Short-term efficacy and safety of pulmonary subsegmentectomy versus segmentectomy in the treatment of patients with small pulmonary nodules: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Jinlong ^1,2 , LIN Zhaohao ^1,2 , MIN Weirun ^1,2 , CAO Wei ^1,2 , LI Haochi ^1,2 , BAI Qizhou ² ,  DONG Xinchun ² ,  GOU Yunjiu ²

1. First Clinical Medical School, Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. First Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding author：

DONG Xinchun, Email: 3050319523@qq.com; GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Subsegmentectomy; segmentectomy; early lung cancer; small pulmonary nodules; video-assisted thoracoscopic surgery; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202405042

Video：

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Objective To systematically evaluate the short-term efficacy and safety of lung subsegmentectomy and segmentectomy in the treatment of small pulmonary nodules. Methods Computer searches were conducted on PubMed, The Cochrane Library, EMbase, Scopus, Web of Science, SinoMed, Wanfang Data, VIP, and CNKI databases to collect relevant literature on the short-term efficacy and safety of lung subsegmentectomy and segmentectomy for small pulmonary nodules from the inception to April 2024. Two researchers independently screened the literature and extracted data according to inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software, and the Newcastle-Ottawa Scale (NOS) was used to assess the quality of the selected literature. Results A total of 15 retrospective cohort studies with 2417 patients were included, among whom 796 patients underwent lung subsegmentectomy and 1621patients underwent segmentectomy. The NOS scores of the included literature were all≥6 points. Meta-analysis results showed that compared with segmentectomy, lung subsegmentectomy had a lower overall postoperative complication rate [OR=0.54, 95%CI (0.39, 0.75), P<0.01] and fewer lymph nodes dissected [MD=−0.43, 95%CI (−0.81, −0.06), P=0.02]. There was no statistical difference between the two surgical methods in terms of operation time [MD=5.11, 95%CI (−4.02, 14.23), P=0.27], intraoperative blood loss [MD=−14.62, 95%CI (−29.58, 0.34), P=0.06], postoperative hospital stay [MD=−0.24, 95%CI (−0.49, 0.01), P=0.06], postoperative drainage time [MD=−0.14, 95%CI (−0.46, 0.18), P=0.40], intraoperative margin width [MD=0.10, 95%CI (−0.16, 0.35), P=0.46], or recurrence rate [OR=1.57, 95%CI (0.53, 4.61), P=0.42]. Subgroup analysis results showed that when using uniportal video-assisted thoracoscopy for surgery, compared with segmentectomy, lung subsegmentectomy had less intraoperative blood loss [MD=−15.57, 95%CI (−28.84, −2.30), P=0.02], shorter postoperative hospital stay [MD=−0.49, 95%CI (−0.63, −0.35), P<0.01], shorter postoperative drainage time [MD=−0.19, 95%CI (−0.35, −0.03), P=0.02], and lower overall complication rate [OR=0.55, 95%CI (0.31, 0.98), P=0.04]. Conclusion Lung subsegmentectomy can achieve similar efficacy as segmentectomy and has a lower overall postoperative complication rate. In terms of safety, lung subsegmentectomy can achieve a margin range close to that of segmentectomy. When performing uniportal thoracoscopic surgery, lung subsegmentectomy has advantages over segmentectomy in terms of intraoperative blood loss, postoperative hospital stay, and drainage time.

Citation： ZHANG Jinlong, LIN Zhaohao, MIN Weirun, CAO Wei, LI Haochi, BAI Qizhou, DONG Xinchun, GOU Yunjiu. Short-term efficacy and safety of pulmonary subsegmentectomy versus segmentectomy in the treatment of patients with small pulmonary nodules: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(10): 1496-1504. doi: 10.7507/1007-4848.202405042 Copy

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
3.	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.
4.	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.
5.	Ettinger DS, Wood DE, Akerley W, et al. Non-small cell lung cancer, version 1. 2015. J Natl Compr Canc Netw, 2014, 12(12): 1738-1761.
6.	Ghaly G, Kamel M, Nasar A, et al. Video-assisted thoracoscopic surgery is a safe and effective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stageⅠnon-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 465-472.
7.	Shimizu K, Nagashima T, Ohtaki Y, et al. Analysis of the variation pattern in right upper pulmonary veins and establishment of simplified vein models for anatomical segmentectomy. Gen Thorac Cardiovasc Surg, 2016, 64(10): 604-611.
8.	常鹏, 侯予龙, 公正, 等. CT三维重建技术辅助胸腔镜扩大肺亚段切除术治疗肺段边缘孤立性结节的短期疗效观察. 中华解剖与临床杂志, 2024, 29(2): 120-123.Chang P, Hou YL, Gong Z, et al. Short‐term curative effect of thoracoscopic extended subsegmentectomy under the assistance of 3D‐CTBA on marginal solitary pulmonary nodules. Chin J Anat Clin, 2024, 29(2): 120-123.
9.	李晓亮, 樊立茂, 郭朝卫, 等. 单孔胸腔镜下肺段切除与肺亚段切除治疗早期非小细胞肺癌的疗效分析. 中华肺部疾病杂志(电子版), 2023, 16(6): 845-848.Li XL, Fan LM, Guo CW, et al. Efficacy analysis of single-port thoracoscopic subsegmentectomy versus segmentectomy in the treatment of early stage non-small cell lung cancer. Chin J Lung Dis (Electronic Edition), 2023, 16(6): 845-848.
10.	刘强, 李志华, 王俊, 等. 肺亚段切除术对比肺段切除术治疗早期小结节肺癌的安全性及短期疗效分析. 南京医科大学学报(自然科学版), 2021, 41(8): 1190-1195.Liu Q, Li ZH, Wang J, et al. Analysis of the safety and short-term efficacy of pulmonary subsegmentectomy versus segmentectomy in the treatment of early-stage small nodular lung cancer. J Nanjing Med Univ (Nat Sci), 2021, 41(8): 1190-1195.
11.	陆世民, 常江华, 荣君, 等. 三维CT支气管血管重建引导下胸腔镜亚节段切除术对肺结节的治疗. 中国医学装备, 2024, 21(1): 110-113.Lu SM, Chang JH, Rong J, et al. Treatment of thoracoscopic subsegmental resection under the guidance of 3D reconstruction of bronchial blood vessels of pulmonary for pulmonary nodule. China Med Equip, 2024, 21(1): 110-113.
12.	马世学, 曹炜, 汪丽祥, 等. 术前三维重建指导下两种手术方式治疗肺段间结节的效果比较. 浙江临床医学, 2023, 25(1): 61-63.Ma SX, Cao W, Wang LX, et al. Preoperative three-dimensional reconstruction-guided treatment of intersegmental lung nodules by two surgical approaches: Comparison of outcomes. Zhejiang Clin Med J, 2023, 25(1): 61-63.
13.	孙翔翔, 徐美青, 章传凯, 等. 以肺亚段为解剖单元的肺结节切除术单中心回顾性分析. 中国临床保健杂志, 2023, 26(5): 705-708.Sun XX, Xu MQ, Zhang CK, et al. A single-center retrspective study of pulmonary nodular resection using lung subsegments as anatomical units. Chin J Clin Healthc, 2023, 26(5): 705-708.
14.	王程, 李炎, 薛博仁, 等. 三维CT支气管血管成像(3D-CTBA)导航联合亚段切除术处理肺段间结节的效果分析. 当代医学, 2019, 25(21): 119-121.Wang C, Li Y, Xue BR, et al. Three-dimensional CT bronchial angiography (3D-CTBA) navigation combined with subsegmental analysis of the effect of resection in the management of intersegmental lung nodules. Contemp Med, 2019, 25(21): 119-121.
15.	吴佳云, 杨建胜, 林良安, 等. 胸腔镜下肺亚段切除术治疗早期肺癌患者的临床效果. 中外医学研究, 2023, 21(29): 137-140.Wu JY, Yang JS, Lin LA, et al. Clinical effect of pulmonary subsegment resection under thoracoscopy in the treatment of patients with early lung cancer. Chin Foreign Med Res, 2023, 21(29): 137-140.
16.	吴涛, 刘建, 詹必成. 胸腔镜下肺亚段切除术临床可行性研究. 蚌埠医学院学报, 2022, 47(5): 608-611, 615.Wu T, Liu J, Zhan BC. Clinical feasibility study of thoracoscopic subsegmental pulmonary resection. J Bengbu Med Coll, 2022, 47(5): 608-611, 615.
17.	吴卫兵, 夏阳, 许晶, 等. 3D导航胸腔镜联合肺亚段切除术治疗肺段间结节的对比研究. 南京医科大学学报(自然科学版), 2018, 38(10): 1424-1427.Wu WB, Xia Y, Xu J, et al. A comparative study of 3D navigated thoracoscopy combined with lung subsegmental resection for intersegmental lung nodules. J Nanjing Medl Univ (Nat Sci), 2018, 38(10): 1424-1427.
18.	徐子唯, 肖博, 王冲, 等. 肺亚段切除在早期肺癌中的应用. 中国医刊, 2023, 58(10): 1087-1090.Xu ZW, Xiao B, Wang C, et al. Application of subsegmentectomy in early lung cancer. Chin J Med, 2023, 58(10): 1087-1090.
19.	朱燚宁, 李志华, 何志成, 等. 胸腔镜下肺亚段切除术的临床对比研究. 南京医科大学学报(自然科学版), 2020, 40(6): 870-874.Zhu YN, Li ZH, He ZC, et al. A comparative clinical study of thoracoscopic subsegmental lung resection. J Nanjing Med Univ (Nat Sci), 2020, 40(6): 870-874.
20.	Chang CC, Yen YT, Lin CY, et al. Single-port video-assisted thoracoscopic surgery subsegmentectomy: The learning curve and initial outcome. Asian J Surg, 2020, 43(5): 625-632.
21.	Gao C, Xu WZ, Wu WB, et al. Surgical outcomes of anatomical sublobar resections of left upper lobe and a technique of subsegmentectomy based on bronchovascular patterns. Asian J Surg, 2023, 46(1): 260-268.
22.	Kato H, Oizumi H, Suzuki J, et al. Roles and outcomes of thoracoscopic anatomic lung subsegmentectomy for lung cancer. Interact Cardiovasc Thorac Surg, 2022, 34(1): 81-90.
23.	Okada M, Nishio W, Sakamoto T, et al. Effect of tumor size on prognosis in patients with non-small cell lung cancer: The role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg, 2005, 129(1): 87-93.
24.	Oizumi H, Kanauchi N, Kato H, et al. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: A report of 52 consecutive cases. J Thorac Cardiovasc Surg, 2011, 141(3): 678-682.
25.	Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
26.	Haruki T, Aokage K, Miyoshi T, et al. Mediastinal nodal involvement in patients with clinical stageⅠnon-small-cell lung cancer: Possibility of rational lymph node dissection. J Thorac Oncol, 2015, 10(6): 930-936.
27.	El-Sherif A, Fernando HC, Santos R, et al. Margin and local recurrence after sublobar resection of non-small cell lung cancer. Ann Surg Oncol, 2007, 14(8): 2400-2405.
28.	周少, 朱潇, 杏福宝, 等. 解剖性肺亚段和联合亚段切除术治疗早期非小细胞肺癌的研究进. 沈阳医学院学报, 2024, 26(1): 79-83.Zhou S, Zhu X, Xing FB, et al. Research progress of anatomical subsegmentectomy and combined subsegmentectomy in the treatment of early non-small cell lung cancer. J Shenyang Med Coll, 2024, 26(1): 79-83.
29.	Hamada A, Oizumi H, Kato H, et al. Learning curve for port-access thoracoscopic anatomic lung segmentectomy. J Thorac Cardiovasc Surg, 2018, 156(5): 1995-2003.
30.	Kato H, Oizumi H, Suzuki J, et al. Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules. J Vis Surg, 2017, 3: 105.
31.	Sawabata N, Ohta M, Matsumura A, et al. Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: A multicenter prospective study. Ann Thorac Surg, 2004, 77(2): 415-420.
32.	Song L, Li S, Hao X, et al. Subsegmentectomy versus segmentectomy resection for the treatment of operable patients with stageⅠA non-small cell lung cancer: A meta-analysis. Front Surg, 2023, 9: 1060507.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
3. 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.
4. 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.
5. Ettinger DS, Wood DE, Akerley W, et al. Non-small cell lung cancer, version 1. 2015. J Natl Compr Canc Netw, 2014, 12(12): 1738-1761.
6. Ghaly G, Kamel M, Nasar A, et al. Video-assisted thoracoscopic surgery is a safe and effective alternative to thoracotomy for anatomical segmentectomy in patients with clinical stageⅠnon-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 465-472.
7. Shimizu K, Nagashima T, Ohtaki Y, et al. Analysis of the variation pattern in right upper pulmonary veins and establishment of simplified vein models for anatomical segmentectomy. Gen Thorac Cardiovasc Surg, 2016, 64(10): 604-611.
8. 常鹏, 侯予龙, 公正, 等. CT三维重建技术辅助胸腔镜扩大肺亚段切除术治疗肺段边缘孤立性结节的短期疗效观察. 中华解剖与临床杂志, 2024, 29(2): 120-123.Chang P, Hou YL, Gong Z, et al. Short‐term curative effect of thoracoscopic extended subsegmentectomy under the assistance of 3D‐CTBA on marginal solitary pulmonary nodules. Chin J Anat Clin, 2024, 29(2): 120-123.
9. 李晓亮, 樊立茂, 郭朝卫, 等. 单孔胸腔镜下肺段切除与肺亚段切除治疗早期非小细胞肺癌的疗效分析. 中华肺部疾病杂志(电子版), 2023, 16(6): 845-848.Li XL, Fan LM, Guo CW, et al. Efficacy analysis of single-port thoracoscopic subsegmentectomy versus segmentectomy in the treatment of early stage non-small cell lung cancer. Chin J Lung Dis (Electronic Edition), 2023, 16(6): 845-848.
10. 刘强, 李志华, 王俊, 等. 肺亚段切除术对比肺段切除术治疗早期小结节肺癌的安全性及短期疗效分析. 南京医科大学学报(自然科学版), 2021, 41(8): 1190-1195.Liu Q, Li ZH, Wang J, et al. Analysis of the safety and short-term efficacy of pulmonary subsegmentectomy versus segmentectomy in the treatment of early-stage small nodular lung cancer. J Nanjing Med Univ (Nat Sci), 2021, 41(8): 1190-1195.
11. 陆世民, 常江华, 荣君, 等. 三维CT支气管血管重建引导下胸腔镜亚节段切除术对肺结节的治疗. 中国医学装备, 2024, 21(1): 110-113.Lu SM, Chang JH, Rong J, et al. Treatment of thoracoscopic subsegmental resection under the guidance of 3D reconstruction of bronchial blood vessels of pulmonary for pulmonary nodule. China Med Equip, 2024, 21(1): 110-113.
12. 马世学, 曹炜, 汪丽祥, 等. 术前三维重建指导下两种手术方式治疗肺段间结节的效果比较. 浙江临床医学, 2023, 25(1): 61-63.Ma SX, Cao W, Wang LX, et al. Preoperative three-dimensional reconstruction-guided treatment of intersegmental lung nodules by two surgical approaches: Comparison of outcomes. Zhejiang Clin Med J, 2023, 25(1): 61-63.
13. 孙翔翔, 徐美青, 章传凯, 等. 以肺亚段为解剖单元的肺结节切除术单中心回顾性分析. 中国临床保健杂志, 2023, 26(5): 705-708.Sun XX, Xu MQ, Zhang CK, et al. A single-center retrspective study of pulmonary nodular resection using lung subsegments as anatomical units. Chin J Clin Healthc, 2023, 26(5): 705-708.
14. 王程, 李炎, 薛博仁, 等. 三维CT支气管血管成像(3D-CTBA)导航联合亚段切除术处理肺段间结节的效果分析. 当代医学, 2019, 25(21): 119-121.Wang C, Li Y, Xue BR, et al. Three-dimensional CT bronchial angiography (3D-CTBA) navigation combined with subsegmental analysis of the effect of resection in the management of intersegmental lung nodules. Contemp Med, 2019, 25(21): 119-121.
15. 吴佳云, 杨建胜, 林良安, 等. 胸腔镜下肺亚段切除术治疗早期肺癌患者的临床效果. 中外医学研究, 2023, 21(29): 137-140.Wu JY, Yang JS, Lin LA, et al. Clinical effect of pulmonary subsegment resection under thoracoscopy in the treatment of patients with early lung cancer. Chin Foreign Med Res, 2023, 21(29): 137-140.
16. 吴涛, 刘建, 詹必成. 胸腔镜下肺亚段切除术临床可行性研究. 蚌埠医学院学报, 2022, 47(5): 608-611, 615.Wu T, Liu J, Zhan BC. Clinical feasibility study of thoracoscopic subsegmental pulmonary resection. J Bengbu Med Coll, 2022, 47(5): 608-611, 615.
17. 吴卫兵, 夏阳, 许晶, 等. 3D导航胸腔镜联合肺亚段切除术治疗肺段间结节的对比研究. 南京医科大学学报(自然科学版), 2018, 38(10): 1424-1427.Wu WB, Xia Y, Xu J, et al. A comparative study of 3D navigated thoracoscopy combined with lung subsegmental resection for intersegmental lung nodules. J Nanjing Medl Univ (Nat Sci), 2018, 38(10): 1424-1427.
18. 徐子唯, 肖博, 王冲, 等. 肺亚段切除在早期肺癌中的应用. 中国医刊, 2023, 58(10): 1087-1090.Xu ZW, Xiao B, Wang C, et al. Application of subsegmentectomy in early lung cancer. Chin J Med, 2023, 58(10): 1087-1090.
19. 朱燚宁, 李志华, 何志成, 等. 胸腔镜下肺亚段切除术的临床对比研究. 南京医科大学学报(自然科学版), 2020, 40(6): 870-874.Zhu YN, Li ZH, He ZC, et al. A comparative clinical study of thoracoscopic subsegmental lung resection. J Nanjing Med Univ (Nat Sci), 2020, 40(6): 870-874.
20. Chang CC, Yen YT, Lin CY, et al. Single-port video-assisted thoracoscopic surgery subsegmentectomy: The learning curve and initial outcome. Asian J Surg, 2020, 43(5): 625-632.
21. Gao C, Xu WZ, Wu WB, et al. Surgical outcomes of anatomical sublobar resections of left upper lobe and a technique of subsegmentectomy based on bronchovascular patterns. Asian J Surg, 2023, 46(1): 260-268.
22. Kato H, Oizumi H, Suzuki J, et al. Roles and outcomes of thoracoscopic anatomic lung subsegmentectomy for lung cancer. Interact Cardiovasc Thorac Surg, 2022, 34(1): 81-90.
23. Okada M, Nishio W, Sakamoto T, et al. Effect of tumor size on prognosis in patients with non-small cell lung cancer: The role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg, 2005, 129(1): 87-93.
24. Oizumi H, Kanauchi N, Kato H, et al. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: A report of 52 consecutive cases. J Thorac Cardiovasc Surg, 2011, 141(3): 678-682.
25. Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
26. Haruki T, Aokage K, Miyoshi T, et al. Mediastinal nodal involvement in patients with clinical stageⅠnon-small-cell lung cancer: Possibility of rational lymph node dissection. J Thorac Oncol, 2015, 10(6): 930-936.
27. El-Sherif A, Fernando HC, Santos R, et al. Margin and local recurrence after sublobar resection of non-small cell lung cancer. Ann Surg Oncol, 2007, 14(8): 2400-2405.
28. 周少, 朱潇, 杏福宝, 等. 解剖性肺亚段和联合亚段切除术治疗早期非小细胞肺癌的研究进. 沈阳医学院学报, 2024, 26(1): 79-83.Zhou S, Zhu X, Xing FB, et al. Research progress of anatomical subsegmentectomy and combined subsegmentectomy in the treatment of early non-small cell lung cancer. J Shenyang Med Coll, 2024, 26(1): 79-83.
29. Hamada A, Oizumi H, Kato H, et al. Learning curve for port-access thoracoscopic anatomic lung segmentectomy. J Thorac Cardiovasc Surg, 2018, 156(5): 1995-2003.
30. Kato H, Oizumi H, Suzuki J, et al. Video-assisted thoracoscopic subsegmentectomy for small-sized pulmonary nodules. J Vis Surg, 2017, 3: 105.
31. Sawabata N, Ohta M, Matsumura A, et al. Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: A multicenter prospective study. Ann Thorac Surg, 2004, 77(2): 415-420.
32. Song L, Li S, Hao X, et al. Subsegmentectomy versus segmentectomy resection for the treatment of operable patients with stageⅠA non-small cell lung cancer: A meta-analysis. Front Surg, 2023, 9: 1060507.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-term efficacy and safety of pulmonary subsegmentectomy versus segmentectomy in the treatment of patients with small pulmonary nodules: A systematic review and meta-analysis

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