Clinical application status of multiple localization methods in the treatment of pulmonary nodules by sub-lobectomy / 中国胸心血管外科临床杂志

@#The precise localization of pulmonary nodules has become an important technical key point in the treatment of pulmonary nodules by thoracoscopic surgery, which is a guarantee for safe margin and avoiding removal of too much normal lung parenchyma. With the development of medical technology and equipment, the methods of locating pulmonary nodules are also becoming less trauma and convenience. There are currently a number of methods applied to the preoperative or intraoperative localization of pulmonary nodules, including preoperative percutaneous puncture localization, preoperative transbronchial localization, intraoperative palpation localization, intraoperative ultrasound localization, and localization according to anatomy. The most appropriate localization method should be selected according to the location of the nodule, available equipment, and surgeon鈥檚 experience. According to the published literatures, we have sorted out a variety of different theories and methods of localization of pulmonary nodules in this article, summarizing their advantages and disadvantages for references.

CALGB140503 study: Is sublobectomy the standard procedure for early peripheral lung cancer? / 中国胸心血管外科临床杂志

@#While lobectomy is the standard surgical procedure for early-stage non-small cell lung cancer (NSCLC), sublobectomy (segmentectomy/wedge resection) has been gaining progress in early-stage peripheral NSCLC in recent years because it preserves more lung parenchyma and has the advantages of good postoperative lung function, relatively less trauma, and faster recovery. However, there has been a lack of standardized randomized clinical trials to study the survival benefits of sublobectomy. The results of a high-profile study from the USA, CALGB140503, have been the subject of intense industry debate since its presentation at the 2022 World Conference on Lung Cancer (IASLC WCLC 2022). The study, which was published in The New England Journal of Medicine on February 9, 2023, was designed to investigate whether sublobectomy was not inferior to lobectomy in terms of survival in patients with early-stage peripheral NSCLC (tumor diameter≤2 cm). The results showed that sublobectomy was not worse than lobectomy for survival in patients with T1aN0M0 peripheral NSCLC with tumor diameter≤2 cm and pathologically confirmed negative hilar and mediastinal lymph nodes. Sublobectomy, including anatomical segmentectomy and wedge resection is an effective NSCLC treatment. The results of this study provide strong evidence for the improved outcomes of sublobectomy in terms of lung function protection and are expected to promote the further use of sublobectomy. However, given the limitations of this study, whether sublobectomy, especially wedge resection, can become a standard procedure still needs to be explored. This paper presents an interpretation of this study and we invite experts in the field to discuss its usefulness in guiding clinical practice and summarise its limitations.

Identification of pulmonary nodule location in three dimensional images and its clinical significance / 中国胸心血管外科临床杂志

@#Objective    To analyze the difference of location identification of pulmonary nodules in two dimensional (2D) and three dimensional (3D) images, and to discuss the identification methods and clinical significance of pulmonary nodules location in 3D space. Methods    The clinical data of 105 patients undergoing sublobectomy in the Department of Thoracic Surgery, the First Affiliated Hospital with Nanjing Medical University from December 2018 to December 2019 were analyzed retrospectively. There were 28 males and 77 females, with an average age of 57.21±13.19 years. The nodule location was determined by traditional 2D method and 3D depth ratio method respectively, and the differences were compared. Results    A total of 30 nodules had different position identification between the two methods, among which 25 nodules in the inner or middle zone of 2D image were located in the peripheral region of 3D image. The overall differences between the two methods were statistically significant (P<0.05). The diagnostic consistency rates of two methods were 66.67% in the right upper lung, 83.33% in the right middle lung, 73.68% in the right lower lung, 75.76% in the left upper lung, and 64.71% in the left lower lung. In each lung lobe, the difference between the two methods in the right upper lung (P=0.014) and the left upper lung (P=0.019) was statistically significant, while in the right middle lung (P=1.000), right lower lung (P=0.460) and left lower lung (P=0.162) were not statistically significant. Conclusion    The 3D position definition of lung nodules based on depth ratio is more accurate than the traditional 2D definition, which is helpful for preoperative planning of sublobectomy.

Prognostic Analysis of Lobectomy versus Sublobar Resection in Patients Aged ≥60 Years with Stage Ia Small Cell Lung Cancer / 中国肺癌杂志

BACKGROUND@#Currently, the prognosis of lobectomy and sub-lobectomy for the treatment of stage Ia small cell lung cancer (SCLC) is rarely reported. We retrospectively studied T1N0M0 (≤3 cm) SCLC patients aged ≥60 years, aiming to comparatively analyze the prognosis of lobectomy and sub-lobectomy in treating patients with Ia SCLC.@*METHODS@#Patients with stage Ia SCLC diagnosed by pathologic between 1992 and 2010 were selected from the "Surveillance, Epidemiology and End Results database"(SEER). Outcome data were compared using Kaplan-Meier (Log-rank test) and Cox model multivariate analysis.@*RESULTS@#We identified 515 patients. Median overall survival (OS) of the lobectomy (n=110), sublobar resection (n=57) and non-surgical (n=348) cohort were 45, 23 and 16 months, respectively. The corresponding 5-year OS of the three groups were 44%, 30%, and 14%, respectively. No significant difference in the prognosis of patients with or without lymph node examination/ dissection (P=0.107) and the 5-year OS of patients underwent lobectomy with chemoradiation was 50%. Cox multivariable analysis showed that operation treatment, including lobectomy and sublobectomy, was one of the independent factors associated with the prognosis of early SCLC patients, and patients undergo lobectomy shows a better OS compared with sublobar resection (Lob vs Sub, HR=0.645; 95%CI: 0.433-0.961, P=0.031).@*CONCLUSIONS@#For age ≥60 years T1N0M0 (≤3 cm) SCLC patients, we recommend anatomical lobectomy combined with adjuvant chemoradiation.

Pretreatment diagnosis and surgical management of minimally invasive adenocarcinoma / 中华胸心血管外科杂志

Objective In 2011's new IASLC-ATS-ERS(International Association for the Study of Lung Cancer,American Thoracic Society,and European Respiratory Society) lung adenocarcinoma classification,adenocarcinoma in situ and minimally invasive adenocarcinoma(MIA) substituted for bronchioloalveolar carcinoma.The excellent prognosis wins these two histologic types a lot of attention.With the development of image technology,more and more lung adenocarcinomas are detected in early stage.Tumors showing a ground-glass nature in preoperative CT scans are more likely to be minimally invasive adenocarcinoma.This review discusses from the following 6 aspects.Imaging characteristics of MIA,the diagnostic value of intraoperative frozen section,preoperative localization,selection of surgical approaches for ground-glass opacity(GGO) nodules,the extent of lymph nodes dissection and management of multiple primary lung adenocarcinoma.The clinical guideline for early-stage lung adenocarcinoma is still controversial,strong evidence and further studies are needed.

Pretreatment diagnosis and surgical management of minimally invasive adenocarcinoma / 中华胸心血管外科杂志

Objective In 2011's new IASLC-ATS-ERS(International Association for the Study of Lung Cancer,American Thoracic Society,and European Respiratory Society) lung adenocarcinoma classification,adenocarcinoma in situ and minimally invasive adenocarcinoma(MIA) substituted for bronchioloalveolar carcinoma.The excellent prognosis wins these two histologic types a lot of attention.With the development of image technology,more and more lung adenocarcinomas are detected in early stage.Tumors showing a ground-glass nature in preoperative CT scans are more likely to be minimally invasive adenocarcinoma.This review discusses from the following 6 aspects.Imaging characteristics of MIA,the diagnostic value of intraoperative frozen section,preoperative localization,selection of surgical approaches for ground-glass opacity(GGO) nodules,the extent of lymph nodes dissection and management of multiple primary lung adenocarcinoma.The clinical guideline for early-stage lung adenocarcinoma is still controversial,strong evidence and further studies are needed.

The role of video‑assisted thoracoscopic surgery in management of the multiple ground‑glass nodules.

OBJECTIVE: We investigated the outcomes of patients with multiple ground‑glass nodules (GGNs) to identify the role of video‑assisted thoracoscopic surgery (VATS) in diagnosis and treatment. PATIENTS AND METHODS: We included patients with multiple GGNs who were qualified for thoracoscopic surgery resection and analyzed the statistics. RESULTS: Fifty‑one GGNs were detected in 21 patients. There were 40 pure GGNs and 11 part‑solid ones. Around 46 of the 51 lesions were resected via VATS. Four pure GGNs <10 mm and deep in the lung were proceeded with continuous follow‑up. One pure GGN measuring 16 mm considered as subnodule and also deep in the lung underwent stereotactic ablative radiotherapy. Resection methods included lobectomy (1), segmentectomy (1), lobectomy + segmentectomy (6), lobectomy + wedge resection (10), and segmentectomy + wedge resection (3). Of the 46 resected lesions, 4 (8.7%) were atypical adenomatous hyperplasia (AAH), 23 (50%) were adenocarcinoma in situ (AIS), 15 (32.7%) were minimally invasive adenocarcinoma (MIA), 2 (4.3%) were invasive adenocarcinoma, one was pulmonary sclerosing hemangioma, and one was nonspecific fibrosis. Intersegmental lymph node metastasis was found in one of the 21 patients. No postoperational complication occurred in any of the patients. CONCLUSION: Multiple GGNs were generally independent primary lung cancers, mainly including AAH, AIS, MIA, rather than intrapulmonary metastasis. VATS was superior to thoracotomy for less invasive and shorter hospital stay.

Clinical application of clock dial integrated positioning for small pulmonary nodules in VATS / 中华胸心血管外科杂志

Objective With the popularization of low dose chest CT examination,a large number of patients with pulmonary nodules(10 mm ＜ D≤20 mm) or small nodules(4 mm ＜ D≤10 mm) emerged.How to accurately position pulmonary nodules especially small nodules in video-assisted thoracoscopic surgery(VATS) is the key.This study explores the positioning method for small pulmonary nodules in VATS.Methods From January 2012 to June 2014,we used a method named clock dial integrated positioning in 316 patients with pulmonary nodules who underwent limited resection or lobectomy in VATS,obtained satisfactory results.Results The accuracy of clock dial integrated positioning method in judgments was 99％ (313/316).296 cases underwent thoracoscopic sublobectomy,including thoracoscopic pulmonary segmental resection in 141 cases and thoracoscopic wedge resection in 155 cases.20 cases underwent thoracoscopic lobectomy.Among them 17 cases had multinodules which were in the different pulmonary segments of the same lobe.Underwent thoracoscopic lobectomy.The positions of 3 cases were error during early cases,underwent VATS lobectomy.The postoperative pathology:194 cases were lung cancer.37 cases were metastatic tumor.85 cases were benign lesions.Conclusion Combined with the clinical treatment experience,we believe that the clock dial integrated positioning method is effective for positioning in VATS.Clinical VATS experiences accumulations are also needed.