Research progress of anatomical segmentectomy in the treatment of early non-small cell lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SUN Zhuochen ,  HUANG Yunchao , ZHAO Guangqiang , LI Xuancheng , LI Shouzhuo , SUO Yuandong , MENG Di

The First Department of Thoracic Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650100, P. R. China;

Corresponding author：

HUANG Yunchao, Email: huangych2001@aliyun.com

Keywords：

Pulmonary nodules; early lung cancer; anatomical segmentectomy; intersegmental plane; review

DOI：

10.7507/1007-4848.202203040

Video：

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Lung cancer, as one of the malignant tumors with the fastest increasing morbidity and mortality in the world, has a serious impact on people's health. With the continuous advancement of medical technology, more and more medical methods are applied to lung cancer screening, which has gradually increased the detection rate of early lung cancer. At present, the standard operation for the treatment of early non-small cell lung cancer (NSCLC) is still lobectomy and mediastinal lymph node dissection. There is a growing trend to use segmentectomy for the treatment of early stage lung cancer. Anatomical segmentectomy not only removes the lesions to the maximum extent, but also preserves the lung function to the greatest extent, and its advantages are also obvious. This article reviews the progress of anatomical segmentectomy in the treatment of early NSCLC.

Citation： SUN Zhuochen, HUANG Yunchao, ZHAO Guangqiang, LI Xuancheng, LI Shouzhuo, SUO Yuandong, MENG Di. Research progress of anatomical segmentectomy in the treatment of early non-small cell lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(10): 1384-1389. doi: 10.7507/1007-4848.202203040 Copy

1.	Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016. J Nat Canc Cent, 2022, 2(1): 1-9.
2.	Zeng W, Zhang W, Zhang J, et al. Systematic review and meta-analysis of video-assisted thoracoscopic surgery segmentectomy versus lobectomy for stage Ⅰ non-small cell lung cancer. World J Surg Oncol, 2020, 18(1): 44.
3.	Schrank Z, Chhabra G, Lin L, et al. Current molecular-targeted therapies in NSCLC and their mechanism of resistance. Cancers (Basel), 2018, 10(7): 224.
4.	Suzuki H, Morimoto J, Mizobuchi T, et al. Does segmentectomy really preserve the pulmonary function better than lobectomy for patients with early-stage lung cancer? Surg Today, 2017, 47(4): 463-469.
5.	Davidson DD, Cheng L. Perspectives of lung cancer control and molecular prevention. Future Oncol, 2019, 15(31): 3527-3530.
6.	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.
7.	Veronesi G, Baldwin DR, Henschke CI, et al. Recommendations for implementing lung cancer screening with low-dose computed tomography in Europe. Cancers (Basel), 2020, 12(6): 1672.
8.	Ardila D, Kiraly AP, Bharadwaj S, et al. End-to-end lung cancer screening with three-dimensional deep learning on low-dose chest computed tomography. Nat Med, 2019, 25(6): 954-961.
9.	蔡雅倩, 张正华, 韩丹, 等. AI对肺磨玻璃结节筛查及定性的临床应用研究. 放射学实践, 2019, 34(9): 958-962.
10.	Chabon JJ, Hamilton EG, Kurtz DM, et al. Integrating genomic features for non-invasive early lung cancer detection. Nature, 2020, 580(7802): 245-251.
11.	Kiranantawat N, McDermott S, Petranovic M, et al. Determining malignancy in CT guided fine needle aspirate biopsy of subsolid lung nodules: Is core biopsy necessary? Eur J Radiol Open, 2019, 6: 175-181.
12.	Lemieux S, Kim T, Pothier-Piccinin O, et al. Ultrasound-guided transthoracic needle biopsy of the lung: sensitivity and safety variables. Eur Radiol, 2021, 31(11): 8272-8281.
13.	Folch EE, Pritchett MA, Nead MA, et al. Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: One-year results of the prospective, multicenter NAVIGATE study. J Thorac Oncol, 2019, 14(3): 445-458.
14.	McGuire AL, Myers R, Grant K, et al. The diagnostic accuracy and sensitivity for malignancy of radial-endobronchial ultrasound and electromagnetic navigation bronchoscopy for sampling of peripheral pulmonary lesions: Systematic review and meta-analysis. J Bronchology Interv Pulmonol, 2020, 27(2): 106-121.
15.	MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
16.	Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
17.	Travis WD, Asamura H, Bankier AA, et al. The IASLC lung cancer staging project: Proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol, 2016, 11(8): 1204-1223.
18.	Shi Y, Wu S, Ma S, et al. Comparison between wedge resection and lobectomy/segmentectomy for early-stage non-small cell lung cancer: A Bayesian meta-analysis and systematic review. Ann Surg Oncol, 2022, 29(3): 1868-1879.
19.	Tosi D, Nosotti M, Bonitta G, et al. Anatomical segmentectomy versus pulmonary lobectomy for stageⅠ non-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.
20.	Sugi K, Kobayashi S, Sudou M, et al. Long-term prognosis of video-assisted limited surgery for early lung cancer. Eur J Cardiothorac Surg, 2010, 37(2): 456-460.
21.	Bedetti B, Bertolaccini L, Rocco R, et al. Segmentectomy versus lobectomy for stageⅠ non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2017, 9(6): 1615-1623.
22.	Broderick SR. Adjuvant and neoadjuvant immunotherapy in non-small cell lung cancer. Thorac Surg Clin, 2020, 30(2): 215-220.
23.	王瑞, 姚烽, 陈春基, 等. 《中华医学会肺癌临床诊疗指南(2019版)》外科治疗解读. 中国胸心血管外科临床杂志, 2020, 27(11): 1265-1268.
24.	Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.
25.	Aokage K, Saji H, Suzuki K, et al. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211). Gen Thorac Cardiovasc Surg, 2017, 65(5): 267-272.
26.	Kohman LJ, Gu L, Altorki N, et al. Biopsy first: Lessons learned from Cancer and Leukemia Group B (CALGB) 140503. J Thorac Cardiovasc Surg, 2017, 153(6): 1592-1597.
27.	Koike T, Nakamura A, Shimizu Y, et al. Characteristics and risk factors of recurrence in clinical stage Ⅰ non-small cell lung cancer patients undergoing anatomic segmentectomy. Gen Thorac Cardiovasc Surg, 2020, 68(9): 1011-1017.
28.	Cao J, Yuan P, Wang Y, et al. Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer. Ann Thorac Surg, 2018, 105(5): 1483-1491.
29.	Mimae T, Miyata Y, Mimura T, et al. Radiologic findings to predict low-grade malignant tumour among clinical T1bN0 lung adenocarcinomas: Lessons from histological subtypes. Jpn J Clin Oncol, 2015, 45(8): 767-773.
30.	Tsutani Y, Miyata Y, Nakayama H, et al. Prediction of pathologic node-negative clinical stage ⅠA lung adenocarcinoma for optimal candidates undergoing sublobar resection. J Thorac Cardiovasc Surg, 2012, 144(6): 1365-1371.
31.	Suzuki K, Watanabe S, Mizusawa J, et al. Predictors of non-neoplastic lesions in lung tumours showing ground-glass opacity on thin-section computed tomography based on a multi-institutional prospective study. Interact Cardiovasc Thorac Surg, 2015, 21(2): 218-223.
32.	Chan EG, Landreneau JR, Schuchert MJ, et al. Preoperative (3-dimensional) computed tomography lung reconstruction before anatomic segmentectomy or lobectomy for stage Ⅰ non-small cell lung cancer. J Thorac Cardiovasc Surg, 2015, 150(3): 523-528.
33.	Qiu B, Ji Y, He H, et al. Three-dimensional reconstruction/personalized three-dimensional printed model for thoracoscopic anatomical partial-lobectomy in stageⅠ lung cancer: A retrospective study. Transl Lung Cancer Res, 2020, 9(4): 1235-1246.
34.	Zhang M, Liu D, Wu W, et al. Preoperative 3D-CT bronchography and angiography facilitates single-direction uniportal thoracoscopic anatomic lobectomy. Ann Transl Med, 2019, 7(20): 526.
35.	She XW, Gu YB, Xu C, et al. Three-dimensional (3D)-computed tomography bronchography and angiography combined with 3D-video-assisted thoracic surgery (VATS) versus conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of non-small cell lung cancer. Thorac Cancer, 2018, 9(2): 305-309.
36.	Iwano S. Planning video-assisted thoracic surgery segmentectomy using three dimensional computed tomography angiography and bronchography with a virtual safety margin. J Vis Surg, 2017, 3: 82.
37.	Hu W, Zhang K, Han X, et al. Three-dimensional computed tomography angiography and bronchography combined with three-dimensional printing for thoracoscopic pulmonary segmentectomy in stage ⅠA non-small cell lung cancer. J Thorac Dis, 2021, 13(2): 1187-1195.
38.	Misaki N, Chang SS, Gotoh M, et al. A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg, 2009, 138(3): 613-618.
39.	Nex G, Schiavone M, De Palma A, et al. How to identify intersegmental planes in performing sublobar anatomical resections. J Thorac Dis, 2020, 12(6): 3369-3375.
40.	Sekine Y, Itoh T, Toyoda T, et al. Precise anatomical sublobar resection using a 3D medical image analyzer and fluorescence-guided surgery with transbronchial instillation of indocyanine green. Semin Thorac Cardiovasc Surg, 2019, 31(3): 595-602.
41.	Mariolo AV, Vieira T, Stern JB, et al. Electromagnetic navigation bronchoscopy localization of lung nodules for thoracoscopic resection. J Thorac Dis, 2021, 13(7): 4371-4377.
42.	Meacci E, Nachira D, Zanfrini E, et al. Uniportal VATS approach to sub-lobar anatomic resections: Literature review and personal experience. J Thorac Dis, 2020, 12(6): 3376-3389.
43.	Feng J, Wang LF, Han TY, et al. Survival outcomes of lobectomy versus segmentectomy in clinical stage Ⅰ non-small cell lung cancer: A meta-analysis. Adv Ther, 2021, 38(7): 4130-4137.
44.	Jin Y, Wang M, Xue L, et al. Clinical application of near-infrared thoracoscopy with indocyanine green in video-assisted thoracoscopic anatomical segmentectomy. Surg Innov, 2019, 26(4): 473-477.
45.	Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique: Selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
46.	Endoh M, Oizumi H, Kato H, et al. Posterior approach to thoracoscopic pulmonary segmentectomy of the dorsal basal segment: A single-institute retrospective review. J Thorac Cardiovasc Surg, 2017, 154(4): 1432-1439.
47.	Ojanguren A, Gossot D, Seguin-Givelet A. Division of the intersegmental plane during thoracoscopic segmentectomy: Is stapling an issue? J Thorac Dis, 2016, 8(8): 2158-2164.
48.	Yazawa T, Igai H, Numajiri K, et al. Comparison of stapler and electrocautery for division of the intersegmental plane in lung segmentectomy. J Thorac Dis, 2021, 13(11): 6331-6342.
49.	Lu T, Zhang R, Jiang K, et al. Electrocautery vs. stapler in comparing safety for segmentectomy of lung cancer: A meta-analysis. Front Surg, 2021, 8: 711685.

1. Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016. J Nat Canc Cent, 2022, 2(1): 1-9.
2. Zeng W, Zhang W, Zhang J, et al. Systematic review and meta-analysis of video-assisted thoracoscopic surgery segmentectomy versus lobectomy for stage Ⅰ non-small cell lung cancer. World J Surg Oncol, 2020, 18(1): 44.
3. Schrank Z, Chhabra G, Lin L, et al. Current molecular-targeted therapies in NSCLC and their mechanism of resistance. Cancers (Basel), 2018, 10(7): 224.
4. Suzuki H, Morimoto J, Mizobuchi T, et al. Does segmentectomy really preserve the pulmonary function better than lobectomy for patients with early-stage lung cancer? Surg Today, 2017, 47(4): 463-469.
5. Davidson DD, Cheng L. Perspectives of lung cancer control and molecular prevention. Future Oncol, 2019, 15(31): 3527-3530.
6. 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.
7. Veronesi G, Baldwin DR, Henschke CI, et al. Recommendations for implementing lung cancer screening with low-dose computed tomography in Europe. Cancers (Basel), 2020, 12(6): 1672.
8. Ardila D, Kiraly AP, Bharadwaj S, et al. End-to-end lung cancer screening with three-dimensional deep learning on low-dose chest computed tomography. Nat Med, 2019, 25(6): 954-961.
9. 蔡雅倩, 张正华, 韩丹, 等. AI对肺磨玻璃结节筛查及定性的临床应用研究. 放射学实践, 2019, 34(9): 958-962.
10. Chabon JJ, Hamilton EG, Kurtz DM, et al. Integrating genomic features for non-invasive early lung cancer detection. Nature, 2020, 580(7802): 245-251.
11. Kiranantawat N, McDermott S, Petranovic M, et al. Determining malignancy in CT guided fine needle aspirate biopsy of subsolid lung nodules: Is core biopsy necessary? Eur J Radiol Open, 2019, 6: 175-181.
12. Lemieux S, Kim T, Pothier-Piccinin O, et al. Ultrasound-guided transthoracic needle biopsy of the lung: sensitivity and safety variables. Eur Radiol, 2021, 31(11): 8272-8281.
13. Folch EE, Pritchett MA, Nead MA, et al. Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: One-year results of the prospective, multicenter NAVIGATE study. J Thorac Oncol, 2019, 14(3): 445-458.
14. McGuire AL, Myers R, Grant K, et al. The diagnostic accuracy and sensitivity for malignancy of radial-endobronchial ultrasound and electromagnetic navigation bronchoscopy for sampling of peripheral pulmonary lesions: Systematic review and meta-analysis. J Bronchology Interv Pulmonol, 2020, 27(2): 106-121.
15. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
16. Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
17. Travis WD, Asamura H, Bankier AA, et al. The IASLC lung cancer staging project: Proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol, 2016, 11(8): 1204-1223.
18. Shi Y, Wu S, Ma S, et al. Comparison between wedge resection and lobectomy/segmentectomy for early-stage non-small cell lung cancer: A Bayesian meta-analysis and systematic review. Ann Surg Oncol, 2022, 29(3): 1868-1879.
19. Tosi D, Nosotti M, Bonitta G, et al. Anatomical segmentectomy versus pulmonary lobectomy for stageⅠ non-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.
20. Sugi K, Kobayashi S, Sudou M, et al. Long-term prognosis of video-assisted limited surgery for early lung cancer. Eur J Cardiothorac Surg, 2010, 37(2): 456-460.
21. Bedetti B, Bertolaccini L, Rocco R, et al. Segmentectomy versus lobectomy for stageⅠ non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2017, 9(6): 1615-1623.
22. Broderick SR. Adjuvant and neoadjuvant immunotherapy in non-small cell lung cancer. Thorac Surg Clin, 2020, 30(2): 215-220.
23. 王瑞, 姚烽, 陈春基, 等. 《中华医学会肺癌临床诊疗指南(2019版)》外科治疗解读. 中国胸心血管外科临床杂志, 2020, 27(11): 1265-1268.
24. Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.
25. Aokage K, Saji H, Suzuki K, et al. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211). Gen Thorac Cardiovasc Surg, 2017, 65(5): 267-272.
26. Kohman LJ, Gu L, Altorki N, et al. Biopsy first: Lessons learned from Cancer and Leukemia Group B (CALGB) 140503. J Thorac Cardiovasc Surg, 2017, 153(6): 1592-1597.
27. Koike T, Nakamura A, Shimizu Y, et al. Characteristics and risk factors of recurrence in clinical stage Ⅰ non-small cell lung cancer patients undergoing anatomic segmentectomy. Gen Thorac Cardiovasc Surg, 2020, 68(9): 1011-1017.
28. Cao J, Yuan P, Wang Y, et al. Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer. Ann Thorac Surg, 2018, 105(5): 1483-1491.
29. Mimae T, Miyata Y, Mimura T, et al. Radiologic findings to predict low-grade malignant tumour among clinical T1bN0 lung adenocarcinomas: Lessons from histological subtypes. Jpn J Clin Oncol, 2015, 45(8): 767-773.
30. Tsutani Y, Miyata Y, Nakayama H, et al. Prediction of pathologic node-negative clinical stage ⅠA lung adenocarcinoma for optimal candidates undergoing sublobar resection. J Thorac Cardiovasc Surg, 2012, 144(6): 1365-1371.
31. Suzuki K, Watanabe S, Mizusawa J, et al. Predictors of non-neoplastic lesions in lung tumours showing ground-glass opacity on thin-section computed tomography based on a multi-institutional prospective study. Interact Cardiovasc Thorac Surg, 2015, 21(2): 218-223.
32. Chan EG, Landreneau JR, Schuchert MJ, et al. Preoperative (3-dimensional) computed tomography lung reconstruction before anatomic segmentectomy or lobectomy for stage Ⅰ non-small cell lung cancer. J Thorac Cardiovasc Surg, 2015, 150(3): 523-528.
33. Qiu B, Ji Y, He H, et al. Three-dimensional reconstruction/personalized three-dimensional printed model for thoracoscopic anatomical partial-lobectomy in stageⅠ lung cancer: A retrospective study. Transl Lung Cancer Res, 2020, 9(4): 1235-1246.
34. Zhang M, Liu D, Wu W, et al. Preoperative 3D-CT bronchography and angiography facilitates single-direction uniportal thoracoscopic anatomic lobectomy. Ann Transl Med, 2019, 7(20): 526.
35. She XW, Gu YB, Xu C, et al. Three-dimensional (3D)-computed tomography bronchography and angiography combined with 3D-video-assisted thoracic surgery (VATS) versus conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of non-small cell lung cancer. Thorac Cancer, 2018, 9(2): 305-309.
36. Iwano S. Planning video-assisted thoracic surgery segmentectomy using three dimensional computed tomography angiography and bronchography with a virtual safety margin. J Vis Surg, 2017, 3: 82.
37. Hu W, Zhang K, Han X, et al. Three-dimensional computed tomography angiography and bronchography combined with three-dimensional printing for thoracoscopic pulmonary segmentectomy in stage ⅠA non-small cell lung cancer. J Thorac Dis, 2021, 13(2): 1187-1195.
38. Misaki N, Chang SS, Gotoh M, et al. A novel method for determining adjacent lung segments with infrared thoracoscopy. J Thorac Cardiovasc Surg, 2009, 138(3): 613-618.
39. Nex G, Schiavone M, De Palma A, et al. How to identify intersegmental planes in performing sublobar anatomical resections. J Thorac Dis, 2020, 12(6): 3369-3375.
40. Sekine Y, Itoh T, Toyoda T, et al. Precise anatomical sublobar resection using a 3D medical image analyzer and fluorescence-guided surgery with transbronchial instillation of indocyanine green. Semin Thorac Cardiovasc Surg, 2019, 31(3): 595-602.
41. Mariolo AV, Vieira T, Stern JB, et al. Electromagnetic navigation bronchoscopy localization of lung nodules for thoracoscopic resection. J Thorac Dis, 2021, 13(7): 4371-4377.
42. Meacci E, Nachira D, Zanfrini E, et al. Uniportal VATS approach to sub-lobar anatomic resections: Literature review and personal experience. J Thorac Dis, 2020, 12(6): 3376-3389.
43. Feng J, Wang LF, Han TY, et al. Survival outcomes of lobectomy versus segmentectomy in clinical stage Ⅰ non-small cell lung cancer: A meta-analysis. Adv Ther, 2021, 38(7): 4130-4137.
44. Jin Y, Wang M, Xue L, et al. Clinical application of near-infrared thoracoscopy with indocyanine green in video-assisted thoracoscopic anatomical segmentectomy. Surg Innov, 2019, 26(4): 473-477.
45. Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique: Selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg, 2007, 133(3): 753-758.
46. Endoh M, Oizumi H, Kato H, et al. Posterior approach to thoracoscopic pulmonary segmentectomy of the dorsal basal segment: A single-institute retrospective review. J Thorac Cardiovasc Surg, 2017, 154(4): 1432-1439.
47. Ojanguren A, Gossot D, Seguin-Givelet A. Division of the intersegmental plane during thoracoscopic segmentectomy: Is stapling an issue? J Thorac Dis, 2016, 8(8): 2158-2164.
48. Yazawa T, Igai H, Numajiri K, et al. Comparison of stapler and electrocautery for division of the intersegmental plane in lung segmentectomy. J Thorac Dis, 2021, 13(11): 6331-6342.
49. Lu T, Zhang R, Jiang K, et al. Electrocautery vs. stapler in comparing safety for segmentectomy of lung cancer: A meta-analysis. Front Surg, 2021, 8: 711685.

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