Abstract

 

OBJECTIVES

We performed sublobar resections, including thoracoscopic segmentectomy and subsegmentectomy for small lung cancers, and analysed the results of indications and outcomes of thoracoscopic subsegmentectomy.

METHODS

Between March 2005 and May 2020, 357 consecutive patients underwent thoracoscopic anatomic sublobar resections for lung cancer, including 68 patients undergoing subsegmentectomy. These patients were compared with 289 patients who underwent segmentectomy during the same period.

RESULTS

Subsegmentectomies included mono-/bi-/tri-subsegmentectomies for 34/23/11 of 68 patients, respectively. The median tumour size was 13.5 mm, significantly smaller than tumours in patients who underwent a segmentectomy (P < 0.001). Tumours obtained by mono-subsegmentectomy (11.0 mm) were significantly smaller than bi-/tri-subsegmentectomy (P = 0.028). The proportion of ground-glass opacity-dominant tumours obtained by subsegmentectomy (85.3%) was higher than that obtained by segmentectomy. The proportion of intentional cases satisfying the criteria for sublobar resection was higher than that of segmentectomy cases. Although tumour locations in 40 patients were not identified during surgery, tumours were correctly resected in 39 patients without tumour markers. The median operative time and blood loss were 167 min and 13 ml, significantly shorter and less, respectively, in subsegmentectomy than in segmentectomy patients (P = 0.005, P = 0.006). Duration of drainage and hospitalization were 1 and 5 days, respectively, for subsegmentectomy patients; complications occurred in 6 (8.8%). Outcomes were similar to those of the segmentectomy patients. Although 4 subsegmentectomy patients died of other diseases, none showed cancer recurrence during a mean follow-up of 50 months.

CONCLUSIONS

Thoracoscopic subsegmentectomy can be used for patients with ground-glass opacity-dominant lung cancers <1.5 cm if adequate margins can be secured.

中文翻译：

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胸腔镜解剖性肺亚段切除术在肺癌中的作用和结局

摘要

 

目标

我们进行了亚肺叶切除术，包括胸腔镜肺段切除术和小肺癌亚肺段切除术，并分析了胸腔镜亚肺段切除术的适应症和结果。

方法

2005 年 3 月至 2020 年 5 月期间，连续 357 名患者接受了胸腔镜下肺癌亚肺叶解剖切除术，其中 68 名患者接受了亚肺段切除术。这些患者与同期接受肺段切除术的 289 名患者进行了比较。

结果

亚段切除术包括对 68 名患者中的 34/23/11 分别进行单/双/三亚段切除术。中位肿瘤大小为 13.5 mm，明显小于接受肺段切除术患者的肿瘤（P  < 0.001）。单亚段切除术（11.0 mm）获得的肿瘤明显小于双/三亚段切除术（P = 0.028）。亚节段切除获得的以磨玻璃样混浊为主的肿瘤比例（85.3%）高于节段切除获得的比例。符合亚肺叶切除标准的有意病例比例高于肺段切除病例。虽然 40 名患者的肿瘤位置在手术过程中未确定，但 39 名患者的肿瘤被正确切除，但没有肿瘤标志物。亚段切除术的中位手术时间和失血量分别为 167 分钟和 13 毫升，明显短于肺段切除术患者（P  = 0.005，P = 0.006)。亚节段切除患者的引流时间和住院时间分别为 1 天和 5 天；6例（8.8%）出现并发症。结果与肺段切除术患者的结果相似。尽管有 4 名亚节段切除术患者死于其他疾病，但在平均 50 个月的随访期间均未出现癌症复发。

结论

如果能够确保足够的切缘，则可对毛玻璃样混浊为主的肺癌患者进行胸腔镜下亚段切除术<1.5 cm。