A single-center retrospective analysis of surgical strategy and clinical outcome of pulmonary nodules using pulmonary subsegments as anatomical unit_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANG Jingjing ¹ , CHEN Zhipeng ¹ , BIAN Chengyu ¹ , WU Weibing ¹ , ZHU Quan ¹ , YUAN Mei ² , CHEN Liang ¹ ,  WANG Jun ¹

1. Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, P.R.China;
2. Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, P.R.China;

Corresponding author：

WANG Jun, Email: drwangjun@njmu.edu.cn

Keywords：

Pulmonary nodule; depth ratio; sublobar resection; pulmonary subsegment; surgery

DOI：

10.7507/1007-4848.202106093

Video：

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Objective To analyze the results and rationality of the lesion-focused strategy with subsegment as the pulmonary anatomical unit for pulmonary nodules with a diameter of ≤2 cm which require surgery. Methods Clinical data of 246 patients with pulmonary nodules who underwent surgery in the Department of Thoracic Surgery of The First Affiliated Hospital of Nanjing Medical University from January 2017 to October 2018 were retrospectively analyzed, including 76 males and 170 females, with an average age of 53.30±11.82 years. The patients were divided into four groups, a single segmentectomy group, a segmentectomy combined with adjacent subsegmentectomy group, a single subsegmentectomy group and a combined subsegmentectomy group, according to the different surgical approaches, to compare preoperative, intraoperative, and postoperative related data. Results There was no perioperative death. Among the four groups, there was no statistical difference in gender (P=0.163), age (P=0.691), diameter of the nodule (P=0.743), longitudinal position of the nodule (depth ratio, P=0.831), postoperative pulmonary leakage (P=0.752), intraoperative blood loss (P=0.135), pathological type (P=0.951) or TNM stage (P=0.995); there were statistical differences in transverse position of the nodule (P<0.001) and number of subsegments involved (P<0.001). The results of multivariate logistic regression analysis showed that compared with combined subsegmentectomy, the odds ratio (OR) of the lung nodule in segmentectomy combined with adjacent subsegmentectomy as intersegment nodules was 5.759 (95%CI 1.162 to 28.539, P=0.032).Conclusion The surgical strategy of lesion focused and subsegment as anatomical unit is safe and feasible for surgical treatment of pulmonary nodules with diameter ≤2 cm. The transverse position of the nodules is an important factor affecting the choice of surgical method for the middle and lateral nodules with a diameter of ≤2 cm, and the longitudinal location of the nodule is not an influencing factor. For nodules in inner zone, the diameter also is one of the factors influencing the choice of surgical method.

Citation： HUANG Jingjing, CHEN Zhipeng, BIAN Chengyu, WU Weibing, ZHU Quan, YUAN Mei, CHEN Liang, WANG Jun. A single-center retrospective analysis of surgical strategy and clinical outcome of pulmonary nodules using pulmonary subsegments as anatomical unit. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(1): 36-43. doi: 10.7507/1007-4848.202106093 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	邱斌, 冀瑛, 白广宇, 等. 解剖性部分肺叶切除术治疗早期肺癌: 实践与发展. 中华胸部外科电子杂志, 2020, 7(4): 240-246.
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5.	吴卫兵, 夏阳, 许晶, 等. 3D导航胸腔镜联合肺亚段切除术治疗肺段间结节的对比研究. 南京医科大学学报(自然科学版), 2018, 38(10): 1424-1427.
6.	Boyden EA. The intrahilar and related segmental anatomy of the lung. Surgery, 1945, 18: 706-731.
7.	Wang J, Xu X, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
8.	吴卫兵, 朱全, 闻伟, 等. 应用改良膨胀萎陷法行胸腔镜锥式肺段切除术146例. 中华胸心血管外科杂志, 2017, 33(9): 517-521.
9.	Wang J, Xu X, Wen W, et al. Technique for tailoring complex demarcation in lung segmentectomy. Thorac Cancer, 2018, 9(11): 1562-1564.
10.	周清华, 范亚光, 王颖, 等. 中国肺癌低剂量螺旋CT筛查指南(2018年版). 中国肺癌杂志, 2018, 21(2): 67-75.
11.	Raman V, Jawitz OK, Voigt SL, et al. The effect of tumor size and histologic findings on outcomes after segmentectomy vs lobectomy for clinically node-negative non-small cell lung cancer. Chest, 2021, 159(1): 390-400.
12.	Zhang Y, Fu F, Chen H. Management of ground-glass opacities in the lung cancer spectrum. Ann Thorac Surg, 2020, 110(6): 1796-1804.
13.	Kim YW, Lee CT. Optimal management of pulmonary ground-glass opacity nodules. Transl Lung Cancer Res, 2019, 8(Suppl 4): S418-S424.
14.	Ye T, Deng L, Wang S, et al. Lung adenocarcinomas manifesting as radiological part-solid nodules define a special clinical subtype. J Thorac Oncol, 2019, 14(4): 617-627.
15.	Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer: A multicenter study. J Thorac Cardiovasc Surg, 2006, 132(4): 769-775.
16.	Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage ⅠA lung adenocarcinoma: Propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
17.	姜格宁, 陈昶, 朱余明, 等. 上海市肺科医院磨玻璃结节早期肺腺癌的诊疗共识(第一版). 中国肺癌杂志, 2018, 21(3): 147-159.
18.	Horinouchi H, Nomori H, Nakayama T, et al. How many pathological T1N0M0 non-small cell lung cancers can be completely resected in one segment? Special reference to high-resolution computed tomography findings. Surg Today, 2011, 41(8): 1062-1066.
19.	Yoshimoto K, Nomori H, Mori T, et al. Combined subsegmentectomy: Postoperative pulmonary function compared to multiple segmental resection. J Cardiothorac Surg, 2011, 6: 17.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 邱斌, 冀瑛, 白广宇, 等. 解剖性部分肺叶切除术治疗早期肺癌: 实践与发展. 中华胸部外科电子杂志, 2020, 7(4): 240-246.
3. NCCN clinical practice guidelines in oncology: Non-small cell lung cancer (version 1.2020). https://www.nccn.org/.
4. 李响, 朱燚宁, 吴卫兵, 等. 肺结节三维空间位置判定方法及临床意义. 中国胸心血管外科临床杂志, 2021, 28(3): 305-310.
5. 吴卫兵, 夏阳, 许晶, 等. 3D导航胸腔镜联合肺亚段切除术治疗肺段间结节的对比研究. 南京医科大学学报(自然科学版), 2018, 38(10): 1424-1427.
6. Boyden EA. The intrahilar and related segmental anatomy of the lung. Surgery, 1945, 18: 706-731.
7. Wang J, Xu X, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
8. 吴卫兵, 朱全, 闻伟, 等. 应用改良膨胀萎陷法行胸腔镜锥式肺段切除术146例. 中华胸心血管外科杂志, 2017, 33(9): 517-521.
9. Wang J, Xu X, Wen W, et al. Technique for tailoring complex demarcation in lung segmentectomy. Thorac Cancer, 2018, 9(11): 1562-1564.
10. 周清华, 范亚光, 王颖, 等. 中国肺癌低剂量螺旋CT筛查指南(2018年版). 中国肺癌杂志, 2018, 21(2): 67-75.
11. Raman V, Jawitz OK, Voigt SL, et al. The effect of tumor size and histologic findings on outcomes after segmentectomy vs lobectomy for clinically node-negative non-small cell lung cancer. Chest, 2021, 159(1): 390-400.
12. Zhang Y, Fu F, Chen H. Management of ground-glass opacities in the lung cancer spectrum. Ann Thorac Surg, 2020, 110(6): 1796-1804.
13. Kim YW, Lee CT. Optimal management of pulmonary ground-glass opacity nodules. Transl Lung Cancer Res, 2019, 8(Suppl 4): S418-S424.
14. Ye T, Deng L, Wang S, et al. Lung adenocarcinomas manifesting as radiological part-solid nodules define a special clinical subtype. J Thorac Oncol, 2019, 14(4): 617-627.
15. Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer: A multicenter study. J Thorac Cardiovasc Surg, 2006, 132(4): 769-775.
16. Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage ⅠA lung adenocarcinoma: Propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
17. 姜格宁, 陈昶, 朱余明, 等. 上海市肺科医院磨玻璃结节早期肺腺癌的诊疗共识(第一版). 中国肺癌杂志, 2018, 21(3): 147-159.
18. Horinouchi H, Nomori H, Nakayama T, et al. How many pathological T1N0M0 non-small cell lung cancers can be completely resected in one segment? Special reference to high-resolution computed tomography findings. Surg Today, 2011, 41(8): 1062-1066.
19. Yoshimoto K, Nomori H, Mori T, et al. Combined subsegmentectomy: Postoperative pulmonary function compared to multiple segmental resection. J Cardiothorac Surg, 2011, 6: 17.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

A single-center retrospective analysis of surgical strategy and clinical outcome of pulmonary nodules using pulmonary subsegments as anatomical unit

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