short-term efficacy of uniportal versus three-port video-assisted thoracoscopic segmentectomy: A retrospective cohort study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Miao ^1,2 ,  ZHANG Hao ¹ , WU Wenbin ² , ZHAO Tian ² , CHEN Weigang ² , ZHANG Hui ²

1. Department of Thoracic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, P. R. China;
2. Department of Cardiothoracic Surgery, Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, P. R. China;

Corresponding author：

ZHANG Hao, Email: haozhang_xz@163.com

Keywords：

Single-direction; uniportal; video-assisted thoracoscopic surgery (VATS); anatomical pulmonary resection; segmentectomy

DOI：

10.7507/1007-4848.202203083

Video：

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Objective To explore the safety and short-term efficacy of uniportal and three-port video-assisted thoracoscopic surgery (VATS) anatomical segmentectomy for pulmonary nodules. Methods The clinical data of 225 patients with consecutive VATS anatomic segmentectomy by the same surgeon in Xuzhou Central Hospital between December 2019 and February 2022 was retrospectively reviewed. There were 85 males and 140 females with an average age of 57.3±11.6 years. These patients were divided into an uniportal VATS group (128 patients) and a three-port VATS group (97 patients) according to the surgical procedures. Single-direction anatomical procedure was utilized in the uniportal VATS group. The operation time, blood loss during the surgery, number of dissected lymph nodes, duration and volume of chest drainage, incidence of complications, and postoperative hospital stay of the two groups were compared. Results There was no conversion to thoracotomy, addition of surgical ports, or mortality in this cohort, with tumor-negative surgical margins. The postoperative pathological staining confirmed 2 (0.9%) patients of lymph node metastasis (pN1) and 4 (1.8%) patients of adenocarcinoma with micropapillary component. As compared with the three-port VATS group, patients in the uniportal VATS group had shorter operation time (115.6±54.7 min vs. 141.5±62.8 min, P=0.001), less intraoperative blood loss (77.2±49.6 mL vs. 96.9±98.1 mL, P=0.050), less total thoracic drainage [394.0 (258.8, 580.0) mL vs. 530.0 (335.0, 817.5) mL, P=0.010], and shorter postoperative hospital stay (7.7±3.7 d vs. 8.7±3.5 d, P=0.031). Both groups showed similar stations and numbers of dissected lymph nodes, incidence of operation-related complications, duration of chest tube drainage, and the drainage volume in the first and second postoperative days (P>0.05). No tumor recurrence or metastasis was recorded in this cohort during the follow-up of 11 (1-26) months. Conclusion Single-direction uniportal VATS anatomical segmentectomy is safe and feasible for the treatment of pulmonary nodules, with better short-term efficacy as compared with the three-port VATS procedure, including shorter operation time, less intraoperative blood loss and thoracic drainage. However, further studies are needed to elucidate the precise indications of segmentectomy for lung cancer.

Citation： ZHANG Miao, ZHANG Hao, WU Wenbin, ZHAO Tian, CHEN Weigang, ZHANG Hui. short-term efficacy of uniportal versus three-port video-assisted thoracoscopic segmentectomy: A retrospective cohort study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(10): 1303-1312. doi: 10.7507/1007-4848.202203083 Copy

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2. 陈晓峰, 王安. 胸腔镜解剖性肺段切除术治疗早期非小细胞肺癌的应用进展. 中国胸心血管外科临床杂志, 2018, 25(11): 1000-1002.
3. 王欢, 刘建, 陈剑, 等. 胸腔镜复杂肺段切除术治疗Ⅰ期非小细胞肺癌的围手术期效果. 中国胸心血管外科临床杂志, 2021, 28(5): 555-559.
4. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
5. Chen YY, Huang WL, Chang CC, et al. Uniportal versus multiportal thoracoscopic complex segmentectomy: Propensity matching analysis. Ann Thorac Cardiovasc Surg, 2021, 27(4): 237-243.
6. Xie D, Wu J, Hu X, et al. Uniportal versus multiportal video-assisted thoracoscopic surgery does not compromise the outcome of segmentectomy. Eur J Cardiothorac Surg, 2021, 59(3): 650-657.
7. 刘成武, 郭成林, 林锋, 等. 单向式胸腔镜肺叶或肺段切除术治疗Ⅰ期肺癌的远期疗效. 中华外科杂志, 2015, 53(10): 742-746.
8. Guo C, Xia L, Mei J, et al. A propensity score matching study of non-grasping en bloc mediastinal lymph node dissection versus traditional grasping mediastinal lymph node dissection for non-small cell lung cancer by video-assisted thoracic surgery. Transl Lung Cancer Res, 2019, 8(2): 176-186.
9. 蒲强, 梅建东, 刘伦旭. 单向式胸腔镜左上肺尖后段切除的视频要点. 中国胸心血管外科临床杂志, 2018, 25(6): 461.
10. 张楼乾, 蒋峰, 李明, 等. 无创三维重建在肺部亚厘米结节定位中应用. 南京医科大学学报(自然科学版), 2019, 39(10): 1491-1493.
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12. 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.
13. 牛玲莉, 刘成武, 王文凭, 等. 单孔胸腔镜解剖性基底段切除术的临床应用. 中国胸心血管外科临床杂志, 2021, 28(6): 725-728.
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17. Ijsseldijk MA, Shoni M, Siegert C, et al. Oncological outcomes of lobar resection, segmentectomy, and wedge resection for T1a non-small-cell lung carcinoma: A systematic review and meta-analysis. Semin Thorac Cardiovasc Surg, 2020, 32(3): 582-590.
18. Mimae T, Saji H, Nakamura H, et al. Survival of octogenarians with early-stage non-small cell lung cancer is comparable between wedge resection and lobectomy/segmentectomy: JACS1303. Ann Surg Oncol, 2021, 28(12): 7219-7227.
19. Zhang X, Lin G, Li J. Comparative effectiveness of lobectomy, segmentectomy, and wedge resection for pathological stage Ⅰ non-small cell lung cancer in elderly patients: A population-based study. Front Surg, 2021, 8: 652770.
20. 傅方求, 马相宜, 张扬, 等. 磨玻璃结节型肺癌患者的个体化全程管理策略. 中国胸心血管外科临床杂志, 2022, 29(1): 1-10.
21. Ettinger DS, Wood DE, Aisner DL, et al. NCCN guidelines insights: Non-small cell lung cancer, version 2. 2021. J Natl Compr Canc Netw, 2021, 19(3): 254-266.
22. Shiono S, Okumura T, Boku N, et al. Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg, 2017, 51(3): 504-510.
23. Hao Z, Liang H, Zhang Y, et al. Surgery for advanced-stage non-small cell lung cancer: Lobectomy or sub-lobar resection? Transl Lung Cancer Res, 2021, 10(3): 1408-1423.
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25. 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.
26. 杨振宇, 刘成武, 梅建东, 等. 肺段切除治疗磨玻璃影为主早期肺癌的围术期及远期效果: 单中心大样本回顾性研究. 中国胸心血管外科临床杂志, 2021, 28(12): 1420-1426.
27. Li F, Zhao Y, Yuan L, et al. Oncologic outcomes of segmentectomy vs. lobectomy in pathologic stage ⅠA (≤2 cm) invasive lung adenocarcinoma: A population-based study. J Surg Oncol, 2020, 121(7): 1132-1139.
28. Dai C, Shen J, Ren Y, et al. Choice of surgical procedure for patients with non-small-cell lung cancer ≤1 cm or >1 to 2 cm among lobectomy, segmentectomy, and wedge resection: A population-based study. J Clin Oncol, 2016, 34(26): 3175-3182.
29. Baig MZ, Razi SS, Muslim Z, et al. Lobectomy demonstrates superior survival than segmentectomy for high-grade non-small cell lung cancer: The National Cancer Database analysis. Am Surg, 2021: 31348211011116.
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32. Yu X, Zhang R, Zhang M, et al. Segmental resection is associated with decreased survival in patients with stage ⅠA non-small cell lung cancer with a tumor size of 21-30 mm. Transl Lung Cancer Res, 2021, 10(2): 900-913.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

short-term efficacy of uniportal versus three-port video-assisted thoracoscopic segmentectomy: A retrospective cohort study in a single center

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