Total Thoracoscopic Anatomic Pulmonary Segmentectomy for 20 Patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIN Zongwu , JIANG Wei , WANG Qun

Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;

Corresponding author：

Keywords：

Thoracoscopy; Anatomic pulmonary segmentectomy; Lung cancer; Pulmonary metastases; Benign pulmonary disease

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Abstract： Objective To evaluate the safety and efficacy of total thoracoscopic anatomic pulmonary segmentectomy for the treatment of early-stage peripheral lung carcinoma, pulmonary metastases and benign pulmonary diseases. Methods We retrospectively analyzed 20 patients who received total thoracoscopic anatomic pulmonary segmentectomy in Zhongshan Hospital of Fudan University from March 2008 to November 2011. There were ten male and ten female patients with a mean age of 58.0（14-86）years. Three ports were used. The pulmonary artery and vein of the segment were
dealt with Hem-o-lok or stapler. The bronchi of the segment were dealt with staplers. Staplers were used in peripheral lung of intersegmental plane. Results All the twenty patients underwent total thoracoscopic anatomic segmentectomy successfully without any conversion to thoracoctomy or lobectomy. No perioperative morbidity or mortality occurred. Postoperative pathological examinations showed lung cancer in 10 patients, pulmonary metastases in 3 patients and benign pulmonary diseases in 7 patients. The mean operative time was 133.0（90-240）min. The mean blood loss was 85.0（50-200）ml. The chest tubes were maintained in position for 3.2 （2-7） d. The mean postoperative hospitalization time was 6.7 （4-11）d.
Conclusion Total thoracoscopic anatomic pulmonary segmentectomy is a feasible and safe technique to be used selectively for Ⅰa stage lung cancer, pulmonary metastases and benign pulmonary diseases that are not appropriate for wedge resection.

Citation： LIN Zongwu,JIANG Wei,WANG Qun,et al.. Total Thoracoscopic Anatomic Pulmonary Segmentectomy for 20 Patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(3): 270-273. doi: Copy

1.	Churchill ED, Belsey R. Segmental pneumonectomy in bronchiectasis： The lingula segment of the left upper lobe. Ann Surg, 1939, 109 （4）： 481-499.
2.	Bonfils-Roberts EA, Clagett OT. Contemporary indications for pulmonary segmental resections. J Thorac Cardiovasc Surg, 1972, 63 （3）： 433-438.
3.	Jensik RJ, Faber LP, Milloy FJ, et al. Segmental resection for lung Cancer. a fifteen-year experience.J Thorac Cardiovasc Surg, 1973, 66（4）： 563-572.
4.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung Cancer. Ann Thorac Surg, 1995, 60 （3）： 615-623.
5.	Fernando HC, Santos RS, Benfield JR, et al. Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung Cancer. J Thorac Cardiovasc Surg, 2005, 129 （2）： 261-267.
6.	Okumura M, Goto M, Ideguchi K, et al. Factors associated with outcome of segmentectomy for non-small cell lung cancer： long-term follow-up study at a single institution in Japan. Lung Cancer, 2007, 58 （2）： 231-237.
7.	Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique： selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. Thorac Cardiovasc Surg, 2007, 133 （3）： 753-758.
8.	Watanabe A, Ohori S, Nakashima S, et al. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg, 2009, 35 （5）： 775-780.
9.	Sugi K, Kobayashi S, Sudou M, et al. Long-term prognosis of video-assisted limited surgery for early lung cancer. Eur J Cardiothorac Surg, 2010, 37 （2）：456-460.
10.	Yamashita S, Chujo M, Kawano Y, et al. Clinical impact of segmentectomy compared with lobectomy under complete video-assisted thoracic surgery in the treatment of stage I non-small cell lung cancer. J Surg Res, 2011, 166 （1）： 46-51.
11.	Oizumi H, Kanauchi N, Kato H, et al. Total thoracoscopic pulmonary segmentectomy. Eur J Cardiothorac Surg, 2009, 36 （2）： 374-377.
12.	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.
13.	Nakamura K, Saji H, Nakajima R, et al. A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer （JCOG0802/WJOG4607L）. Jpn J Clin Oncol, 2010, 40 （3）： 271-274.
14.	National Institutes of Health. National Cancer Institute. CALGB-140503. Phase Ⅲ randomized study of lobectomy versus sublobar resection in patients with small peripheral stage IA non-small cell lung cancer. [2010-03-16] http：//www. cancer. gov/clinicaltrials/CALGB-140503.
15.	El-Sherif A, Gooding WE, Santos R, et al. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer： a 13-year analysis. Ann Thorac Surg, 2006, 82 （2）： 408-415.
16.	Sienel W, Stremmel C, Kirschbaum A, et al. Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localization and width of resection margins–implications for patient selection for segmentectomy. Eur J Cardiothorac Surg, 2007, 31 （3）： 522-527.
17.	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.
18.	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.
19.	Watanabe S, Oda M, Go T, et al. Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized （2 cm or less） lung cancer? Retrospective analysis of 225 patients. Eur J Cardiothorac Surg, 2001, 20 （5）： 1007-1011.
20.	Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer：a multicenter study. J Thorac Cardiovasc Surg, 2006, 132 （4）：769-775.
21.	Wolf AS, Richards WG, Jaklitsch MT, et al. Lobectomy versus sublobar resection for small （2 cm or less） non-small cell lung cancers. Ann Thorac Surg, 2011, 92 （5）： 1819-1823.

1. 　Churchill ED, Belsey R. Segmental pneumonectomy in bronchiectasis： The lingula segment of the left upper lobe. Ann Surg, 1939, 109 （4）： 481-499.
2. 　Bonfils-Roberts EA, Clagett OT. Contemporary indications for pulmonary segmental resections. J Thorac Cardiovasc Surg, 1972, 63 （3）： 433-438.
3. 　Jensik RJ, Faber LP, Milloy FJ, et al. Segmental resection for lung Cancer. a fifteen-year experience.J Thorac Cardiovasc Surg, 1973, 66（4）： 563-572.
4. 　Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung Cancer. Ann Thorac Surg, 1995, 60 （3）： 615-623.
5. 　Fernando HC, Santos RS, Benfield JR, et al. Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung Cancer. J Thorac Cardiovasc Surg, 2005, 129 （2）： 261-267.
6. 　Okumura M, Goto M, Ideguchi K, et al. Factors associated with outcome of segmentectomy for non-small cell lung cancer： long-term follow-up study at a single institution in Japan. Lung Cancer, 2007, 58 （2）： 231-237.
7. 　Okada M, Mimura T, Ikegaki J, et al. A novel video-assisted anatomic segmentectomy technique： selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. Thorac Cardiovasc Surg, 2007, 133 （3）： 753-758.
8. 　Watanabe A, Ohori S, Nakashima S, et al. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg, 2009, 35 （5）： 775-780.
9. 　Sugi K, Kobayashi S, Sudou M, et al. Long-term prognosis of video-assisted limited surgery for early lung cancer. Eur J Cardiothorac Surg, 2010, 37 （2）：456-460.
10. 　Yamashita S, Chujo M, Kawano Y, et al. Clinical impact of segmentectomy compared with lobectomy under complete video-assisted thoracic surgery in the treatment of stage I non-small cell lung cancer. J Surg Res, 2011, 166 （1）： 46-51.
11. 　Oizumi H, Kanauchi N, Kato H, et al. Total thoracoscopic pulmonary segmentectomy. Eur J Cardiothorac Surg, 2009, 36 （2）： 374-377.
12. 　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.
13. 　Nakamura K, Saji H, Nakajima R, et al. A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer （JCOG0802/WJOG4607L）. Jpn J Clin Oncol, 2010, 40 （3）： 271-274.
14. 　National Institutes of Health. National Cancer Institute. CALGB-140503. Phase Ⅲ randomized study of lobectomy versus sublobar resection in patients with small peripheral stage IA non-small cell lung cancer. [2010-03-16] http：//www. cancer. gov/clinicaltrials/CALGB-140503.
15. 　El-Sherif A, Gooding WE, Santos R, et al. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer： a 13-year analysis. Ann Thorac Surg, 2006, 82 （2）： 408-415.
16. 　Sienel W, Stremmel C, Kirschbaum A, et al. Frequency of local recurrence following segmentectomy of stage IA non-small cell lung cancer is influenced by segment localization and width of resection margins–implications for patient selection for segmentectomy. Eur J Cardiothorac Surg, 2007, 31 （3）： 522-527.
17. 　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.
18. 　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.
19. 　Watanabe S, Oda M, Go T, et al. Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized （2 cm or less） lung cancer? Retrospective analysis of 225 patients. Eur J Cardiothorac Surg, 2001, 20 （5）： 1007-1011.
20. 　Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer：a multicenter study. J Thorac Cardiovasc Surg, 2006, 132 （4）：769-775.
21. 　Wolf AS, Richards WG, Jaklitsch MT, et al. Lobectomy versus sublobar resection for small （2 cm or less） non-small cell lung cancers. Ann Thorac Surg, 2011, 92 （5）： 1819-1823.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Total Thoracoscopic Anatomic Pulmonary Segmentectomy for 20 Patients

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