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• W4213164735 abstract "Central MessageAnatomical segmentectomy with hilar and mediastinal lymph node dissection should be standard surgery for NSCLC ≤2 cm with a C/T ratio >0.5, ie, solid predominant features, on HRCT images.See Article page 207. Anatomical segmentectomy with hilar and mediastinal lymph node dissection should be standard surgery for NSCLC ≤2 cm with a C/T ratio >0.5, ie, solid predominant features, on HRCT images. See Article page 207. One definitive answer to the clinical question as to whether patients with early-stage, non–small cell lung cancer (NSCLC) ≤2 cm should be treated by segmentectomy or lobectomy has transpired from a prospective randomized trial conducted by the Japanese Clinical Oncology Group 0802 (JCOG0802)/West Japan Oncology Group 4607L (WJOG4607L).1Saji H. Okada M. Tsuboi M. Nakajima R. Suzuki K. Aokage K. et al.Segmentectomy versus lobectomy in small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L): a multicentre, randomised, controlled, phase 3 trial.Lancet. September 7, 2021; ([Epub ahead of print])Google Scholar,2Nakamura K. Saji H. Nakajima R. Okada M. Asamura H. Shibata T. 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: 271-274Google Scholar The results of this clinical trial indicated that radical anatomical segmentectomy with hilar and mediastinal lymph node dissection should be the standard surgical procedure for peripherally located NSCLC ≤2 cm with a consolidation to tumor ratio >0.5, eg, solid predominant features on high-resolution computed tomography images. Moreover, the ongoing JCOG1211 and Cancer and Leukemia Group B (CALGB) 140503 trial will disclose additional information about segmentectomy for patients with early-stage NSCLCs.3Aokage K. Saji H. Suzuki K. Mizutani T. Katayama H. Shibata T. et al.A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211).Gen Thorac Cardiovasc Surg. 2017; 65: 267-272Google Scholar,4Altorki N.K. Wang X. Wigle D. Gu L. Darling G. Ashrafi A.S. et al.Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non–small-cell lung cancer: post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503).Lancet Respir Med. 2018; 6: 915-924Google Scholar Thus, segmentectomy is a key surgical procedure that general thoracic surgeons will need to master as the frequency of detecting small NSCLC continues to increase. Considering the size of a whole tumor rather than only the solid part and central or peripheral location is important for securing a surgical margin to avoid local recurrence after segmentectomy.5Mimae T. Okada M. Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non–small cell lung cancer?.Gen Thorac Cardiovasc Surg. 2020; 68: 703-706Google Scholar In addition, segmentectomy has many procedural variations, such as the subsegmentectomy described by Liu and colleagues.6Liu C. Wang W. Liu L. Thoracoscopic complex pulmonary basal subsegmentectomy: a combined subsegmentectomy of left s9b+10b.J Thorac Cardiovasc Surg Tech. 2022; 12: 207-209Google Scholar Therefore, surgeons will need to understand the anatomical profiles of the pulmonary artery/vein and the bronchus as well as the size and location of tumors. Methods of separating the intersegmental plane mainly comprise cautery and stapling; the latter was selected in the reported case. Cautery is more effective than stapling for postoperative lung expansion, whereas staples are more effective against postoperative air leakage, especially for patients with emphysema or interstitial pneumonia. If pulmonary status is normal as in the reported case, then cautery is also appropriate for separating lung parenchyma. Separating the anatomically correct intersegmental or -subsegmental plane with cautery minimizes blood loss and air leakage for subsegmentectomy as well as segmentectomy. Regarding lung parenchyma separation on the intersegmental plane, the pulmonary vein is a key structure that functions as a drainage vessel for the lung. Only the pulmonary vein from a resected lung segment needs to be cut to avoid residual lung congestion. Therefore, the pulmonary vein should be cut and lung parenchyma should be separated during the last part of surgical procedure. Although the report includes an excellent surgical video, surgeons must be aware of the underlying possibility that the disorientated pulmonary vein could be cut. The report mentions in the Discussion section that the subsegmental hili of S9b/10b are not easy to approach through the interlobar fissures. However, not only because the pulmonary vessels and the bronchus can be easily identified from the transinferior ligament view, identification from various directions including the interlobar fissure view is also important without regard for the transinferior ligament approach. Thoracoscopic complex pulmonary basal subsegmentectomy: A combined subsegmentectomy of left s9b+10bJTCVS TechniquesVol. 12PreviewSegmentectomy is widely used in the treatment of peripheral pulmonary nodules while preserving more functional pulmonary parenchyma.1 For intersegmental nodules, which are deeply located in the pulmonary parenchyma near the intersegmental border, a sufficient margin might not be obtained from a simple segmentectomy. In such cases, combined subsegmentectomy becomes the appropriate therapy of choice.2 As thoracoscopic anatomical basal segmentectomies, those involving the lateral (S9) and/or posterior (S10) basal segments are technically challenging,3 and combined subsegmentectomy involving S9b and S10b would be one of the most technically demanding ones. Full-Text PDF Open Access" @default.
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• W4213164735 title "Commentary: Segmentectomy as a standard surgery, a new era in small sized, peripheral, non-small cell lung cancer" @default.
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