Masaaki Sato1,2, Taiji Kuwata3, Atsushi Kitamura4, Kenji Misawa5, Kota Imashimizu6, Keiji Yamanashi7, Masaki Ikeda8, Terumoto Koike9, Masashi Kobayashi10, Shinji Kosaka11, Ryuta Fukai12, Noritaka Isowa13, Kazuhiro Nagayama2, Akihiro Aoyama1, Hiroshi Date1, Jun Nakajima2. 1. Department of Thoracic Surgery, Kyoto University, Kyoto, Japan. 2. Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan. 3. The Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushyu, Japan. 4. Department of Respiratory Medicine, St. Luke's International Hospital, Tokyo, Japan. 5. Department of Thoracic Surgery, Aizawa Hospital, Matsumoto, Japan. 6. Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan. 7. Department of Thoracic Surgery, Kitano Hospital, Osaka, Japan. 8. Department of Thoracic Surgery, Nagara Medical Center, Gifu, Japan. 9. Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. 10. Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan. 11. Department of Thoracic Surgery, Shimane Prefectural Central Hospital, Izumo, Japan. 12. Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan. 13. Department of Thoracic Surgery, Matsue Red Cross Hospital, Matsue, Japan.
Abstract
BACKGROUND: Virtual-assisted lung mapping (VAL-MAP), a bronchoscopic multi-spot dye-marking technique, was tested for its ability to resect ground glass nodules (GGNs) in sublobar lung resections. METHODS: All patients were prospectively registered in the multi-institutional lung mapping (MIL-MAP) study using VAL-MAP. The data were retrospectively analyzed, focusing on GGNs. GGN characteristics, pathological findings, operation type, and the surgical contribution of VAL-MAP were evaluated. RESULTS: The 370 GGNs in 299 patients included 257 pure and 113 mixed GGNs. There were 146 wedge resections (43.6%), 99 simple segmentectomies (29.6%), and 60 complex segmentectomies (18.0%). The largest number of marks were used in complex segmentectomy (4.05±0.74), followed by simple segmentectomy (3.35±0.97) and wedge resection (2.96±0.80). The overall successful resection rate was 98.6%. Multiple [2-5] GGNs were concurrently targeted by VAL-MAP in 53 patients (17.7%) with 123 GGNs. Two concurrent resections were conducted in 36 patients (12.1%), most commonly wedge resection and segmentectomies (21 patients). Among 190 sub-centimeter GGNs, 24 out of 51 GGNs ≤5 mm in diameter (47.1%) and 113 of 139 GGNs >5 mm in diameter (81.3%) were primary lung cancer (P<0.0001). Regarding the contribution of VAL-MAP to successful resection, wedge resection and pure GGNs were graded higher than both other resection types and mixed GGNs. CONCLUSIONS: VAL-MAP enabled thoracoscopic limited resection of GGNs. Its multiple marks facilitated resections of multi-centric GGNs. Resected suspicious GGNs >5 mm in diameter are likely to be lung cancer. VAL-MAP may impact decision-making regarding the indications and type of surgery for suspicious small GGNs.
BACKGROUND: Virtual-assisted lung mapping (VAL-MAP), a bronchoscopic multi-spot dye-marking technique, was tested for its ability to resect ground glass nodules (GGNs) in sublobar lung resections. METHODS: All patients were prospectively registered in the multi-institutional lung mapping (MIL-MAP) study using VAL-MAP. The data were retrospectively analyzed, focusing on GGNs. GGN characteristics, pathological findings, operation type, and the surgical contribution of VAL-MAP were evaluated. RESULTS: The 370 GGNs in 299 patients included 257 pure and 113 mixed GGNs. There were 146 wedge resections (43.6%), 99 simple segmentectomies (29.6%), and 60 complex segmentectomies (18.0%). The largest number of marks were used in complex segmentectomy (4.05±0.74), followed by simple segmentectomy (3.35±0.97) and wedge resection (2.96±0.80). The overall successful resection rate was 98.6%. Multiple [2-5] GGNs were concurrently targeted by VAL-MAP in 53 patients (17.7%) with 123 GGNs. Two concurrent resections were conducted in 36 patients (12.1%), most commonly wedge resection and segmentectomies (21 patients). Among 190 sub-centimeter GGNs, 24 out of 51 GGNs ≤5 mm in diameter (47.1%) and 113 of 139 GGNs >5 mm in diameter (81.3%) were primary lung cancer (P<0.0001). Regarding the contribution of VAL-MAP to successful resection, wedge resection and pure GGNs were graded higher than both other resection types and mixed GGNs. CONCLUSIONS: VAL-MAP enabled thoracoscopic limited resection of GGNs. Its multiple marks facilitated resections of multi-centric GGNs. Resected suspicious GGNs >5 mm in diameter are likely to be lung cancer. VAL-MAP may impact decision-making regarding the indications and type of surgery for suspicious small GGNs.
Authors: Amgad El-Sherif; Hiran C Fernando; Ricardo Santos; Brian Pettiford; James D Luketich; John M Close; Rodney J Landreneau Journal: Ann Surg Oncol Date: 2007-05-16 Impact factor: 5.344