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 of 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 can achieve comparable long-term outcomes with lobectomy for deep early-stage lung cancer with diameter≤2 cm. Methods We retrospectively screened patients with deep early-stage non-small cell lung cancer (NSCLC) with diameter≤2 cm who underwent lobectomy or segmentectomy in the First Affiliated Hospital of Nanjing Medical University from 2012 to 2018. All pulmonary segmentectomy was performed using 3D-guided cone-shaped segmentectomy with segment or subsegment as the resection unit. Univariate and multivariate regression analyses 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 the lobectomy group were significantly higher than those in the 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) rate and overall survival (OS) rate of patients in the segmentectomy group were significantly better than those in the lobectomy group (5-year DFS rate: 98.64% vs. 89.77%, P<0.001; 5-year OS rate: 99.55% vs. 92.10%, P<0.001). Multivariate regression analysis showed that the differences between two groups were not significant [DFS rate: HR=0.52. 95%CI (0.11, 2.59), P=0.427; OS rate: HR=0.08. 95%CI (0.00, 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 1.44 cm and 1.49 cm and the mean consolidation tumor ratio (CTR) of 0.46 and 0.52, respectively. There was no statistical difference in DFS rate (P=0.640) or OS rate (P=0.310) between the two groups. Conclusion 3D-guided cone-shaped segmentectomy can be an acceptable treatment for low-grade malignant NSCLC deep in lung parenchyma with diameter≤2 cm, and its oncology effect is not inferior to lobectomy.

Citation： XU Wenzheng, LI Zhihua, PAN Xianglong, HE Zhicheng, XU Jing, ZHU Quan, WU Weibing, CHEN Liang. Oncological outcome of 3D-guided cone-shaped segmentectomy for deep early-stage lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(10): 1413-1421. doi: 10.7507/1007-4848.202212006 Copy

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.Oncology Society of Chinese Medical Association, Chinese Medical Association Publishing House. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2022 edition). Chin J Oncol, 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.
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.Hu S, Wang Q, Wei HX, et al. Puncture positioning versus free-of-puncture positioning under three-dimensional navigation in the anatomical segmentectomy for pulmonary nodules: A retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 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.Wu WB, Zhu Q, Wen W, et al. Modified inflation-deflation for 146 thoracscopic cone-shaped segmentectomies. Chin J Thorac Cardiovasc Surg, 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.
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.Yu TF, Xu H, Liu XS, et al. CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules before video-assisted thoracoscopic resection: The clinic application. Chin J Thorac Cardiovasc Surg, 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.Oncology Society of Chinese Medical Association, Chinese Medical Association Publishing House. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2022 edition). Chin J Oncol, 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.
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.Hu S, Wang Q, Wei HX, et al. Puncture positioning versus free-of-puncture positioning under three-dimensional navigation in the anatomical segmentectomy for pulmonary nodules: A retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 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.Wu WB, Zhu Q, Wen W, et al. Modified inflation-deflation for 146 thoracscopic cone-shaped segmentectomies. Chin J Thorac Cardiovasc Surg, 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.
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.Yu TF, Xu H, Liu XS, et al. CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules before video-assisted thoracoscopic resection: The clinic application. Chin J Thorac Cardiovasc Surg, 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

Oncological outcome of 3D-guided cone-shaped segmentectomy for deep early-stage lung cancer

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