Safety and clinical outcomes of thoracoscopic segmentectomy in bilateral lung cancer: A single-center retrospective study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GAO Xuehan , GUO Chao , YANG Libing , ZHANG Jiaqi , LIU Lei , ZHOU Mengxin , ZHAO Ke , LIU Hongsheng ,  LI Shanqing

Department of Thoracic Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, 100730, P. R. China;

Corresponding author：

LI Shanqing, Email: lishanqing@pumch.cn

Keywords：

Video-assisted thoracoscopic surgery; anatomical segmentectomy; lung cancer; one-stage bilateral surgery; two-stage bilateral surgery

DOI：

10.7507/1007-4848.202208054

Video：

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Objective To assess the safety and clinical outcomes of segmentectomy in one- or two-staged video-assisted thoracoscopic surgery (VATS) for bilateral lung cancer. Methods We retrospectively enrolled 100 patients who underwent VATS segmentectomy for bilateral lung cancer at the Department of Thoracic Surgery of Peking Union Medical College Hospital from December 2013 to May 2022. We divided the patients into two groups: a one-stage group (52 patients), including 17 males and 35 females with a mean age of 55.17±11.09 years, and a two-stage group (48 patients), including 16 males and 32 females with a mean age of 59.88±11.48 years. We analyzed multiple intraoperative variables and postoperative outcomes. Results All 100 patients successfully completed bilateral VATS, and at least unilateral lung received anatomical segmentectomy. Patients in the one-stage group were younger (P=0.040), had lower rate of comorbidities (P=0.030), were less likely to have a family history of lung cancer (P=0.018), and had a shorter interval between diagnosis and surgery (P=0.000) compared with patients in the two-stage group. Wedge resection on the opposite side was more common in the one-stage group (P=0.000), while lobectomy was more common in the two-stage group. The time to emerge from anesthesia in the one-stage group was longer than that in the first and second operations of the two-stage group (P=0.000, P=0.002). Duration of surgery and anesthesia were similar between two groups (P>0.05). Total number of lymph node stations for sampling and dissection (P=0.041) and lymph nodes involved (P=0.026) were less in the one-stage group. Intraoperative airway management was similar between two groups (P>0.05). The one-stage group was associated with lower activities of daily living (ADL) scores. Conclusion Segmentectomy is safe in one- or two-staged VATS for bilateral lung cancer, including contralateral sublobectomy and lobectomy. Duration of surgery and perioperative complications are similar between two groups, but the one-stage group is associated with lower ADL scores. On the basis of comprehensive consideration in psychological factors, physical conditions and personal wishes of patients, one-staged sequential bilateral VATS can be the first choice.

Citation： GAO Xuehan, GUO Chao, YANG Libing, ZHANG Jiaqi, LIU Lei, ZHOU Mengxin, ZHAO Ke, LIU Hongsheng, LI Shanqing. Safety and clinical outcomes of thoracoscopic segmentectomy in bilateral lung cancer: A single-center retrospective study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 39-46. doi: 10.7507/1007-4848.202208054 Copy

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5.	Xu G, Fu X. One-stage video-assisted thoracic surgery for bilateral multiple pulmonary nodules. J Thorac Dis, 2019, 11(2): 535-541.
6.	Sun E, Mello MM, Rishel CA, et al. Association of overlapping surgery with perioperative outcomes. JAMA, 2019, 321(8): 762-772.
7.	Mello MM, Livingston EH. Managing the risks of concurrent surgeries. JAMA, 2016, 315(15): 1563-1564.
8.	屈日荣, 郝志鹏, 彭澍, 等. 同期双侧单孔胸腔镜切除肺多发磨玻璃影的单中心经验. 中国胸心血管外科临床杂志, 2020, 27(8): 948-952.
9.	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.
10.	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.
11.	Li G, Xie S, Hu F, et al. Segmentectomy or wedge resection in stage ⅠA lung squamous cell carcinoma and adenocarcinoma? J Cancer, 2021, 12(6): 1708-1714.
12.	Yao F, Yang H, Zhao H. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules. J Thorac Dis, 2016, 8(3): 469-475.
13.	Zhang Y, Wang Y, Lv C, et al. Clinical analysis of 56 cases of simultaneous bilateral video-assisted thoracoscopic surgery for bilateral synchronous multiple primary lung adenocarcinoma. J Thorac Dis, 2018, 10(12): 6452-6457.
14.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
15.	Ettinger DS, Wood DE, Aisner DL, et al. Non-Small cell lung cancer, version 3. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(5): 497-530.
16.	胥丰恺, 王琳, 卢春来, 等. 双侧多原发肺癌的分期手术安全间隔时长分析. 中国临床医学, 2022, 29(3): 454-458.
17.	Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage ⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
18.	Lan L, Qiu Y, Zhang C, et al. Comparison of single-stage and two-stage bilateral video-assisted thoracic surgery. J Int Med Res, 2020, 48(11): 300060520967558.
19.	Mizuno Y, Iwata H, Shirahashi K, et al. One-stage bilateral pulmonary resections for pulmonary metastases. Gen Thorac Cardiovasc Surg, 2014, 62(1): 53-57.
20.	Watanabe T, Tanahashi M, Suzuki E, et al. Surgical treatment and outcomes for synchronous multiple lung cancer. Kyobu Geka, 2021, 74(1): 9-15.
21.	Negi T, Suda T, Tochii S, et al. Subxiphoid uniportal bilateral lung wedge resection. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i100-i102.
22.	Wang J, Xu M, Zhang C, et al. Clinical analysis of subxiphoid single-port thoracoscopic surgery for simultaneous bilateral lung lesion resection. BMC Surg, 2022, 22(1): 203.

1. Leventakos K, Peikert T, Midthun DE, et al. Management of multifocal lung cancer: Results of a survey. J Thorac Oncol, 2017, 12(9): 1398-1402.
2. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
3. 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.
4. Yang H, Sun Y, Yao F, et al. Surgical therapy for bilateral multiple primary lung cancer. Ann Thorac Surg, 2016, 101(3): 1145-1152.
5. Xu G, Fu X. One-stage video-assisted thoracic surgery for bilateral multiple pulmonary nodules. J Thorac Dis, 2019, 11(2): 535-541.
6. Sun E, Mello MM, Rishel CA, et al. Association of overlapping surgery with perioperative outcomes. JAMA, 2019, 321(8): 762-772.
7. Mello MM, Livingston EH. Managing the risks of concurrent surgeries. JAMA, 2016, 315(15): 1563-1564.
8. 屈日荣, 郝志鹏, 彭澍, 等. 同期双侧单孔胸腔镜切除肺多发磨玻璃影的单中心经验. 中国胸心血管外科临床杂志, 2020, 27(8): 948-952.
9. 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.
10. 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.
11. Li G, Xie S, Hu F, et al. Segmentectomy or wedge resection in stage ⅠA lung squamous cell carcinoma and adenocarcinoma? J Cancer, 2021, 12(6): 1708-1714.
12. Yao F, Yang H, Zhao H. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules. J Thorac Dis, 2016, 8(3): 469-475.
13. Zhang Y, Wang Y, Lv C, et al. Clinical analysis of 56 cases of simultaneous bilateral video-assisted thoracoscopic surgery for bilateral synchronous multiple primary lung adenocarcinoma. J Thorac Dis, 2018, 10(12): 6452-6457.
14. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
15. Ettinger DS, Wood DE, Aisner DL, et al. Non-Small cell lung cancer, version 3. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(5): 497-530.
16. 胥丰恺, 王琳, 卢春来, 等. 双侧多原发肺癌的分期手术安全间隔时长分析. 中国临床医学, 2022, 29(3): 454-458.
17. Tsutani Y, Miyata Y, Nakayama H, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage ⅠA lung adenocarcinoma: Wedge resection or segmentectomy. Chest, 2014, 145(1): 66-71.
18. Lan L, Qiu Y, Zhang C, et al. Comparison of single-stage and two-stage bilateral video-assisted thoracic surgery. J Int Med Res, 2020, 48(11): 300060520967558.
19. Mizuno Y, Iwata H, Shirahashi K, et al. One-stage bilateral pulmonary resections for pulmonary metastases. Gen Thorac Cardiovasc Surg, 2014, 62(1): 53-57.
20. Watanabe T, Tanahashi M, Suzuki E, et al. Surgical treatment and outcomes for synchronous multiple lung cancer. Kyobu Geka, 2021, 74(1): 9-15.
21. Negi T, Suda T, Tochii S, et al. Subxiphoid uniportal bilateral lung wedge resection. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i100-i102.
22. Wang J, Xu M, Zhang C, et al. Clinical analysis of subxiphoid single-port thoracoscopic surgery for simultaneous bilateral lung lesion resection. BMC Surg, 2022, 22(1): 203.

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Safety and clinical outcomes of thoracoscopic segmentectomy in bilateral lung cancer: A single-center retrospective study

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