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@#Objective To compare the clinical effects of lobectomy and sublobar resection in the treatment of lung metastasis and to analyze the factors affecting patient prognosis. Methods A retrospective analysis was performed on the clinical data of 165 patients with pulmonary metastasis who underwent thoracic surgery at the Affiliated Tumor Hospital of Xinjiang Medical University between March 2010 and May 2021, including 67 males and 98 females, with a median age of 52 (44, 62) years. According to the operation methods, patients were divided into a lobectomy group and a sublobar resection group. The clinical data of the patients were compared between the two groups. The Cox proportional hazard model was used for univariate and multivariate analyses. Results The 3- and 5-year overall survival rates were 60.0% and 34.3%, respectively, and the median survival time was 24 months. The 3- and 5-year disease-free survival rates were 39.4% and 23.7%, respectively. Compared with the lobectomy group, the sublobar resection group had shorter operation time for pulmonary metastases (P<0.001), less intraoperative blood loss (P<0.001), less drainage volume on the first day after surgery (P<0.001), less incidence of prolonged air leak (P=0.004), shorter drainage tube indwelling time (P=0.002), and shorter postoperative hospital stay (P=0.023). The disease-free survival time after sublobar resection and lobectomy was 26 months and 24 months, respectively, with no statistical difference (P=0.970). The total survival time of the two groups was 73 months and 69 months, respectively, with no significant difference (P=0.697). Multivariate analysis showed that sex [HR=0.616, 95%CI (0.390, 0.974), P=0.038], disease-free interval [HR=1.753, 95%CI (1.082, 2.842), P=0.023], and postoperative adjuvant therapy [HR=2.638, 95%CI (1.352, 5.147), P=0.004] were independent influencing factors for disease-free survival of patients who underwent pulmonary metastasectomy. Disease-free interval [HR=2.033, 95%CI (1.062, 3.894), P=0.032] and preoperative carcinoembryonic antigen level [HR=2.708, 95%CI (1.420, 5.163), P=0.002] were independent factors influencing the overall survival of patients in this group. Conclusion Sublobar resection provides a safe and effective treatment option for patients with pulmonary metastasis on the premise of ensuring R0 resection of lung metastasis. Sex, disease-free interval, preoperative carcinoembryonic antigen level, and adjuvant therapy after pulmonary metastasectomy are the independent influencing factors for the prognosis.
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@#Objective To analyze the results and rationality of the lesion-focused strategy with subsegment as the pulmonary anatomical unit for pulmonary nodules with a diameter of ≤2 cm which require surgery. Methods Clinical data of 246 patients with pulmonary nodules who underwent surgery in the Department of Thoracic Surgery of The First Affiliated Hospital of Nanjing Medical University from January 2017 to October 2018 were retrospectively analyzed, including 76 males and 170 females, with an average age of 53.30±11.82 years. The patients were divided into four groups, a single segmentectomy group, a segmentectomy combined with adjacent subsegmentectomy group, a single subsegmentectomy group and a combined subsegmentectomy group, according to the different surgical approaches, to compare preoperative, intraoperative, and postoperative related data. Results There was no perioperative death. Among the four groups, there was no statistical difference in gender (P=0.163), age (P=0.691), diameter of the nodule (P=0.743), longitudinal position of the nodule (depth ratio, P=0.831), postoperative pulmonary leakage (P=0.752), intraoperative blood loss (P=0.135), pathological type (P=0.951) or TNM stage (P=0.995); there were statistical differences in transverse position of the nodule (P<0.001) and number of subsegments involved (P<0.001). The results of multivariate logistic regression analysis showed that compared with combined subsegmentectomy, the odds ratio (OR) of the lung nodule in segmentectomy combined with adjacent subsegmentectomy as intersegment nodules was 5.759 (95%CI 1.162 to 28.539, P=0.032). Conclusion The surgical strategy of lesion focused and subsegment as anatomical unit is safe and feasible for surgical treatment of pulmonary nodules with diameter ≤2 cm. The transverse position of the nodules is an important factor affecting the choice of surgical method for the middle and lateral nodules with a diameter of ≤2 cm, and the longitudinal location of the nodule is not an influencing factor. For nodules in inner zone, the diameter also is one of the factors influencing the choice of surgical method.
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@#Objective To investigate the surgical procedure selection, operation technique and safety of anatomic sublobar resection for pulmonary nodules. Methods The clinical data of 242 patients with clinical stage ⅠA lung cancer who underwent anatomic sublobar resection in our hospital between 2017 and 2020 were retrospectively analyzed. There were 81 males and 161 females with a median age of 57.0 (50.0, 65.0) years. They were divided into 4 groups according to the surgical methods, including a segmentectomy group (n=148), a combined segmentectomy group (n=31), an enlarged segmentectomy group (n=43) and an anatomic wedge resection group (n=20). The preoperative CT data, operation related indexes and early postoperative outcomes of each group were summarized. Results The median medical history of the patients was 4.0 months. The median maximum diameter of nodule on CT image was 1.1 cm, and the consolidation/tumor ratio (CTR) was ≤0.25 in 81.0% of the patients. A total of 240 patients were primary lung adenocarcinoma. The median operation time was 130.0 min, the median blood loss was 50.0 mL, the median chest drainage time was 3.0 d, and the hospitalization cost was (53.0±12.0) thousand yuan. The operation time of combined segmentectomy was longer than that of the segmentectomy group (P=0.001). The operation time (P=0.000), intraoperative blood loss (P=0.000), lymph nodes dissected (P=0.007) and cost of hospitalization (P=0.000) in the anatomic wedge resection group were shorter or less than those in the other three groups. There was no significant difference in the drainage time, total drainage volume, air leakage or postoperative hospital stay among the four groups (P>0.05). Conclusion The combined application of segmentectomy and wedge resection technique provides a more flexible surgical option for the surgical treatment of early lung cancer with ground glass opacity as the main component.
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@#Objective To investigate the effectiveness of sublobar resection and lobectomy via uniportal video-assisted thoracoscopic surgery (U-VATS) for lung metastases from colorectal cancer. Methods Retrospective research was conducted on 42 colorectal cancer patients with lung metastases who underwent U-VATS sublobar resection and lobectomy at the Tongji Hospital, Huazhong University of Science and Technology between April 2016 and May 2019, including 24 males and 18 females with an average age of 58.0±9.9 years. Among them 17 patients received U-VATS sublobar resection and 25 patients received lobectomy. The operation time, intraoperative blood loss, postoperative pulmonary infection, drainage tube indwelling time, drainage volume on the first day after surgery, postoperative hospital stay were analyzed between the two groups, and the relationship between the prognosis and clinical characteristics of the two groups was compared. Results Sublobar resection patients had less lung metastases (P=0.043) and shorter operation time (P=0.023) compared with the lobectomy patients. There was no significant difference between the lobectomy and sublobar resection groups in intraoperative blood loss (P=0.169), rate of postoperative infection (P=0.982), postoperative drainage duration (P=0.265), drainage volume on the first day after surgery (P=0.402) and postoperative hospital stay (P=0.612). The progression-free survival of the two groups was 25.19 months and 23.63 months (P=0.721), and their overall survival was 29.09 months and 30.64 months (P=0.554). Conclusion Considering guantity and locations of lung metastases, U-VATS sublobar resection can achieve a similar prognosis to lobectomy for lung metastases from colorectal cancer. Further efficacy of this surgical strategy remains to be proved by longer follow-up.
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In recent years, with the popularization of low-dose computed tomography (LDCT) and high-resolution CT (HRCT), the discovery rate of early-staged non-small cell lung cancer has been on the rise, and more thoracic surgeons have explored more reasonable resection scope. Clinical studies have demonstrated that there is a lower rate of local tumor recurrence in patients with negative lung margins compared with positive ones. Therefore, it is of great clinical significance to ensure the negative margin during sublobar resection for early-staged lung cancer. This paper will focus on this area. .
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung , Pathology , General Surgery , Lung , Pathology , General Surgery , Lung Neoplasms , Pathology , General Surgery , Neoplasm Staging , RecurrenceABSTRACT
The curative treatment of choice for stage Ⅰ or Ⅱ non-small cell lung cancer (NSCLC) patients is usually surgical resection and the two surgical resection methods are lobectomy and sublobar resection.At present,the standard resection for early stage NSCLC is lobectomy.But more and more researches involve the sublobar resection for early stage NSCLC and its effect has been controversial.The research of how to improve the outcomes of sublobar resection is also emerging endlessly.The present paper reviews the effect of sublobar resection and the factors of impacting on its curative effect.