Oncological outcome of 3D-guided cone-shaped segmentectomy for deep early-stage lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Wenzheng , LI Zhihua , PAN Xianglong , HE Zhicheng , XU Jing , ZHU Quan ,  WU Weibing ,  CHEN Liang

Department of Thoracic Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, P. R. China;

Corresponding author：

WU Weibing, Email: wuweibing95@163.com; CHEN Liang, Email: clbright0909@njmu.edu.cn

Keywords：

Conical segmentectomy; lobectomy; deep lung cancer; oncological outcomes

DOI：

10.7507/1007-4848.202212006

Video：

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Objective To investigate whether 3D-guided cone-shaped segmentectomy could achieve comparable long-term outcomes with lobectomy for ≤2 cm deep early-stage lung cancer. Methods We retrospectively screened patients with ≤2 cm deep early-stage non-small cell lung cancer (NSCLC) who underwent lobectomy or segmentectomy at our center from January 2012 to December 2018. All pulmonary segmentectomy was performed using 3D-guided cone-shaped segmentectomy with segment or subsegment as the resection unit. Univariate and multivariate regression analysis were performed by Cox proportional hazard regression model. The patients who underwent segmentectomy and lobectomy were matched 1:1 by propensity-score matching analysis. The oncological outcomes of two groups were compared. Results Our cohort was divided into a segmentectomy group (n=222) and a lobectomy group (n=127). The age, total nodule size, solid component size and proportion of pure solid nodule in lobectomy group were significantly higher than those in segmentectomy group. The median follow-up time was 49 months. Surgical margins were negative in all patients. The local recurrence rate of segmentectomy was 0.45%. The disease-free survival (DFS) and overall survival (OS) of patients in segmentectomy group were significantly better than those in the lobectomy group (5-year DFS: 98.64% vs. 89.77%, P<0.001; 5-year OS: 99.55% vs. 92.10%, P<0.001). Multivariate regression analysis showed that the differences between two groups were not significant [DFS: HR=0.52 (0.11, 2.59), P=0.427; OS: HR=0.08 (0, 3.24), P=0.179] after adjusting for other factors. After propensity score matching, 77 patients were preserved in both segmentectomy group and lobectomy group, with the mean nodule size of 1.49 cm and 1.44 cm and the mean consolidation tumor ratio (CTR) of 0.52 and 0.46, respectively. There was no statistical difference in DFS (P=0.640) and OS (P=0.310) between two groups. Conclusion 3D-guided cone-shaped segmentectomy could be an acceptable treatment for ≤2 cm low-grade malignant NSCLC deep in lung parenchyma, and its oncology effect was not inferior to lobectomy.

1.	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.
2.	Altorki NK, Wang X, Kozono D, et al. PL03.06 lobar or sub-lobar resection for peripheral clinical stage Ⅰa = 2 cm non-small cell lung cancer (NSCLC): Results from an international randomized phase Ⅲ trial (CALGB 140503 [Alliance]). J Thorac Oncol, 2022, 17(9, Supplement): S1-S2.
3.	中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2022版). 中华肿瘤杂志, 2022, 44(6): 457-490.
4.	Liu W, Lai H, Wang Z, et al. Does surgical margin affect recurrence and survival after sublobar pulmonary resection for lung cancer? Interact Cardiovasc Thorac Surg, 2022, 34(6): 1089-1094.
5.	Wu WB, Xu XF, Wen W, et al. Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy. J Thorac Dis, 2016, 8(Suppl 9): S710-S715.710-715.
6.	Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
7.	胡硕, 王琦, 魏海星, 等. 三维导航免穿刺和穿刺定位行解剖性肺段切除术治疗肺结节的回顾性队列研究. 中国胸心血管外科临床杂志, 2021, 28(10): 1202-1206.
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.	Wu W, He Z, Xu J, et al. Anatomical pulmonary sublobar resection based on subsegment. Ann Thorac Surg, 2021, 111(6): e447-e450.447-45.
10.	Yao F, Wu W, Zhu Q, et al. Thoracoscopic pulmonary segmentectomy with collateral ventilation method. Ann Thorac Surg, 2021, 112(6): 1814-1823.
11.	Wang J, Xu X, Wen W, et al. Technique for tailoring complex demarcation in lung segmentectomy. Thorac Cancer, 2018, 9(11): 1562-1564.
12.	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.
13.	Nomori H, Yamazaki I, Machida Y, et al. Lobectomy versus segmentectomy: A propensity score-matched comparison of postoperative complications, pulmonary function and prognosis. Interact Cardiovasc Thorac Surg, 2022, 34(1): 57-65.
14.	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.
15.	Nakamoto K, Omori K, Nezu K, et al. Superselective segmentectomy for deep and small pulmonary nodules under the guidance of three-dimensional reconstructed computed tomographic angiography. Ann Thorac Surg, 2010, 89(3): 877-883.
16.	Takamori S, Oizumi H, Suzuki J, et al. Video-assisted thoracoscopic segmentectomy for deep and peripheral small lung cancer. Thorac Cardiovasc Surg, 2022, 70(3): 233-238.
17.	Tane S, Kitamura Y, Kimura K, et al. Segmentectomy versus lobectomy for inner-located small-sized early non-small-cell lung cancer. Interact Cardiovasc Thorac Surg, 2022, 35(4): ivac218.
18.	俞同福, 徐海, 刘希胜, 等. 术前CT引导下亚甲蓝与Hookwire联合定位肺小结节临床应用价值. 中华胸心血管外科杂志, 2012, 28(7): 401-404.
19.	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.
20.	Nomori H, Shiraishi A, Yamazaki I, et al. Extent of segmentectomy that achieves greater lung preservation than lobectomy. Ann Thorac Surg, 2021, 112(4): 1127-1133.

1. 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.
2. Altorki NK, Wang X, Kozono D, et al. PL03.06 lobar or sub-lobar resection for peripheral clinical stage Ⅰa = 2 cm non-small cell lung cancer (NSCLC): Results from an international randomized phase Ⅲ trial (CALGB 140503 [Alliance]). J Thorac Oncol, 2022, 17(9, Supplement): S1-S2.
3. 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2022版). 中华肿瘤杂志, 2022, 44(6): 457-490.
4. Liu W, Lai H, Wang Z, et al. Does surgical margin affect recurrence and survival after sublobar pulmonary resection for lung cancer? Interact Cardiovasc Thorac Surg, 2022, 34(6): 1089-1094.
5. Wu WB, Xu XF, Wen W, et al. Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy. J Thorac Dis, 2016, 8(Suppl 9): S710-S715.710-715.
6. Wu WB, Xia Y, Pan XL, et al. Three-dimensional navigation-guided thoracoscopic combined subsegmentectomy for intersegmental pulmonary nodules. Thorac Cancer, 2019, 10(1): 41-46.
7. 胡硕, 王琦, 魏海星, 等. 三维导航免穿刺和穿刺定位行解剖性肺段切除术治疗肺结节的回顾性队列研究. 中国胸心血管外科临床杂志, 2021, 28(10): 1202-1206.
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. Wu W, He Z, Xu J, et al. Anatomical pulmonary sublobar resection based on subsegment. Ann Thorac Surg, 2021, 111(6): e447-e450.447-45.
10. Yao F, Wu W, Zhu Q, et al. Thoracoscopic pulmonary segmentectomy with collateral ventilation method. Ann Thorac Surg, 2021, 112(6): 1814-1823.
11. Wang J, Xu X, Wen W, et al. Technique for tailoring complex demarcation in lung segmentectomy. Thorac Cancer, 2018, 9(11): 1562-1564.
12. 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.
13. Nomori H, Yamazaki I, Machida Y, et al. Lobectomy versus segmentectomy: A propensity score-matched comparison of postoperative complications, pulmonary function and prognosis. Interact Cardiovasc Thorac Surg, 2022, 34(1): 57-65.
14. 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.
15. Nakamoto K, Omori K, Nezu K, et al. Superselective segmentectomy for deep and small pulmonary nodules under the guidance of three-dimensional reconstructed computed tomographic angiography. Ann Thorac Surg, 2010, 89(3): 877-883.
16. Takamori S, Oizumi H, Suzuki J, et al. Video-assisted thoracoscopic segmentectomy for deep and peripheral small lung cancer. Thorac Cardiovasc Surg, 2022, 70(3): 233-238.
17. Tane S, Kitamura Y, Kimura K, et al. Segmentectomy versus lobectomy for inner-located small-sized early non-small-cell lung cancer. Interact Cardiovasc Thorac Surg, 2022, 35(4): ivac218.
18. 俞同福, 徐海, 刘希胜, 等. 术前CT引导下亚甲蓝与Hookwire联合定位肺小结节临床应用价值. 中华胸心血管外科杂志, 2012, 28(7): 401-404.
19. 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.
20. Nomori H, Shiraishi A, Yamazaki I, et al. Extent of segmentectomy that achieves greater lung preservation than lobectomy. Ann Thorac Surg, 2021, 112(4): 1127-1133.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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