Perioperative Efficacy Evaluation Of Thoracoscopic Segmentectomy And Cuneectomy In Elderly Patients

Objective: To investigate the feasibility,safety and perioperative outcomes of thoracoscopic lung segmental resection and wedge resection in elderly patients with Ground-glass opacity(GGO)on chest CT.The study will provide a basis for clinical selection of the procedure.Methods:The clinical data of 62 patients with pulmonary malignancies who underwent surgical treatment at the Department of Thoracic Surgery,First Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2021 were retrospectively analyzed.Among them,35 cases underwent thoracoscopic lung wedge resection and 27 cases underwent thoracoscopic lung segmental resection.Results:All 62 patients underwent surgery successfully,with no perioperative deaths or need for intermediate open-heart surgery.Preoperative general information was similar between the two groups.The lung wedge resection group had a shorter operating time,less intraoperative bleeding,and shorter hospital stay than the lung segment group.These differences were statistically significant(P < 0.05).The lung segment group had more cleared lymph nodes and larger distance between the resection margin and the tumour than the lung wedge group.These differences were also statistically significant(P < 0.05).Although the incidence of postoperative complications was higher in the lung segment group,there was no statistically significant difference(P > 0.05).However,the lung segment group had a significantly higher incidence of postoperative pulmonary air leakage than the lung wedge group(P < 0.05).There were no deaths,recurrences,or metastases observed during postoperative follow-up in either group.Conclusions: Both sub lobectomies are safe and feasible for the treatment of early stage lung adenocarcinoma presenting as GGO.From an oncological point of view,thoracoscopic lung segmental resection allows for more lymph nodes to be cleared and the distance between the tumour margins to be ensured,and should be preferred for GGO larger than 1 cm with a risk of lymph node metastasis.However,this procedure is more invasive,involves more loss of lung parenchyma and has more complications,and has a higher incidence of postoperative air leak and pulmonary embolism,so it may be less beneficial in older patients with preoperative comorbidities and poor imaging and intraoperative findings of lung parenchyma.Thoracoscopic lung wedge resection is less invasive and less disruptive to the patient during the perioperative period than lung segmental resection,and recovery is faster.Thoracoscopic wedge resection is therefore recommended for patients with lung adenocarcinoma smaller than 2 cm,especially those smaller than 1 cm,or for older patients with more underlying disease and poor lung quality.