Thoracoscopic anatomical sublobar resection for deep interlobar lung cancer with fused fissure.

BACKGROUND

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).

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.