In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy an appropriate alternative to video-assisted thoracoscopic lobectomy?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy an appropriate alternative to video-assisted thoracoscopic lobectomy?' Two hundred papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. In one meta-analysis identified, there was no significant difference observed between groups in overall survival (HR = 0.808, 95% CI 0.556-1.174). All other studies identified also found no significant difference in overall survival. As well, local and distant recurrence rates and disease-free survival were similar in all studies. Two studies identified a significantly greater number of lymph nodes dissected with the video-assisted thoracosopic surgery (VATS) lobectomy procedure; however, all other studies noted no significant difference. There was evidence from two studies that VATS segmentectomy is associated with a shorter length of hospital stay than lobectomy. Between both groups, there was an overall low number of postoperative complications and 30-day mortality (highest n = 2), highlighting the safety of both procedures. Three studies compared patient groups with similar tumour sizes; the average tumour size was 17 ± 1 mm. However, in the four other observational studies, the tumour size in the VATS lobectomy group was significantly larger. From the limited evidence currently available, VATS segmentectomy appears to be a valid alternative to VATS lobectomy. The included studies were mainly retrospective observational studies, with one meta-analysis; however, there are currently two large randomized trials ongoing with results expected to be reported in 2021.

Lex JR ，Naidu B 《-》

In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy a suitable alternative to thoracotomy and segmentectomy in terms of morbidity and equivalence of resection?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy a suitable alternative to thoracotomy and segmentectomy in terms of morbidity and equivalence of resection?' Altogether 232 papers were found as a result of the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Only one study compared the survival rates of video-assisted thoracoscopic surgery (VATS) and open surgery and found no significant difference in overall (P = 0.605) and disease-free (P = 0.996) survival between these groups. The mean length of hospital stay was reported as shorter following VATS when compared with open surgery in all of the studies looking at this outcome. The greatest difference in length of hospital stay reported was 4.8 days (VATS 3.5 days and open 8.3 days). The duration of chest tube placement was also universally reported as shorter in patients having VATS procedures when compared with open procedures. Two studies compared the number of lymph nodes that could be sampled when completing this operation by VATS using an open approach and neither found there to be a significant difference between these numbers. Using the evidence collected, we conclude that anatomical segmentectomy performed by VATS is a safe and effective alternative to conventional techniques in the surgical management of non-small-cell lung cancer. We are aware that the current evidence is limited and existing studies all examine small numbers of patients. Unfortunately, at present there is no blinded randomized control trial comparing these two surgical methods. There is also no study comparing the utility of each method for differing anatomical locations of segments. This should be kept in mind when interpreting the results of the studies presented.

Linden D ，Linden K ，Oparka J 《-》

Systematic review and meta-analysis of video-assisted thoracoscopic surgery segmentectomy versus lobectomy for stage I non-small cell lung cancer.

Zeng W ，Zhang W ，Zhang J ，You G ，Mao Y ，Xu J ，Yu D ，Peng J ，Wei Y ... -  《World Journal of Surgical Oncology》

[To Explore Clinical Value of Single-port Video-assisted Thoracoscopic Surgery 
in Elderly Patients with Non-small Cell Lung Cancer: Lobectomy, Segmentectomy 
and Lobectomy vs Segmentectomy].

Huang L ，Zheng B ，Chen C ，Zheng W ，Zhu Y ，Guo C ... -  《-》

Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure.

Anatomic sublobar resection is currently being assessed as an alternative to lobectomy for primary lung cancers less than 2 cm in size. Open segmentectomy is a proven oncologic procedure for patients with reduced cardiopulmonary reserve and significant comorbidities. With the increased use of thoracoscopy, a video-assisted thoracoscopic surgery (VATS) segmentectomy may be as safe and effective as an open segmentectomy. We performed a retrospective review of patients who underwent a segmentectomy between May 2002 and March 2009 at Emory University Hospital. Forty-one patients underwent pulmonary segmentectomy; 26 through thoracotomy (open) and 15 by a thoracoscopic (VATS) approach. Both groups were well matched for age, gender, and preoperative risk factors. Segmentectomy was performed for primary lung cancer in 25 (61%) patients. There was no difference in tumor size, number of lymph node stations sampled, or number of lymph nodes removed based upon approach. The remaining indications for surgery were metastatic disease in 12 patients and benign disease in 4 patients. All patients underwent R0 resections. There was no significant difference in operative time, but patients undergoing a VATS segmentectomy had significantly reduced chest tube durations and hospital stays. Major complications occurred in 19% of patients in the open group and none in the VATS group. There were two operative deaths (4.8%), both in the open group. Video-assisted thoracoscopic surgery segmentectomy is a safe procedure which has fewer complications and a reduced hospital stay when compared with an open segmentectomy. This approach may be the ideal oncologic procedure for patients with small lung cancers (<2 cm) and (or) limited cardiopulmonary reserve and significant comorbidities.

Leshnower BG ，Miller DL ，Fernandez FG ，Pickens A ，Force SD ... -  《-》