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Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas

Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan

Received 10 September 2008; received in revised form 27 December 2008; accepted 8 January 2009.

^_* Corresponding author. Tel.: +81 11 611 2111x3312; fax: +81 11 613 7318. (Email: atsushiw{at}sapmed.ac.jp).

Objective: Segmentectomy for non-small cell lung cancer (NSCLC) is believed to increase the rates of recurrence and postoperative air leak. We sought to present our clinical data and outcome of VATS (video-assisted thoracoscopic surgery) segmentectomies with systematic node dissection for selected NSCLC patients. Methods: Inclusion criteria were clinical T1N0M0 peripheral NSCLC measuring 2 cm (n = 38) and NSCLC with interlobar invasion, which cause positive surgical margin with malignancy after lobectomy of a primary lesion and only partial resection of invasion site (n = 3). Outcome variables include hospital course, complications, mortality, recurrence patterns and survival. The intersegmental border was identified using the intersegmental veins as landmark and the demarcation between the resected (inflated) and preserved (collapsed) lungs. The intersegmental plane was divided by an endoscopic stapler and electrocautery. Results: The mean operative time and intraoperative bleeding were 220 min (range 100–306) and 183 ml (30–730), respectively. The number of stapler cartridges used for intersegmental division was 2 (1–5). Postoperative air leak (>7 days), which required no surgical intervention, occurred in two patients. The chest tube drainage duration was 3 days. There were no in-hospital deaths. The numbers of resected subsegments and reserved subsegments in comparison with lobectomy were 5 (2–13) and 5 (3–13), respectively. The FEV1.0 after VS was higher than the predictive FEV1.0 after lobectomy, if the latter was performed as standard procedure. We experienced four cases of distant metastasis after segmentectomy, but there was no case of local recurrence. The 5-year survival and recurrence-free survival rates in pathological stage IA NSCLC were 89.9% and 93.3%, respectively. Conclusions: VATS segmentectomy with systematic node dissection is a reasonable treatment option for selected peripheral NSCLC.

Key Words: Segmentectomy • Video-assisted thoracoscopic surgery • Early lung cancer