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Title: [The Initial Experience of Video-assisted Thoracic Surgery Segmentectomy for Early Stage Lung Cancer].
Author: Ma S, Yan T, Wang K, Wang J, Song J, Wang T, He W, Bai J, Jin L, Liang H.
Journal: Zhongguo Fei Ai Za Zhi; 2018 Feb 20; 21(2):99-103. PubMed ID: 29526176.
Abstract:
BACKGROUND: Segmentectomy can retains more healthy lung tissue than lobectomy, but it remains controversial in oncology for early stage lung cancer. The aim of this study is to discuss the problems of video-assisted thoracic surgery (VATS) segmentectomy in early stage lung cancer, by analyzing the clinical and pathological data of 35 cases and reviewing the literature. METHODS: There were 35 patients who received segmentectomy by complete video-assisted thoracic surgery, from May 2013 to July 2017, in single operation group in the Third Hospital of Peking University. We analyzed the patient's clinical and pathological data, intraoperative and postoperative complications, lymph node number and metastasis its situation, and compared postoperative pathology and preoperative computed tomography (CT) imaging type. In 35 cases of segmentectomy, there were 11 males and 24 females, with an average age of 57.7 years old. The lesions located in the right upper lobe were 8 cases, in the right lower lobe were 8 cases, in the left upper lobe were 13 cases, in the left lower lobe were 6 cases. The mean maximum diameter of CT imaging was 12.7 mm, and the largest diameter of hilar and mediastinal lymph nodes was less than 10 mm. 23 of them were ground glass predominating and 12 were solid components predominating. RESULTS: All 35 cases were successfully completed VATS anatomical segmentectomy. The average operation time was 153 minutes, the amount of bleeding was 51 mL. There were 10 cases of air leakage after operation, all of which were not more than 3 days. There was contralateral atelectasis in 1 case, chylothorax in 1 case. The average length of hospitalization was 6.1 days. There was no other complications outpatient related to surgery, in 30 days after discharge. The pathological changes were as follow, 2 cases of metastatic tumor, 8 cases of benign lung disease and 25 cases of primary lung cancer. In the 25 cases of primary lung cancer, there were 14 cases of invasive lung adenocarcinoma (7 cases were groundglassopacity (GGO) predominating in CT imaging), 4 cases of micro-invasive adenocarcinoma (3 cases were GGO predominating in CT imaging), 6 cases of adenocarcinoma in situ (all were pure GGO in CT imaging), 1 case of lung squamous cell carcinoma (mainly composed of solid in CT imaging). An average of 7.2 lymph nodes were removed in 25 cases of lung cancer, and all lymph nodes had no metastasis. CONCLUSIONS: VATS anatomical segmentectomy is technically safe and reliable, and the indications for lung cancer need to be strictly controlled. Its advantages still need to be confirmed by prospective randomized controlled trials. 背景与目的肺段切除较肺叶切除能够更多地保留健康肺组织，但其在早期肺癌根治性方面仍存在争议。本研究分析35例完全胸腔镜下解剖性肺段切除术临床病理资料并复习文献，探讨胸腔镜下肺段切除术在早期肺癌治疗中面临的问题。方法回顾北京大学第三医院2013年5月-2017年7月单一手术组35例完全胸腔镜下肺段切除术患者的临床病理资料，观察术中及术后并发症等安全性指标及淋巴结清扫数目、转移情况，并将术后病理类型与术前影像类型比对分析。35例肺段切除术中男性11例，女性24例，平均年龄57.7岁。病灶位于右肺上叶者8例，右肺下叶者8例，左肺上叶者13例，左肺下叶者6例。计算机断层扫描（computed tomography, CT）影像学肿瘤最大径平均12.7 mm，肺门及纵隔淋巴结最大直径均小于10 mm，以磨玻璃成为主者23例，以实性成分为主者12例。结果 35例均顺利完成电视辅助胸腔镜手术（video-assisted thoracic surgery, VATS）解剖性肺段切除术，平均手术时间为153 min，出血量为51 mL。术后漏气10例，均未超过3天。健侧肺不张1例，乳糜胸1例。平均住院时间为6.1天。出院后30天内门诊复查未发生其他院外手术相关并发症。病理为转移瘤者2例，良性肺病8例，原发肺癌25例。25例原发肺癌中浸润性肺腺癌14例［CT以肺磨玻璃影（ground-glass opacity, GGO）为主者7例］，微小浸润腺癌4例（GGO为主者3例），原位腺癌6例（CT均为纯GGO），肺鳞癌1例（CT以实性成分为主）。25例肺癌平均切除淋巴结7.2枚，所有淋巴结无癌转移。结论 VATS解剖性肺段切除术技术上安全可靠，其在肺癌治疗中适应症需严格掌握，其优势仍需前瞻性随机对照实验来证实。.

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