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

Abstract

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 vs. 1.27 cm, P<0.001) and a higher proportion of margin to tumor size ratio ≥1 (73.1% vs. 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% vs. 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.