Analysis Of The Short-Term Efficacy Of Thoracoscopic Segmentectomy And Pulmonary Wedge Resection In The Treatment Of Adenocarcinoma In Situ With Ground-Glass Opacity

Objective: To investigate and evaluate the clinical efficiency,safety and short-term outcomes for treating Adenocarcinoma In Situ with ground-glass opacity as the main phenotype by using segmentectomy and wedge resection.Methods: Retrospective analysis was performed on 76 patients with Adenocarcinoma In Situ with ground-glass opacity as the main phenotype from Department of Thoracic Surgery,Shengjing Hospital Affiliated to China Medical University from February 2015 to February 2017.According to the operation methods were divided into segmentectomy group(32 cases)and wedge group(44 cases).Evaluated and compared two groups of patients with Operation time,intraoperative blood loss estimation,time of thoracic indwelling,mean hospital stay,1 day postoperative pain score,number of lymph node dissection,distance from the cutting edge to the tumor,morbidity of postoperative complications and followed up for short-term prognosis.Results: All the 76 patients completed the surgery successfully,with no case needed a second operation and no death occurred during perioperative.There was no significant difference in preoperative general data between the two groups.The patients in the wedge group had less operation time,intraoperative blood loss estimation,thoracic duct indwelling time,average hospitalization time after surgery and VAS Pain score on the first day after surgery than those in segmentectomy group,the difference was statistically significant(P<0.05).The number of lymph node dissection in the segmentectomy group were greater than those in the lung wedge group,the difference was statistically significant(P < 0.05).The distance between the cutting edge and tumor in the segmentectomy group was greater than that in the wedge group,but the difference was not statistically significant(P > 0.05).In terms of complications,The incidence of postoperative complications in the segmentectomy group was higher than that in the wedge resection group,but the difference was not statistically significant(P>0.05).but in particular,the incidence of postoperative pulmonary air leakage in the segmentectomy group was higher than that in the wedge group,and the difference was statistically significant(P < 0.05).Postoperative follow-up showed that no death,recurrence or metastasis were found in both groups,and the 2-year overall survival rate and tumor-free survival rate were both 100%.Conclusion: Both sublobectomy treatments are safe and feasible for adenocarcinoma in situ in the form of GGO.From the perspective of oncology,pulmonary segmentectomy can clear more lymph nodes and ensure the distance of tumor resection margin.For GGO greater than 1cm with the risk of lymph node metastasis,segmentectomy should be given priority.However,due to the greater trauma and more complications of this operation metohd,it is possible that the patients with older age and multiple preoperative comorbidity and poor quality of lung parenchyma will benefit less by segmentectomy.wedge resection during the perioperative period of patients can cause less trauma and impact than segmentectomy,so that it can recover faster。Therefore,wedge resection is recommended for adenocarcinoma in situ with tumor less than 2cm,especially for Adenocarcinoma In Situ with tumor less than 1cm,or for elderly patients with more underlying diseases and poor lung quality.