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Beyond the Standard: A Paradigm Shift with Precision Lung Cancer...
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Beyond the Standard: A Paradigm Shift with Precision Lung Cancer Surgery

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: closed (30 August 2024) | Viewed by 8892

Special Issue Editors

Prof. Dr. Kimihiro Shimizu

E-Mail Website
Guest Editor
Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
Interests: lung cancer surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Takashi Eguchi

E-Mail Website
Guest Editor
Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
Interests: complex lung segmentectomy; lung cancer; minimally invasive surgery; perioperative risk assessment; robotic surgery; spread through air spaces (STAS)
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue of the journal Cancers focuses on the paradigm shift in the field of lung cancer surgery, with a particular emphasis on “precision” surgery with the recent advances in lung-preserving sublobar resection. Recent trials have challenged the traditional approach of lobectomy for early-stage lung cancer, showing that sublobar resection can be just as effective in terms of survival rates.

The articles in this Special Issue cover a range of topics related to the shift towards precision surgery, including studies on the efficacy and safety of lung-preserving sublobar resection compared to traditional lobectomy. In addition, the Special Issue explores the latest advances in personalized and tailored treatments based on individual functional status, as well as simulation and navigation technology that can help to guide surgeons to achieve successful resections. The Special Issue also features articles on the use of localization tools in lung cancer surgery, which can help to improve the accuracy of tumor targeting.

Overall, this Special Issue showcases the exciting developments in the field of early-stage lung cancer surgery and highlights the potential for precision surgery to improve patient outcomes. With contributions from leading experts in the field, this Special Issue is a must-read for anyone interested in the latest research and advancements in lung cancer surgery.

Prof. Dr. Kimihiro Shimizu
Dr. Takashi Eguchi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

 

Keywords

  • early-stage lung cancer
  • surgery
  • lung-preserving sublobar resection
  • localization tools
  • tailored treatment

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Published Papers (7 papers)

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Research

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9 pages, 5252 KiB  
Article
Intraoperative Transbronchial Metallic Coil Marking for Small Peripheral Pulmonary Lesions in a Hybrid Operation Room
by Naoya Kawakita, Hiroaki Toba, Naoki Miyamoto, Shinichi Sakamoto, Hiroyuki Sumitomo, Taihei Takeuchi, Atsushi Morishita, Ayaka Baba, Emi Takehara, Keisuke Fujimoto, Masakazu Goto and Hiromitsu Takizawa
Cancers 2024, 16(23), 4038; https://doi.org/10.3390/cancers16234038 - 1 Dec 2024
Viewed by 1115
Abstract
Background/Objectives: Computed tomography (CT)-guided transbronchial metallic coil marking is useful for identifying the locations of small peripheral pulmonary lesions. Even deeply located lesions may be accurately identified and resected with adequate margins. This method is also applicable to multiple lesions. The present [...] Read more.
Background/Objectives: Computed tomography (CT)-guided transbronchial metallic coil marking is useful for identifying the locations of small peripheral pulmonary lesions. Even deeply located lesions may be accurately identified and resected with adequate margins. This method is also applicable to multiple lesions. The present study examined the efficacy of our marking method using cone-beam CT (CBCT) under general anesthesia in a hybrid operation room. Methods: In the hybrid operation room, an ultrathin bronchoscope was inserted into the objective bronchus under virtual bronchoscopic navigation, and a metallic coil was installed under CBCT guidance. The lesion was then resected with wedge resection by single- or 3-port video-assisted thoracoscopic surgery under fluorescence guidance. Eighty-seven patients with 90 lesions were treated between October 2016 and December 2022. The median lesion size was 11 mm and the median distance from the pleural surface was 8.7 mm. Lesions comprised 19 pure ground-glass nodule (GGN), 35 partly solid, and 36 solid types. Results: All lesions were visualized by CBCT, and metallic coils were installed into the objective bronchi. The median distance from lesions to coils was 3.6 mm, and the median marking time was 23.5 min. All lesions were resected with sufficient margins. In total, 57 lesions were diagnosed as primary lung cancer, 26 as metastatic lung tumors, 3 as nodular lymphoid hyperplasia, and 4 as others. There were no complications associated with the marking procedure. Conclusions: CBCT represents an alternative modality for identifying peripheral lung lesions due to its ability to visualize even small GGNs. It is a minimally invasive technique because the treatment sequence is completed under general anesthesia with the same quality as previous methods performed in a CT-equipped interventional radiology suite. Full article
(This article belongs to the Special Issue Beyond the Standard: A Paradigm Shift with Precision Lung Cancer Surgery)
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13 pages, 1771 KiB  
Article
Single-Stage Image-Guided Percutaneous Ablation with Thoracoscopic Resection for Multiple Pulmonary Lesions in a Hybrid Operating Room: A Retrospective Study
by Ling-Kai Chang, Po-Keng Su, Pak-Si Chan, Shwetambara Malwade, Wen-Yuan Chung and Shun-Mao Yang
Cancers 2024, 16(20), 3512; https://doi.org/10.3390/cancers16203512 - 17 Oct 2024
Viewed by 831
Abstract
Background: Different approaches are required in treating patients with multiple pulmonary lesions. A multistage procedure may increase the risk of complications and patient discomfort. This study reports an initial experience with single-stage management of multiple lung lesions using percutaneous ablation with thoracoscopic resection [...] Read more.
Background: Different approaches are required in treating patients with multiple pulmonary lesions. A multistage procedure may increase the risk of complications and patient discomfort. This study reports an initial experience with single-stage management of multiple lung lesions using percutaneous ablation with thoracoscopic resection in a hybrid operating room (HOR). Methods: We retrospectively evaluated patients who underwent combined ablation and resection in an HOR between May 2022 and July 2024. All patients received a single anesthesia via endotracheal tube intubation. The clinical data, operative findings, and pathological characteristics of the lung nodules were recorded. Results: A total of 22 patients were enrolled in this study. Twenty patients underwent unilateral procedures, while the other two patients underwent bilateral procedures. Ablations were performed before lung resection in 21 patients; only 1 patient underwent surgery first. The median global operating room time was 227.0 min. The median total radiation dose (dose area product) was 14,076 μGym2. The median hospital postoperative length of stay was 2 days. Conclusions: The single-stage procedure of percutaneous ablation with thoracoscopic resection under general anesthesia in an HOR is feasible and safe. This procedure is an alternative method for managing multiple pulmonary lesions. Full article
(This article belongs to the Special Issue Beyond the Standard: A Paradigm Shift with Precision Lung Cancer Surgery)
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11 pages, 3450 KiB  
Article
Comparison of the Learning Curve between Uniportal and Robotic Thoracoscopic Approaches in Pulmonary Segmentectomy during the Implementation Period Using Cumulative Sum Analysis
by Hitoshi Igai, Kazuki Numajiri, Fumi Ohsawa, Kazuhito Nii and Mitsuhiro Kamiyoshihara
Cancers 2024, 16(1), 184; https://doi.org/10.3390/cancers16010184 - 29 Dec 2023
Cited by 2 | Viewed by 1033
Abstract
Background: The aim of this retrospective study was to compare the learning curve and perioperative outcomes between the two approaches uVATS and RATS during their implementation periods. Methods: The uVATS group included 77 consecutive uVATS segmentectomies performed by HI between February 2019 and [...] Read more.
Background: The aim of this retrospective study was to compare the learning curve and perioperative outcomes between the two approaches uVATS and RATS during their implementation periods. Methods: The uVATS group included 77 consecutive uVATS segmentectomies performed by HI between February 2019 and June 2022, while the RATS group included 30 between July 2022 and September 2023. The patient characteristics, perioperative outcomes, and learning curves were compared between the two groups. The learning curve was evaluated using operative time and cumulative sum (CUSUMOT) analysis. Results: Most patient characteristics and perioperative outcomes were equivalent between the two groups. In the uVATS group, after a positive slope was observed until the 14th case (initial period), a plateau was observed until the 38th case (stable period). Finally, a negative slope was observed after the 38th case (proficiency period). In the RATS group, after a positive slope was observed until the 16th case (initial period), a plateau was observed until the 22nd case (stable period). Finally, a negative slope was observed after the 22nd case (proficiency period). Conclusions: In segmentectomy, a surgeon reached the proficiency period earlier in RATS than in uVATS, although the trends to the stable period were similar. Full article
(This article belongs to the Special Issue Beyond the Standard: A Paradigm Shift with Precision Lung Cancer Surgery)
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11 pages, 14185 KiB  
Communication
Influencing Factors on Intersegmental Identification Adequacy in Segmentectomy with Intraoperative Indocyanine Green (ICG) Intravenous Administration
by Harushi Ueno, Tomohiro Setogawa, Ayaka Makita, Yuko Ohara, Yoshito Imamura, Shoji Okado, Hiroki Watanabe, Yuta Kawasumi, Yuka Kadomatsu, Taketo Kato, Shota Nakamura, Tetsuya Mizuno and Toyofumi Fengshi Chen-Yoshikawa
Cancers 2023, 15(24), 5876; https://doi.org/10.3390/cancers15245876 - 17 Dec 2023
Cited by 1 | Viewed by 1185
Abstract
Accurate identification of the intersegmental plane is essential in segmentectomy, and Indocyanine Green (ICG) assists in visualizing lung segments. Various factors, including patient-related, intraoperative, and technical issues, can influence boundary delineation. This study aims to assess the rate of unsuccessful intersegmental identification and [...] Read more.
Accurate identification of the intersegmental plane is essential in segmentectomy, and Indocyanine Green (ICG) assists in visualizing lung segments. Various factors, including patient-related, intraoperative, and technical issues, can influence boundary delineation. This study aims to assess the rate of unsuccessful intersegmental identification and identify the contributing factors. We analyzed cases of lung segmentectomy from April 2020 to March 2023, where intraoperative ICG was intravenously administered during robot-assisted or video-assisted thoracoscopic surgery. Cases where fluorescence extended beyond expected boundaries within 30 s were classified as the “unclear boundary group”. This group was then compared to the “clear boundary group”. The study encompassed 111 cases, 104 (94%) of which were classified under the “clear boundary group” and 7 (6%) under the “unclear boundary group”. The “unclear boundary group” had a significantly lower DLCO (15.7 vs. 11.8, p = 0.03) and DLCO/VA (4.3 vs. 3.0, p = 0.01) compared to the “clear boundary group”. All cases in the “unclear boundary group” underwent lower lobe segmentectomy. ICG administration effectively outlines pulmonary segments. Challenges in segment demarcation may occur in cases with low DLCO and DLCO/VA values, particularly during lower lobe segmentectomy. Full article
(This article belongs to the Special Issue Beyond the Standard: A Paradigm Shift with Precision Lung Cancer Surgery)
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Review

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16 pages, 1674 KiB  
Review
Performing High-Quality Sublobar Resections: Key Differences Between Wedge Resection and Segmentectomy
by Benjamin Bottet, Niek Hugen, Matthieu Sarsam, Mathias Couralet, Sonia Aguir and Jean-Marc Baste
Cancers 2024, 16(23), 3981; https://doi.org/10.3390/cancers16233981 - 27 Nov 2024
Viewed by 796
Abstract
Lung cancer remains the leading cause of cancer-related deaths worldwide. The introduction of targeted treatments and immunotherapy in lung cancer has transformed patient care by offering “precision medicine” focused on the characteristics of the disease. The same concept has emerged in lung cancer [...] Read more.
Lung cancer remains the leading cause of cancer-related deaths worldwide. The introduction of targeted treatments and immunotherapy in lung cancer has transformed patient care by offering “precision medicine” focused on the characteristics of the disease. The same concept has emerged in lung cancer surgery. This “precision surgery” aims to determine the best surgical approach based on the characteristics of the cancer, the patient’s cardiorespiratory status, and technological advances in thoracic surgery. While lobectomy continues to be the gold standard for managing early-stage lung cancer, the implementation of screening programs has enabled the earlier detection of smaller tumors. In this context, sublobar resections, particularly segmentectomy, have emerged as valuable options in the treatment of early-stage lung cancer. Recent studies suggest that sublobar resections, including segmentectomy and wedge resection, provide a viable alternative to lobectomy. This review explores the various resection strategies available, tailored to patient and tumor characteristics, and highlights modern preoperative techniques aimed at advancing precision surgery. Full article
(This article belongs to the Special Issue Beyond the Standard: A Paradigm Shift with Precision Lung Cancer Surgery)
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12 pages, 2729 KiB  
Review
Evolution of Three-Dimensional Computed Tomography Imaging in Thoracic Surgery
by Toyofumi Fengshi Chen-Yoshikawa
Cancers 2024, 16(11), 2161; https://doi.org/10.3390/cancers16112161 - 6 Jun 2024
Cited by 2 | Viewed by 1355
Abstract
Radiologic reconstruction technology allows the wide use of three-dimensional (3D) computed tomography (CT) images in thoracic surgery. A minimally invasive surgery has become one of the standard therapies in thoracic surgery, and therefore, the need for preoperative and intraoperative simulations has increased. Three-dimensional [...] Read more.
Radiologic reconstruction technology allows the wide use of three-dimensional (3D) computed tomography (CT) images in thoracic surgery. A minimally invasive surgery has become one of the standard therapies in thoracic surgery, and therefore, the need for preoperative and intraoperative simulations has increased. Three-dimensional CT images have been extensively used, and various types of software have been developed to reconstruct 3D-CT images for surgical simulation worldwide. Several software types have been commercialized and widely used by not only radiologists and technicians, but also thoracic surgeons. Three-dimensional CT images are helpful surgical guides; however, in almost all cases, they provide only static images, different from the intraoperative views. Lungs are soft and variable organs that can easily change shape by intraoperative inflation/deflation and surgical procedures. To address this issue, we have developed a novel software called the Resection Process Map (RPM), which creates variable virtual 3D images. Herein, we introduce the RPM and its development by tracking the history of 3D CT imaging in thoracic surgery. The RPM could help develop a real-time and accurate surgical navigation system for thoracic surgery. Full article
(This article belongs to the Special Issue Beyond the Standard: A Paradigm Shift with Precision Lung Cancer Surgery)
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12 pages, 3213 KiB  
Review
Harnessing 3D-CT Simulation and Planning for Enhanced Precision Surgery: A Review of Applications and Advancements in Lung Cancer Treatment
by Kazutoshi Hamanaka, Kentaro Miura, Takashi Eguchi and Kimihiro Shimizu
Cancers 2023, 15(22), 5400; https://doi.org/10.3390/cancers15225400 - 14 Nov 2023
Cited by 5 | Viewed by 1713
Abstract
The clinical application of three-dimensional computed tomography (3D-CT) technology has rapidly expanded in the last decade and has been applied to lung cancer surgery. Two consecutive reports of large-scale prospective clinical trials from Japan and the United States have brought a paradigm shift [...] Read more.
The clinical application of three-dimensional computed tomography (3D-CT) technology has rapidly expanded in the last decade and has been applied to lung cancer surgery. Two consecutive reports of large-scale prospective clinical trials from Japan and the United States have brought a paradigm shift in lung cancer surgery and may have led to a rapid increase in sublobar lung resections. Sublobar resection, especially segmentectomy, requires a more precise understanding of the anatomy than lobectomy, and preoperative 3D simulation and intraoperative navigation support it. The latest 3D simulation software packages are user-friendly. Therefore, in this narrative review, we focus on recent attempts to apply 3D imaging technologies, particularly in the sublobar resection of the lung, and review respective research and outcomes. Improvements in CT accuracy and the use of 3D technology have advanced lung segmental anatomy. Clinical applications have enabled the safe execution of complex sublobar resection through a minimally invasive approach, such as video-assisted thoracoscopic surgery and robotic surgery. However, currently, many facilities still render 3D images on two-dimensional monitors for usage. In the future, it will be challenging to further spread and advance intraoperative navigation through the application of 3D output technologies such as extended reality. Full article
(This article belongs to the Special Issue Beyond the Standard: A Paradigm Shift with Precision Lung Cancer Surgery)
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