Single-direction video-assisted thoracoscopic surgery anatomic basal segmentectomy in 352 patients: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Chengwu , PU Qiang , MEI Jiandong , ZHU Yunke , MA Lin , GUO Chenglin ,  LIU Lunxu

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

LIU Lunxu, Email: lunxu_liu@aliyun.com

Keywords：

Video-assisted thoracoscopic surgery (VATS); segmentectomy; lung cancer; single-direction

DOI：

10.7507/1007-4848.202204062

Video：

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Objective To share the clinical experience of video-assisted thoracoscopic surgery (VATS) anatomic basal segmentectomy by single-direction method. Methods The clinical data of 352 patients who underwent VATS anatomic basal segmentectomy in West China Hospital between April 2015 and April 2021 were retrospectively reviewed, including 96 males and 256 females with a median age of 50 (range, 26-81) years. All basal segmentectomies were performed under thoracoscopy, through the interlobar fissure or inferior pulmonary ligament approach, and following the strategy of single-direction and the method of "stem-branch". Results All patients underwent basal segmentectomy successfully (49 patients of uniportal procedure, 3 patients of biportal procedure and 300 patients of triportal procedure) without addition of incisions or conversion to thoracotomy and lobectomy. The median operation time was 118 (range, 45-340) min, median intraoperative blood loss was 20 (range, 5-500) mL, median drainage time was 2 (range, 1-22) d and median postoperative hospital stay was 4 (range, 2-24) d. The postoperative complications included pneumonia in 6 patients, prolonged drainage (air leakage duration＞5 d or drainage duration＞7 d) in 18 patients, cerebral infarction in 1 patient and other complications in 2 patients. All patients were treated well and discharged without main complaints. No perioperative death happened. Conclusion VATS anatomic basal segmentectomy is feasible and safe. It can be performed in a simple manner following the strategy of single-direction.

Citation： LIU Chengwu, PU Qiang, MEI Jiandong, ZHU Yunke, MA Lin, GUO Chenglin, LIU Lunxu. Single-direction video-assisted thoracoscopic surgery anatomic basal segmentectomy in 352 patients: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(10): 1284-1289. doi: 10.7507/1007-4848.202204062 Copy

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9.	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.
10.	Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical ⅠA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol, 2011, 6(4): 751-756.
11.	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.
12.	Iwata H, Shirahashi K, Mizuno Y, et al. Feasibility of segmental resection in non-small-cell lung cancer with ground-glass opacity. Eur J Cardiothorac Surg, 2014, 46(3): 375-379.
13.	Mimae T, Okada M. Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer? Gen Thorac Cardiovasc Surg, 2020, 68(7): 703-706.

1. Sato M, Murayama T, Nakajima J. Concepts and techniques: How to determine and identify the appropriate target segment in anatomical pulmonary segmentectomy? J Thorac Dis, 2019, 11(3): 972-986.
2. 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.
3. Kikkawa T, Kanzaki M, Isaka T, et al. Complete thoracoscopic S9 or S10 segmentectomy through a pulmonary ligament approach. J Thorac Cardiovasc Surg, 2015, 149(3): 937-939.
4. Igai H, Kamiyoshihara M, Kawatani N, et al. Thoracoscopic lateral and posterior basal (S9+10) segmentectomy using intersegmental tunnelling. Eur J Cardiothorac Surg, 2017, 51(4): 790-791.
5. Sato M, Murayama T, Nakajima J. Thoracoscopic stapler-based "bidirectional" segmentectomy for posterior basal segment (S10) and its variants. J Thorac Dis, 2018, 10(Suppl 10): S1179-S1186.
6. Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
7. Pu Q, Liu C, Guo C, et al. Stem-branch: A novel method for tracking the anatomy during thoracoscopic S9-10 segmentectomy. Ann Thorac Surg, 2019, 108(5): e333-e335.
8. Liu C, Liao H, Guo C, et al. Single-direction thoracoscopic basal segmentectomy. J Thorac Cardiovasc Surg, 2020, 160(6): 1586-1594.
9. 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.
10. Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical ⅠA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol, 2011, 6(4): 751-756.
11. 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.
12. Iwata H, Shirahashi K, Mizuno Y, et al. Feasibility of segmental resection in non-small-cell lung cancer with ground-glass opacity. Eur J Cardiothorac Surg, 2014, 46(3): 375-379.
13. Mimae T, Okada M. Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer? Gen Thorac Cardiovasc Surg, 2020, 68(7): 703-706.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Single-direction video-assisted thoracoscopic surgery anatomic basal segmentectomy in 352 patients: A retrospective study in a single center

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