 (5.0, 7.0) d. Postoperative complications included pulmonary infection in 9 patients, hemoptysis in 3 patients, persistent pulmonary leakage>3 d in 4 patients, pneumothorax in 1 patient, pleural effusion in 1 patient, and myocardial infarction in 1 patient. All of the patients were cured and discharged without perioperative death. ConclusionThoracoscopic CSS is relatively complex. Preoperative planning under three-dimensional reconstruction and intraoperative fine operation are helpful for safe completion.