Anatomical Resection Research Articles (Page 1)

The first total pancreatectomy (TP) resulting in survival past the immediate postoperative period was performed at Mayo Clinic in 1944. Although still uncommonly performed, indications have recently fluctuated. We aimed to evaluate trends in TP utilization and outcomes over four decades. Patients who underwent single-stage TP at Mayo Clinic Rochester from 1988 to 2024 were analyzed in two cohorts: Early Era (EE, 1988-2009) and Modern Era (ME, 2010-2024). In total, 437 patients were identified: 118 during EE (mean 8/year) and 319 during ME (mean 21/year). Primary indications were adenocarcinoma (42% EE vs. 60% ME), IPMN (31% EE vs. 17% ME), and chronic pancreatitis (11% EE vs. 13% ME) (p<0.001). Concurrent vascular resection was performed in 9.3% (EE; all venous only) vs. 53% (ME; venous alone in 20% and arterial with/without venous in 33%) (p<0.001). Multivisceral resection was performed in <1% (EE) vs. 24% (ME) (p<0.001). Major complications occurred in 13% (EE) vs. 27% (ME) (p=0.018) and ninety-day mortality was 3.4% (EE) vs. 6.3% (ME) (p=0.35). For adenocarcinoma, 5-year median OS from both surgery and diagnosis was significantly improved in ME (p=0.009 and p<0.001, respectively). Median last HbA1c was 7.7 (EE) vs. 7.3 (ME) (p<0.001). Among patients surviving >1 year, insulin pumps were utilized in 12% (EE) vs. 49% (ME) (p<0.001). Use of TP has dramatically increased in recent years, primarily for adenocarcinoma alongside increased use of neoadjuvant therapy and ever-expanding criteria for anatomic resectability. Operative complexity has significantly increased with resultant increased perioperative morbidity. TP remains a higher-risk procedure, specifically with en-bloc vascular resections, emphasizing the importance of appropriate patient selection, preoperative patient education, and thoughtful postoperative and long-term management.

In minimally invasive surgeries such as video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS), unexpected complications may necessitate conversion to thoracotomy. This study aimed to compare the rates, causes, and implications of conversion to thoracotomy between VATS and RATS. We retrospectively reviewed data from 1135 patients who underwent anatomical lung resection for primary lung cancer via VATS (n = 580) or RATS (n = 555) from 2011 to 2024. Conversion causes were categorized using the Vascular, Anatomy, Lymph node, Technical (VALT) system. Perioperative outcomes and independent predictors of conversion were analyzed via multivariate logistic regression. The overall conversion rate was significantly lower in the RATS group than in the VATS group (2.0% vs. 7.8%, p < 0.001). RATS was associated with fewer anatomical (0.9% vs. 3.1%, p = 0.010) and lymph node-related (0.2% vs. 2.6%, p < 0.001), with no significant difference in vascular-related conversions (0.9% vs. 2.1%, p = 0.142). Multivariate analysis identified age ≥ 75year, clinical T2-4, and N1-2 stage as independent risk factors, while RATS use was protective. Emergency conversions were uncommon in both groups, whereas RATS appeared advantageous in technically demanding settings. RATS significantly reduces the risk of conversion, particularly in anatomically or nodally complex cases, without increasing vascular complications.

Postoperative air leak is among the most common complications in thoracic surgery. Current management strategies are often suboptimal. Intrapleural administration of a glucose solution has emerged as a novel therapeutic approach; however, its clinical value has not been thoroughly investigated. This study aimed to compare the effectiveness of intrapleural 40% glucose solution versus autologous blood patch pleurodesis in managing postoperative air leak. This prospective, randomized, controlled study enrolled patients who underwent anatomical lung resections (segmentectomy, lobectomy, or bilobectomy) at the Department of Thoracic Surgery, Poznan University of Medical Sciences, between November 2023 and December 2024. Patients with postoperative air leak were randomized to receive either 40% glucose (study group) or autologous blood (control group). The primary end-point was cessation of postoperative air leak. Secondary end-points included incidence of residual air space, chest pain, and reoperation. A total of 110 patients were included: 47 in the glucose group and 63 in the blood group. Glucose administration resulted in a higher rate of postoperative air leak resolution (95.7% vs 82.5%, p = 0.033; 95% CI: 2.2% to 24.2%). The glucose group had a shorter postoperative hospital stay(7 vs 9 days, p = 0.036). Chest pain occurred more frequently in the glucose group, but the difference was not statistically significant(10.6% vs 4.8%, p = 0.24). No major infectious complications were observed. Residual air space occurence and reoperation rates were comparable. Intrapleural 40% glucose solution achieved a higher resolution rate of postoperative air leak compared to autologous blood patch pleurodesis, with a comparable safety profile.

There is no procedure exclusively designed for congenital lung malformation (CLM) in the literature. This study aims to propose a novel procedure and evaluate its safety and efficacy in treating CLM patients. A retrospective review of clinical data was conducted for patients who underwent thoracoscopic anatomical lesion resection (TALR), thoracoscopic lobectomy (TL), and thoracoscopic segmentectomy (TS) in our hospital from January 2018 to December 2023. Intraoperative and postoperative outcomes were compared between the groups. Besides, preoperative CT scan image and intraoperative videos of the patients who underwent TALR were reviewed. Of all patients, 259 patients in TALR group, 100 in TL group, and 112 in TS group were included for comparative analysis. More operative time was used in TALR group compared to lobectomy (108min vs. 61min, P < 0.001) and segmentectomy (108min vs. 80min, P < 0.001), respectively. The parameters such as major bleeding rate, air leak rate, and remnant lesion rate in TALR group were not inferior to that in groups of lobectomy and segmentectomy. In 259 (91.5%) patients, the normal lung exhibited a lobular structure resembling a turtle shell which can be distinguished from the lesion thus forming a clear external lesion boundaries. Additionally, the internal lesion demarcation can be marked by the pulmonary veins from CT scan image. Lesion boundaries are present in CLM, with most being identifiable on CT image and visible on the surface of the lobe to the naked eye. These findings could contribute to the advancement of TALR which was comparable to TL and TS in terms of safety and efficacy.

The next-generation sequencing (NGS)–based Oncomine Dx Target Test (ODxTT) is the standard tool for guiding postoperative adjuvant therapy in patients with non-small cell lung cancer (NSCLC) in Japan. To advance precision oncology, we evaluated the clinical utility of an in-house comprehensive genomic profiling (CGP) assay, Rapid-Neo, as a complementary approach to ODxTT in surgically resected NSCLC. Patients with pathological stage II–III NSCLC who underwent anatomical surgical resection between December 2019 and May 2024 were included. Resected specimens underwent genomic analysis using both ODxTT and Rapid-Neo CGP. We evaluated the mutational concordance and the frequency of additional actionable alterations identified by CGP. Among 68 eligible patients, driver mutation results were concordant in 64 (94.1%) cases. Crucially, CGP rescued one patient for targeted therapy by detecting an EGFR mutation where ODxTT failed due to insufficient DNA. CGP also identified rare EGFR variants not covered by ODxTT in two cases, although it failed to detect a RET fusion in one patient. Furthermore, CGP revealed additional actionable alterations, such as tumor suppressor gene mutations, in 57 patients (83.8%). Our in-house CGP shows high concordance with ODxTT and serves as a powerful complementary tool. These findings support a strategic testing algorithm where CGP is incorporated for patients with negative or inconclusive ODxTT results, or at the time of recurrence, to maximize opportunities for individualized therapy in resected NSCLC.

Minimally invasive surgery (MIS) has transformed hepatobiliary procedures, providing significant advantages over traditional open techniques. However, challenges remain, especially in major hepatectomies and posterior segment resections due to the inherent limitations of laparoscopy. The caudate lobe (segment I), located deep within the liver and adjacent to critical vascular structures, presents unique technical difficulties, making it one of the most challenging segments to access laparoscopically. Robot-assisted surgery has emerged as a promising alternative, offering enhanced precision and control, allowing for more precise suturing and ligation of retrohepatic vessels and bile ducts. While there are still hurdles related to liver mobilization and hemostasis, these can be effectively managed through careful preoperative planning and intraoperative techniques, such as three-dimensional (3D) reconstructions and counterstaining with indocyanine green, which improve the safety and efficacy of anatomical caudate lobe resections. Therefore, this study aims to explore the safety and feasibility of robot-assisted complete caudectomy, detailing the technical aspects step-by-step through a case video example of an anatomical resection for hepatocarcinoma with Glissonean pedicle access.

Thoracoscopic anatomical pulmonary resection has proven highly effective in adults. However, applying this technique to pediatric patients poses specific challenges due to their unique physiological and psychological traits. The application of the enhanced recovery after surgery (ERAS) concept has proven successful in adults, leading to an investigation into its potential effectiveness in pediatric thoracoscopic anatomical pulmonary resection. We conducted a single-center before–after comparative study at Beijing Children’s Hospital including 522 children (ERAS n = 323; standard care n = 199) undergoing thoracoscopic anatomical pulmonary resections from August 2019 to November 2024. The ERAS group underwent perioperative management that adhered to ERAS principles. The outcomes evaluated encompassed operative duration, duration of tube placement, length of hospital stay, hospitalization expenses, and quality of life. Among 522 children (ERAS n = 323; standard care n = 199), ERAS was associated with shorter operative time (53.5 ± 26.4 vs 97.9 ± 50.9 minutes), shorter chest-tube duration (2.0 ± 0.9 vs 4.4 ± 2.5 days), reduced length of stay (7.6 ± 2.8 vs 10.0 ± 4.0 days), and lower hospitalization cost (CNY 31,455.3 ± 6677.9 vs 37,139.8 ± 11,481.7); all P < .001. Quality of life favored ERAS (Barthel Grade 0/1 [≥61 points]: 323/323 [100%] vs 146/199 [73.4%]; Grade 2 seen only in standard care: 53/199 [26.6%]; P < .001). The ERAS management model significantly associated with postoperative recovery, minimizes complications, and decreases hospital stays in pediatric thoracoscopic anatomical pulmonary resection, showcasing substantial clinical benefits. Additional verification in larger groups is necessary to establish its wider applicability.

Aim of this study is to evaluate the prognostic role of nodal parameter in early stage pathologically patients with N0 who underwent lobectomy and lymphadenectomy. Clinical and pathological characteristics of patients who underwent anatomical lung resection from 1/01/2010 to 31/12/2019 were reviewed and retrospectively analyzed. GGO and part-solid tumors, MIA, AIS, more than 5cm in size, with nodal and/or distant metastases, or receiving neoadjuvant treatment were excluded. Operatory and pathological report were reviewed to collect data on lymphadenectomy. The primary end-point was disease-free survival (DFS), calculated from surgery to recurrence appearance. Clinical/pathological characteristics and nodal parameters were associate to DFS using Kaplan-Meier curves. The log-rank test was used to assess differences between subgroups. A multivariable model was built using Cox-regression analysis, including variable resulting significant (p value<0.05), at univariable analysis. The final analysis was conducted on 487 patients. Most patients presented stage I tumor (82.4%). The mean number of resected nodes (#RN), resected N1 (#RN1) nodes, and resected N2 nodes (#RN2) resulted 9.5±8.0, 3.4±4.3, and 5.9±4.4. The mean number of total resected stations (#RS), N1 resected stations (#RSN1), and N2 resected stations (#RSN2) resulted 2.5±1.6, 1±0.8, and 1.5±1.2, respectively. During a mean follow-up of 43±28months, a recurrence occurred in 137 (28.1%) patients. At univariable analysis, age<70years (p=0.025), N1 lymphadenectomy (p=0.019), #RSN1≥3 (p=0.001), #RN≥10 (p=0.019), #RN1≥3 (p<0.001), node sampling with more than 3 resected nodes (p=0.049), at least 3 stations with 3 N1 nodes resected (p=0.013), at least 3 stations resected with 10 lymphnodes, and 3N1 lymphnodes (p=0.020) significantly correlated with improved DFS. Multivariable analysis confirmed as independent prognostic factor #RN1≥3 (p=0.017; HR 1.782; and 95% CI: 1.107-2.867). Patients with #RN1≥3 presented a 5-years DFS of 76.3% versus 57.8% of patients with #RN1<3 (p=0.001). Hilar lymphadenectomy seems to significantly correlate with disease-free survival in patients with pN0NSCLC and should be better defined in lymphadenectomy guidelines.

Patients with single metastases from colorectal cancer constitute a subgroup with an excellent 5-year OS of 55-70% and with a real chance for cure. In this situation, local margin recurrence in the lung may impair the prognosis and thus is the main outcome target of surgery. A retrospective multicenter analysis of patients with single metastases from colorectal cancers was performed. Four German Thoracic Surgery units contributed data from their prospective metastasectomy databases. Statistical analysis was focused on tumor recurrence and risk factors for local margin recurrence. 166 patients from four centers could be further analyzed. For later comparison, 93 (56%) anatomic resections and 73 (44%) non-anatomic resections were pooled. Tumor recurrence was detected: at any site 87/161 (54%), within the lung 62/161 (38.5%) at intrapulmonary margins 25/145 (17.2%) and in intrathoracic lymph nodes 14/138 (10.1%). Intrapulmonary local margin recurrence was more often found in non-anatomic (25.4%) versus anatomic (11.6%) resections (p = 0.052). After propensity score matching (PSM), local margin recurrence was significantly more frequent after non-anatomic resection of intermediate and peripherally located metastases (p = 0.042). Furthermore, local margin recurrence was associated with small safety margins (p < 0.001), small number of lymph nodes removed (p < 0.001) and with intrathoracic lymph node recurrence (p = 0.001). The 5- and 10-year OS of the whole group was 70% and 47% with a median survival of 9.0 years. The 5- and 10-year RFS of the whole group was 59% and 43% with a median of 7.3 years. This study demonstrates that anatomical resection of single CRC lung metastases is superior to non-anatomic resection with respect to local radicality and local intrapulmonary margin recurrence, but there was no difference in OS and RFS.

ABSTRACTObjectiveAlthough uniportal video‐assisted thoracoscopic surgery (uVATS) is increasingly adopted for early‐stage lung cancer, long‐term survival data comparing different forms of anatomic resection remain limited. This study aimed to evaluate the long‐term oncologic outcomes—specifically, 5‐year disease‐free survival (DFS) and overall survival (OS)—of patients with clinical stage I non‐small cell lung cancer (NSCLC) who underwent uVATS segmentectomy or lobectomy. Secondary outcomes included perioperative parameters and complication rates.MethodWe conducted a retrospective analysis of patients with clinical stage I NSCLC who underwent uVATS anatomical resection (lobectomy or segmentectomy) between January 2014 and December 2020. The primary endpoints were 5‐year DFS and OS, while the secondary endpoints included operative time, drainage duration, hospital stay, conversion rates, and postoperative complications.ResultsA total of 386 patients with clinical stage I NSCLC underwent uVATS anatomical resection, with 280 receiving lobectomy and 106 undergoing segmentectomy. The 5‐year DFS and OS rates did not significantly differ between segmentectomy and lobectomy for patients with pathological stage IA tumors. Segmentectomy was associated with a shorter drainage duration. The overall conversion rate to multiple‐port VATS or thoracotomy was 1.8%, with no 30‐day surgical mortality observed. Prolonged air leaks were the most common complication.ConclusionuVATS anatomical resection is an effective treatment option for clinical stage I NSCLC, offering comparable long‐term survival outcomes for segmentectomy and lobectomy in selected patients. Further prospective studies are warranted to confirm these findings and optimize patient selection.

Probiotic Prophylaxis With Clostridium butyricum for Postoperative Infections Following Lung Resection: A Propensity Score-Weighted Analysis.

Surgical feasibility for the single-incision laparoscopic left-sided anatomical liver resection: A cohort comparative study.

Quantification of remnant liver ischemia after hepatectomy using advanced 3D-software analysis and its impact on hepatocellular carcinoma recurrence.

A Comparative Analysis of Nodal Spread in Solid-Predominant vs Pure-Solid Stage IA Hypometabolic Lung Adenocarcinoma.

P3.13.02 The Effectiveness of Anatomical Versus Non-Anatomical Resection for Treatment of Small Cell Lung Carcinoma

Impact of minimally invasive surgical approach on oncological completeness of resection in lung cancer surgery.

Is adjuvant chemotherapy beneficial in NSCLC patients over 75? Insights from a retrospective analysis.

Minimally invasive anatomic lung resections are the standard for early non-small-cell lung cancer, and the robotic approach has gained popularity and the latest frontier is the uniportal robotic (uRATS) approach. The goal of our study is to share our series showing technical details, feasibility and early outcomes. From December 2024, we started the uRATS programme for selected patients. Continuous and dichotomous variables were recorded about surgery and the perioperative period. Non-parametric tests were used to compare the data between uRATS and contemporary patients treated with robotic multiport RATS. In 4months we performed two segmentectomies and five Lobectomy through uRATS, while one patient was converted due to incomplete fissure. No severe perioperative complications occurred and in the comparison with the multiport approach, no significant differences in operative time, conversions and complications were observed. The Uniportal RATS approach was safe and feasible with adequate surgical and oncologic post-operative results.

Incidental gallbladder cancer (iGBC) presents unique management challenges. This retrospective single-center study evaluates perioperative and long-term outcomes following oncologic revisional resection (ORR) via open and minimally invasive surgery (MIS) over a 25-year period. Patients diagnosed T1b-T3 iGBC undergone ORR (anatomical resection of liver segments 4b-5 and regional lymphadenectomy) from January 2000 through December 2024 were included. Perioperative and oncologic outcomes were compared between surgical approaches using multivariable and inverse probability of treatment weighting (IPTW) analyses. A total of 95 patients were included. While MIS was associated with longer operative times and more frequent use of vascular clamping, it resulted in shorter hospital stays without compromising oncologic outcomes. Five-year cancer-specific and recurrence-free survival rates were 64.3% and 55.8%, respectively, with no significant differences between surgical approaches. Multivariable analysis confirmed that long-term prognosis is predominantly determined by tumor biology, specifically T-stage ≥ 3, positive lymph nodes, perineural/lymphovascular invasion, and residual disease, rather than surgical technique. Findings from this study support the safe integration of minimally invasive approach for iGBC ORR in experienced centers, offering comparable oncologic efficacy, improved recovery profiles and supporting its broader adoption.

Abstract Background: Sclerosing pneumocytoma (SP) is a rare benign pulmonary neoplasm that can mimic malignancy on radiologic imaging, presenting a diagnostic challenge. Case: A 56-year-old woman was evaluated for an incidentally detected 30 mm solid mass in the the left lower lobe. PET/CT revealed increased FDG uptake (SUVmax: 5.5), and MRI showed marked contrast enhancement suggestive of a neuroendocrine tumor. Bronchoscopy revealed no endobronchial involvement. Pulmonary function was sufficient for resection. Given the lesion’s central location, imaging findings concerning for malignancy, and absence of a preoperative diagnosis, video-assisted thoracoscopic lobectomy with mediastinal lymph node dissection was performed. Histopathological and immunohistochemical analysis confirmed SP. The postoperative course was uneventful, and no recurrence was observed during 14 months of follow-up. Conclusion: SP should be included in the differential diagnosis of solitary pulmonary nodules. In patients with radiological features mimicking malignancy, anatomical resection may be required for definitive diagnosis and oncological safety.