PDF herunterladen
Zentralbl Chir 2014; 139(1): 102-107
DOI: 10.1055/s-0033-1350872
Übersicht – Thoraxchirurgie
Georg Thieme Verlag KG Stuttgart · New York

Videoassistierte thorakoskopische (VATS) sublobäre anatomische Resektionen beim Lungenkarzinom

Video-Assisted Thoracoscopic (VATS) Sublobar Anatomic Resections for Lung Cancer
J. Bodner
Sektion Thoraxchirurgie, UKGM Gießen, Deutschland
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
28. Februar 2014 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Als anatomische Segmentresektion wird die chirurgische Entfernung eines oder mehrerer bronchopulmonaler Segmente unter individueller Versorgung der entsprechenden bronchovaskulären Strukturen bezeichnet. Neben benignen Erkrankungen und unklaren Rundherden kann eine anatomische Segmentresektion bei prä- bzw. minimalinvasiven Adenokarzinomen sowie beim invasiven Frühkarzinom (T1a) indiziert sein. Die videoassistierte thorakoskopische (VATS) Technik der anatomischen Segmentresektion unterscheidet sich in wenigen Punkten von der konventionellen Methode. Sie ist technisch anspruchsvoll, verbindet aber minimale Invasivität mit maximalem Parenchymerhalt. Dadurch kann die videoassistierte thorakoskopische anatomische Segmentresektion für lungenfunktionell stark eingeschränkte, polymorbide Patienten mit NSCLC eine chirurgische Therapieoption darstellen. Ihr onkologischer Stellenwert ist anhand der verfügbaren Datenlage jedoch noch nicht endgültig beurteilbar.

Abstract

Pulmonary segmentectomy implies the removal of one or more anatomic units of the lung. It requires dissection of the segmental bronchus and artery and identification of the intersegmental vein, which should be respected. Benign lesions, solitary pulmonary nodules, pulmonary adenocarcinoma in situ and T1a lung cancer are possible indications. The VATS approach for segmentectomies is technically challenging and differs slightly from the conventional open one. Its combination of minimal invasiveness with a maximum of lung parenchyma preservation provides a surgical treatment option for NSCLC patients with little pulmonary reserve. Data on the oncologic outcome after VATS segmentectomy are inconclusive as yet.

Schlüsselwörter

Segmentresektion - videoassistierte Thorakoskopie (VATS) - Bronchialkarzinom

Key words

segmentectomy - video-assisted thoracoscopy (VATS) - lung cancer
 

  • Literatur

  • 1 Church TR, Black WC, Aberle TR et al. Results of initial low-dose computed tomographic screening for lung cancer. N Eng J Med 2013; 368: 1980-1991
    CrossrefPubMedSuche in Google Scholar
  • 2 Atkins BZ, Harpole jr. DH, Magnum JH et al. Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally invasive approach. Ann Thorac Surg 2007; 84: 1107-1113
    CrossrefPubMedSuche in Google Scholar
  • 3 Yan TD, Black D, Bannon BG et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 2009; 27: 2553-2562
    CrossrefPubMedSuche in Google Scholar
  • 4 Okada M, Koike T, Higashiyama M et al. Radical sublobar for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg 2006; 132: 769-775
    CrossrefPubMedSuche in Google Scholar
  • 5 Swanson SJ, Herndon JE, DʼAmico T et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802 – a prospective, multiinstitution feasibility study. J Clin Oncol 2007; 25: 4993-4997
    CrossrefPubMedSuche in Google Scholar
  • 6 Kramer R, Glass A. Bronchosopic localization of lung abscess. Ann Otol Rhinol Laryngol 1932; 41: 1210-1240
    PubMedSuche in Google Scholar
  • 7 Churchill ED, Belsey R. Segmental pneumonectomy in bronchiectasis. Ann Surg 1939; 109: 481-499
    CrossrefPubMedSuche in Google Scholar
  • 8 Kent EM, Blades B. The anatomic approach to pulmonary resection. Ann Surg 1942; 116: 782-794
    PubMedSuche in Google Scholar
  • 9 Overholt RH, Langer L. The Technique of pulmonary Resection. Springfield: Charles C Thomas; 1951
    Suche in Google Scholar
  • 10 McCormack PM, Martini N. The changing role of surgery for pulmonary metastases. Ann Thorac Surg 1979; 28: 139-145
    CrossrefPubMedSuche in Google Scholar
  • 11 Jensik RJ, Faber LP, Milloy FJ et al. Segmental resection for a lung cancer. A fifteen-year experience. J Thorac Cardiovasc Surg 1973; 66: 563-572
    PubMedSuche in Google Scholar
  • 12 Shields TW, Higgins jr. GA. Proceedings: Minimal pulmonary resection in treatment of carcinoma of the lung. Arch Surg 1974; 108: 420-422
    CrossrefPubMedSuche in Google Scholar
  • 13 Bennett WF, Smith RA. Segmental resection for bronchogenic carcinoma: a surgical alternative for the compromised patient. Ann Thorac Surg 1979; 27: 169-172
    CrossrefPubMedSuche in Google Scholar
  • 14 Schuchert MJ, Pettiford BL, Keeley S et al. Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer. Ann Thorac Surg 2007; 84: 926-933
    CrossrefPubMedSuche in Google Scholar
  • 15 Yim AP, Ko KM, Chau WS et al. Video-assisted thoracoscopic anatomic lung resections. The initial Hong Kong experience. Chest 1996; 109: 13-17
    CrossrefPubMedSuche in Google Scholar
  • 16 Schuchert MJ, Bettiford BL, Pennathur A et al. Anatomic segmentectomy for stage I non-small-cell lung cancer: comparison of video-assisted thoracic surgery versus open approach. J Thorac Cardiovasc Surg 2009; 138: 1318-1325
    CrossrefPubMedSuche in Google Scholar
  • 17 Okada M, Mimura T, Ikegaki J et al. A novel video-assisted segmentectomy technique: selective segmental inflation via bronchofiberoptic jet followed by cautery cutting. J Thorac Cardiovasc Surg 2007; 133: 753-758
    CrossrefPubMedSuche in Google Scholar
  • 18 Hansen HJ, Petersen RM, Christensen H. Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach. Surg Endosc 2011; 25: 1263-1269
    CrossrefPubMedSuche in Google Scholar
  • 19 Witte B, Wolf M, Hillebrand H et al. Complete video-assisted thoracoscopic surgery anatomic segmentectomy for clinical stage I lung carcinoma – technique and feasibility. Interact Cardiovasc Thorac Surg 2011; 13: 148-152
    CrossrefPubMedSuche in Google Scholar
  • 20 Watanabe A, Miyajima M, Kawaharada N et al. Two separate thoroscopic segmentectomies with vessel sealing system. Eur J Cardiothorac Surg 2012; 41: e62-e64
    CrossrefPubMedSuche in Google Scholar
  • 21 Soukiasian HJ, Hong E, McKenna RJ. Video-assisted trisegmentectomy and left upper lobectomy provide equivalent survivals for stage IA and IB lung cancer. J Thorac Cardiovasc Surg 2012; 144: S23-S26
    CrossrefPubMedSuche in Google Scholar
  • 22 Swanson SJ. Video-assisted thoracic surgery segmentectomy: the future of surgery for lung cancer?. Ann Thorac Surg 2010; 89: S2096-S2097
    CrossrefPubMedSuche in Google Scholar
  • 23 Watanabe A, Ohori S, Nakashima S et al. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg 2009; 35: 775-780
    CrossrefPubMedSuche in Google Scholar
  • 24 Leshnower BG, Miller DL, Fernandez FG et al. Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure. Ann Thorac Surg 2010; 89: 1571-1576
    CrossrefPubMedSuche in Google Scholar
  • 25 Shapiro M, Weiser TS, Wisnivesky JP et al. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer. J Thorac Cardiovasc Surg 2009; 137: 1388-1393
    CrossrefPubMedSuche in Google Scholar
  • 26 Rami-Porta R, Tsuboi M. Sublobar resection for lung cancer. Eur Resp J 2009; 2: 426-435
    PubMedSuche in Google Scholar
  • 27 Billfinger TV, Baram D. Sublobar resection in nonsmall cell lung carcinoma. Curr Opin Pulm Med 2008; 14: 292-296
    CrossrefPubMedSuche in Google Scholar
  • 28 DʼAmato TA, Galloway M, Szydlowski G et al. Intraoperative brachytherapy following thoracoscopic wedge resection of stage I lung cancer. Chest 1998; 114: 1112-1115
    CrossrefPubMedSuche in Google Scholar
  • 29 Lee W, Daly BDT, DiPetrillo TA. Limited resection for non-small cell lung cancer: observed local control with implantation of I-125 brachytherapy seeds. Ann Thor Surg 2003; 75: 237-242
    CrossrefPubMedSuche in Google Scholar
  • 30 Read RC, Yoder G, Scheffer RC. Survival after conservative resection for T1 N0 M0 non-small cell lung cancer. Ann Thorac Surg 1990; 499: 391-400
    PubMedSuche in Google Scholar
  • 31 Warren WH, Faber LP. Segmentectomy versus lobectomy in patients with stage I pulmonary carcinoma. Five-year survival and patterns of intrathoracic recurrence. J Thorac Cardiovasc Surg 1994; 107: 1087-1094
    PubMedSuche in Google Scholar
  • 32 Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 1995; 60: 615-623
    CrossrefPubMedSuche in Google Scholar
  • 33 Cerfolio RJ, Allen MS, Trastek VF et al. Lung resection in patients with compromised pulmonary function. Ann Thorac Surg 1996; 62: 348-351
    CrossrefPubMedSuche in Google Scholar
  • 34 Kodama K, Doi O, Higashiyama M et al. Intentional limited resection for selected patients with T1 N0 M0 non-small-cell lung cancer: a single-institution study. J Thorac Cardiovasc Surg 1997; 114: 347-353
    CrossrefPubMedSuche in Google Scholar
  • 35 Martin-Ucar AE, Nakas A, Pilling JE et al. A case matched study of anatomical segmentectomy versus lobectomy for stage I lung cancer in high-risk patients. Eur J Cardiothorac Surg 2005; 27: 675-679
    CrossrefPubMedSuche in Google Scholar
  • 36 El-Sherif A, Fernando HC, Santos R. Margin and local recurrence after sublobar resection of non-small cell lung cancer. Ann Surg Oncol 2007; 14: 2400-2405
    CrossrefPubMedSuche in Google Scholar
  • 37 Sienel W, Stremmel C, Kirschbaum A et al. Frequency of local recurrence following segmentectomy of stage IA nonsmall cell lung cancer is influenced by segment localization and width of resection margins – implications for patient selection for segmentectomy. Eur J Cardiothorac Surg 2007; 31: 522-528
    CrossrefPubMedSuche in Google Scholar
  • 38 Smith CB, Swanson SJ, Mhango G et al. Survival after segmentectomy and wedge resection in stage I non-small-cell lung cancer. J Thorac Oncol 2013; 8: 73-78
    CrossrefPubMedSuche in Google Scholar
  • 39 Mery CM, Pappas AN, Bueno R et al. Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database. Chest 2005; 128: 237-245
    CrossrefPubMedSuche in Google Scholar
  • 40 Travis WD, Brambilia E, Noguchi M et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6: 244-285
    CrossrefPubMedSuche in Google Scholar
  • 41 Yamada S, Kohno T. Video-assisted thoracic surgery for pure ground-glass opacities 2 cm or less in diameter. Ann Thorac Surg 2004; 77: 1911-1915
    CrossrefPubMedSuche in Google Scholar