He Zhicheng, Xu Wenzheng, Li Zhihua, Zheng Jianan, Wang Qi, Jin Tianyu, Pan Xianglong, Kaprekar Varad, Chen Liang, Wu Weibing
Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
J Thorac Dis. 2024 Dec 31;16(12):8162-8172. doi: 10.21037/jtd-24-84. Epub 2024 Dec 28.
The technical challenges associated with the removal of small nodules in challenging locations rather than peripheral locations remain unaddressed. We sought to illustrate the parenchymal-sparing surgical approach employed for deep interlobar lung cancer with fused fissures (DILCFFs).
A retrospective review of 43 patients with cT1N0M0 DILCFFs from January 2013 through December 2022 was performed. Patients were grouped into the non-anatomical extended resection (NER): either a lobectomy or a (sub)segmentectomy for the predominant location with an extended wedge resection of a portion of an adjacent lobe, and the anatomical resection (AR): combined a lobectomy or a (sub)segmentectomy for the predominant location with a (sub)segmentectomy of an adjacent lobe.
In total, 17 patients underwent NER, 26 with AR. There were more cases undergoing preoperative nodule localization in the NER group. The AR arm conferred a wider surgical margin (2.52 1.27 cm, P<0.001) and a higher proportion of margin to tumor size ratio ≥1 (73.1% 35.3%, P=0.01) than the NER arm. A total of 10 types of interlobar vessels within fused fissures were identified with an overall incidence of 88.4% (38/43). No patients in both arms experienced severe morbidity. Five patients allocated to the NER arm experienced local recurrence at the surgical margin, in comparison with zero in the AR arm (29.4% 0%, P=0.006).
AR of partial of the adjacent lobe provides a wider surgical margin than that of NER in the removal of DILCFFs, potentially accounting for the lower incidence of margin failure.
与在具有挑战性的位置而非周边位置切除小结节相关的技术挑战仍未得到解决。我们试图阐述用于治疗伴有融合性裂的深部叶间肺癌（DILCFF）的实质保留手术方法。
对2013年1月至2022年12月期间43例cT1N0M0 DILCFF患者进行回顾性研究。患者被分为非解剖性扩大切除术（NER）组：对主要病变部位行肺叶切除术或（亚）段切除术，并对相邻肺叶的一部分行扩大楔形切除术；以及解剖性切除术（AR）组：对主要病变部位行肺叶切除术或（亚）段切除术，并对相邻肺叶行（亚）段切除术。
总共17例患者接受了NER，26例接受了AR。NER组术前结节定位的病例更多。与NER组相比，AR组的手术切缘更宽（2.52±1.27 cm，P<0.001），切缘与肿瘤大小比值≥1的比例更高（73.1%±35.3%，P=0.01）。在融合性裂内共识别出10种叶间血管类型，总发生率为88.4%（38/43）。两组均无患者发生严重并发症。分配到NER组的5例患者手术切缘出现局部复发，而AR组为零（29.4%±0%，P=0.006）。
在切除DILCFF时，对相邻肺叶部分进行AR比NER提供更宽的手术切缘，这可能是切缘失败发生率较低的原因。
