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Noriyoshi Sawabata, Akikazu Kawase, Nobumasa Takahashi, Takeshi Kawaguchi, Tetsukan Woo, Yuichi Saito, Satoshi Shiono, Noriyuki Matsutani
Stage I non-small cell lung cancer (NSCLC) is a localized disease without metastasis; therefore, it can be treated effectively with local therapies. Pulmonary resection is the most frequent treatment, performed as pulmonary wedge resection, segmentectomy, lobectomy, or pneumonectomy. Some retrospective clinical studies of pulmonary wedge resection suggest that its outcome may be inferior to that of anatomical pulmonary resection, whereas other recent studies, which assess surgical margin status, leveled acceptable outcomes...
June 19, 2018: Surgery Today
Wenfei Xue, Guochen Duan, Xiaopeng Zhang, Hua Zhang, Qintao Zhao, Zhifei Xin
Background: Although limited resection was once considered the surgical treatment for patients with Phase IA non-small-cell lung cancer (NSCLC), there has been an ongoing controversial surgical indication for wedge resection and segmentectomy in recent years. The objective of this study was to compare overall survival (OS) and disease-free survival (DFS) of segmentectomy and wedge resection for early stage NSCLC, using a meta-analysis. Methods: Systematic research was conducted using four online databases to search for studies published before 2017...
2018: OncoTargets and Therapy
Yusuke Kimura, Tomohide Hori, Takafumi Machimoto, Tatsuo Ito, Toshiyuki Hata, Yoshio Kadokawa, Shigeru Kato, Daiki Yasukawa, Yuki Aisu, Yuichi Takamatsu, Taku Kitano, Tsunehiro Yoshimura
BACKGROUND: Few cases of postoperative arterioportal fistula (APF) have been documented. APF after hepatectomy is a very rare surgery-related complication. CASE PRESENTATION: A 62-year-old man was diagnosed with hepatocellular carcinoma in segments 5 and 8, respectively. Anterior segmentectomy was performed as a curative surgery. Each branch of the hepatic artery, portal vein, and biliary duct for the anterior segment was ligated together as the Glissonean bundle...
June 15, 2018: Surgical Case Reports
Naoko Ose, Yukiyasu Takeuchi, Yuko Kobori, Akio Hayashi, Daieuke Ishida, Teruka Kawai
BACKGROUND: Surgical resection is the first choice for intralobar sequestration (ILS). A lobectomy is often performed, though we consider that a segmentectomy may be sufficient for benign cases if the sequestration is completely included within a segment. CASE PRESENTATION: We treated a 36-year-old female diagnosed with ILS. Chest computed tomography (CT) revealed several cystic lesions with niveau formation and consolidation in left segment (S)10 without communication of the bronchus and abnormal artery branching from the descending aorta...
June 7, 2018: Surgical Case Reports
Rumi Higuchi, Taichiro Goto, Takahiro Nakagomi, Toshio Oyama
A 22-year-old woman presented with a feeling of chest tightness. Chest computed tomography showed a dendritic shadow in the left segment 1 + 2c, surrounded by hyperlucent emphysematous changes. Bronchoscopy revealed loss of the orifice of bronchus 1 + 2c. Thus a diagnosis of bronchial atresia was made, and a left upper division segmentectomy was performed. Bronchial atresia should be considered in the differential diagnosis of young patients with an abnormal chest shadow. It can be diagnosed based on the characteristic imaging and bronchoscopic findings...
January 1, 2018: Asian Cardiovascular & Thoracic Annals
Aritoshi Hattori, Takeshi Matsunaga, Kazuya Takamochi, Shiaki Oh, Kenji Suzuki
BACKGROUND: It is evident that the frequency of nodal metastasis in part-solid lung adenocarcinoma is significantly low. For those cases, the prognostic impact of the lymph nodal dissection is highly controversial. METHODS: We reviewed 462 clinical-stage I radiological part-solid lung adenocarcinoma patients who underwent lobectomy or segmentectomy with lymphadenectomy. Consolidation tumor ratio (CTR) was evaluated for all patients. Extent of LNDs was classified into systematic/lobe-specific mediastinal-LND (m-LND) and hilar-LND only (h-LND)...
May 28, 2018: Annals of Thoracic Surgery
Zhitao Gu, Huimin Wang, Teng Mao, Chunyu Ji, Yangwei Xiang, Yan Zhu, Ping Xu, Wentao Fang
Background: Limited resections for early stage lung cancer have been of increasing interests recently. However, it is still unclear to what extent a limited resection could preserve pulmonary function comparing to standard lobectomy, especially in the context of minimally invasive surgery. The purpose of this study was to evaluate postoperative changes of spirometry in patients undergoing video-assisted thoracic surgery (VATS) lobectomy or limited resections. Methods: Spirometry tests were obtained prospectively before and 6 months after 75 VATS lobectomy, 34 VATS segmentectomy, 15 VATS wedge resection...
April 2018: Journal of Thoracic Disease
Changqing Shao, Cuiling Zheng, Wanshu Yan, Yi Shen, Zhixue Zhang
The aim of the study was to investigate the efficacy and safety of minimally invasive segmentectomy in the treatment of lung cancer. A total of 86 lung cancer patients in early stage were selected for the treatment between May, 2010 and December, 2010. The patients were randomly divided into the control (n=43) and observation (n=43) groups. Patients in the control group received conventional thoracotomy as treatment, while thoracoscopic segmentectomy was performed for patients in the observation group. Factors including intraoperative bleeding amount, number of dissected lymph nodes, surgery duration, postoperative intubation time and length of stay (LOS) were compared between the two groups...
June 2018: Oncology Letters
Patricia M de Groot, Mylene T Truong, Myrna C B Godoy
Surgical resection offers the best hope of cure for patients with operable early-stage lung cancer. Wedge resection, segmentectomy, lobectomy, or pneumonectomy may be performed depending on the size and location of the tumor. Radiologists must be familiar with the types of surgical resection utilized in the treatment of lung carcinoma and with their normal and abnormal postsurgical appearance on imaging studies. Prompt identification of postoperative complications on imaging is essential to appropriate patient management and helps to determine when additional intervention is warranted...
June 2018: Seminars in Ultrasound, CT, and MR
Hiroaki Kuroda, Tatsuya Yoshida, Takaaki Arimura, Tetsuya Mizuno, Noriaki Sakakura, Yukinori Sakao
BACKGROUND: Our previous report suggested that fluorescence thoracoscopic anatomical segmentectomy (TAS) using intravenous (IV) indocyanine green (ICG) injection is safe, feasible, and efficacious for identifying segmental boundaries. However, contrast visualization in the conventional indocyanine green mode (CIM) remains relatively obscure in smoking-related comorbidities. Our aim was to evaluate the safety and efficacy of recently released Spectra-A with CIM by simultaneous observation...
July 2018: Journal of Surgical Research
Koyo Shirahashi, Hirotaka Yamamoto, Mitsuyoshi Matsumoto, Yusaku Miyamaoto, Hiroyasu Komuro, Kiyoshi Doi, Hisashi Iwata
Background: Recently, minimally invasive surgical approaches have been developed, typified by video-assisted thoracic surgery (VATS). A meticulous surgical procedure to prevent local recurrence is required during segmentectomy for clinical stage I non-small-cell primary lung cancer. In this article, we demonstrated the validity of hybrid VATS segmentectomy. Methods: Of these 125 patients, 62 (49.6%) underwent intensively radical segmentectomy (RS). The remaining 63 (50...
April 2018: Journal of Thoracic Disease
Benoît Bédat, Frédéric Triponez, Samira Mercedes Sadowski, Christophe Ellenberger, Marc Licker, Wolfram Karenovics
Background: The aim of the present study was to assess the impact of near-infrared angiography in guiding intraoperatively sublobar anatomical resection by video-assisted thoracic surgery (VATS). Methods: We retrospectively analyzed data from 67 patients who underwent segmentectomy by VATS from November 2014 to November 2017 at the University Hospitals of Geneva, Switzerland. The need to modify arterial or parenchymal resection based on intraoperative near-infrared imaging was considered the primary study outcome...
April 2018: Journal of Thoracic Disease
Makoto Endoh, Hiroyuki Oizumi, Hirohisa Kato, Jun Suzuki, Hikaru Watarai, Akira Hamada, Katsuyuki Suzuki, Kenta Nakahashi, Mitsuaki Sadahiro
Background: Visualization of intersegmental planes in the lung is desirable for precise anatomical lung segmentectomy. We developed the slip-knot method for creating inflation-deflation lines. This study aimed to assess relevant data for thoracoscopic segmentectomy performed using this method. Methods: In the slip-knot method, the objective segmental bronchus is looped with a monofilament thread. One end of the thread is then pulled during temporary bilateral ventilation, causing the knot to slip toward the bronchus...
April 2018: Journal of Thoracic Disease
Mitsuyoshi Matsumoto, Koyo Shirahashi, Hirotaka Yamamoto, Yusaku Miyamaoto, Hiroyasu Komuro, Kiyoshi Doi, Hisashi Iwata
Background: Division of intersegmental planes is one of the important practical issues for segmentectomy to obtain feasible outcomes without relapse for clinical stage I non-small cell lung cancer. Almost all surgeons perform this procedure using a stapler. However, division of intersegmental planes for segmentectomy can also be performed by electrocautery. In this article, we demonstrate the merits and drawbacks of division of the intersegmental plane by electrocautery for segmentectomy...
April 2018: Journal of Thoracic Disease
Luis Angel Hernandez-Arenas, Rushmi D Purmessur, Diego Gonzalez-Rivas
Uniportal video-assisted thoracoscopic surgery (VATS) segmentectomy is a technically more complex procedure than uniportal VATS lobectomy, since a detailed comprehension of the segmental anatomy is required. Anatomic sublobar resection can achieve outcomes equivalent to lobectomy in selected patients with stage IA non-small cell lung carcinoma (NSCLC). In this paper we describe our clinical experiences and introduce the technical details of uniportal VATS segmentectomy, including expertise advice ("tips and tricks") in patient selection, positioning and incisions and technical highlights of the most common types of segmentectomies...
April 2018: Journal of Thoracic Disease
Jean Marc Baste, Valentin Soldea, Samy Lachkar, Philippe Rinieri, Mathieu Sarsam, Benjamin Bottet, Christophe Peillon
Minimally invasive sublobar anatomical resection is becoming more and more popular to manage early lung lesions. Robotic-assisted thoracic surgery (RATS) is unique in comparison with other minimally invasive techniques. Indeed, RATS is able to better integrate multiple streams of information including advanced imaging techniques, in an immersive experience at the level of the robotic console. Our aim was to describe three-dimensional (3D) imaging throughout the surgical procedure from preoperative planning to intraoperative assistance and complementary investigations such as radial endobronchial ultrasound (R-EBUS) and virtual bronchoscopy for pleural dye marking...
April 2018: Journal of Thoracic Disease
Agathe Seguin-Givelet, Madalina Grigoroiu, Emmanuel Brian, Dominique Gossot
Although sublobar resection (SLR) for treating non-small cell lung carcinoma (NSCLC) is still controversial, thoracoscopic segmentectomy is rising. Performing it by closed chest surgery is complex as it means confirming the location of the lesion, identifying vascular and bronchial structures, preserving venous drainage of adjacent segments, severing the intersegmental plane and ensuring an oncological safety margin with no manual palpation and different landmarks. Accurate planning is mandatory. We discuss in this article the interest of 3D reconstruction and mapping technics to enhance safety and reliability of these procedures...
April 2018: Journal of Thoracic Disease
Masaaki Sato, Tomonori Murayama, Jun Nakajima
Thoracoscopic segmentectomy for the posterior basal segment (S10) and its variant (e.g., S9+10 and S10b+c combined subsegmentectomy) is one of the most challenging anatomical segmentectomies. Stapler-based segmentectomy is attractive to simplify the operation and to prevent post-operative air leakage. However, this approach makes thoracoscopic S10 segmentectomy even more tricky. The challenges are caused mostly from the following three reasons: first, similar to other basal segments, "three-dimensional" stapling is needed to fold a cuboidal segment; second, the belonging pulmonary artery is not directly facing the interlobar fissure or the hilum, making identification of target artery difficult; third, the anatomy of S10 and adjacent segments such as superior (S6) and medial basal (S7) is variable...
April 2018: Journal of Thoracic Disease
Zaid M Abdelsattar, Shanda H Blackmon
There are many novel technologies that enable complex segmentectomy to be performed. As lung cancer screening becomes more prevalent, patients are increasingly diagnosed with early stage lung cancer, multifocal disease, and second primary tumors. This shift to an earlier clinical presentation combined with advances in technology and an emphasis on minimally invasive techniques have led to the current developments we are now seeing with anatomic segmentectomy. In this paper, we describe the operative technique of an indocyanine green (ICG)-guided video-assisted thoracoscopic surgery (VATS) single basilar segmental resection, augmented with methylene blue dye marker localization via SuperDimension electromagnetic navigational bronchoscopy...
April 2018: Journal of Thoracic Disease
Sameer A Hirji, Scott J Swanson
Contemporary management of early stage non-small cell lung cancer (NSCLC) is evolving and can be attributed to a change in size and histology of lung cancer, advancements in imaging modalities, instrumentation and surgical techniques. The emergence of segmentectomy has further challenged the existing treatment landscape, with promising results. Despite limited widespread adoption, video-assisted thoracoscopic surgery (VATS) segmentectomy is a safe option in the treatment of patients with small stage I lung cancers, with excellent oncologic results and improved morbidity relative to open techniques...
April 2018: Journal of Thoracic Disease
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