Myobatake Ryota, Tsubochi Hiroyoshi, Nakano Tomoyuki, Minegishi Kentaro, Endo Shunsuke
Department of Thoracic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Kyobu Geka. 2019 Jul;72(7):510-515.
The most important step in lung segmentectomy is to determine an appropriate intersegmental plane to obtain sufficient pre- and intraoperative margins. Inappropriate dissection of the lung parenchyma leads to loss of oncological validity and additionally causes various complications such as pneumonia, prolonged air leakage, lung congestion, and atelectasis.
In this study, we evaluated the validity of segmentectomy for non-small cell lung cancer (NSCLC) based on evaluation of survival outcomes and recurrence patterns.
In principle, we usually perform video-assisted thoracic surgery segmentectomy. Hilar dissection is performed along the intersegmental vein under ultrasonographic guidance, and the peripheral lung parenchyma is subsequently stapled. We usually create inflation-deflation lines from before to determine the intersegmental lines. Recently, near-infrared fluorescence imaging with indocyanine green is also used.
We retrospectively reviewed data of 101 patients who underwent segmentectomy for lung cancer between 2007 and 2014.
The 5- and 10-year overall survival rates were 84% and 62%, respectively. The 5- and 10-year recurrence-free survival rates were 83% and 63%, respectively. Recurrence at the surgical margin occurred in 5 patients( pulmonary stump:4 patients, bronchial stump:1 patient).
Segmentectomy may be acceptable for patients with Stage I NSCLC. Accurate determination of the intersegmental plane is essential to avoid stump recurrence.
肺段切除术最重要的步骤是确定合适的段间平面，以获得足够的术前和术中切缘。肺实质的不恰当解剖会导致肿瘤切除的有效性丧失，并额外引发各种并发症，如肺炎、持续性漏气、肺淤血和肺不张。
在本研究中，我们基于生存结果和复发模式的评估，评价了非小细胞肺癌（NSCLC）肺段切除术的有效性。
原则上，我们通常进行电视辅助胸腔镜手术肺段切除术。在超声引导下沿段间静脉进行肺门解剖，随后用吻合器处理外周肺实质。我们通常从前开始制造充气-放气线以确定段间线。最近，也使用了吲哚菁绿近红外荧光成像技术。
我们回顾性分析了2007年至2014年间101例行肺癌肺段切除术患者的数据。
5年和10年总生存率分别为84%和62%。5年和10年无复发生存率分别为83%和63%。手术切缘复发5例（肺残端：4例，支气管残端：1例）。
对于I期NSCLC患者，肺段切除术可能是可接受的。准确确定段间平面对于避免残端复发至关重要。
