Optimal planning and management strategies for minimally invasive lung segmentectomies: an international Delphi consensus report
Year: 2024
Type: article
Abstract: OBJECTIVES: CALGB140503/JCOG0802 RCTs comparing lobectomy with sublobar resection in stage IA NSCLC have confirmed the non-inferiority of segmentectomy. Additional insight is needed to improve preoperative work-up and intraoperative strategies to increase safety and promote the dissemination of minimally invasive segmentectomy (MIS). A Delphi panel study assessed the level of consensus among surgeons for the planning and management of MIS. METHODS: Twenty-one expert lung surgeons represented academic institutions, major teaching hospitals, and community hospitals from Europe, North America, and Asia. A 3-round Delphi methodology was used to analyse the answers of each panellist. Recognizing that questions with fewer response options have a higher consensus probability due to limited variability, weighted consensus thresholds were modified based on the number of response options. RESULTS: The 21 panellists responded to all 3 rounds of questions. Based on the most robust consensus (94.4%), 3D chest CT reconstructions are recommended only when planning complex segmentectomies. Surgeons should perform 3D reconstructions chest CT scans (consensus = 83.3%). The most effective and safest technique is image-guided VATS in a hybrid operating room (consensus = 83.3%). Dyes with intravenous administration are the safest technique for identifying the intersegmental plane during MIS (consensus = 72.2%). Augmented/mixed reality will probably not immediately help reduce perioperative complications (consensus = 72.2%). CONCLUSIONS: This Delphi consensus supports 3D reconstructions and preoperative pulmonary nodule localization before complex MIS. These recommendations should be considered when allocating resources to improve MIS's safety and oncologic efficacy for patients with small, early-stage lung cancers.
Authors: Luca Bertolaccini, Firas Abu Akar, Clemens Aigner, Alessandro Brunelli, Georges Decker, Wentao Fang, József Furák, Mahmoud Ismail, Marcelo Jiménez, Andreas Kirschbaum, Marko Kostic, Marco Lucchi, Shehab Mohamed, Sudish C Murthy, Calvin S H Ng, Heribert Ortlieb, Nuria Novoa, Elena Prisciandaro, Lorenzo Spaggiari, Paula A Ugalde Figueroa, Francesco Zaraca
Institutions: European Institute of Oncology, Tel Aviv University, Al-Quds University, Wolfson Medical Center, Medical University of Vienna, St James's University Hospital, Shanghai Jiao Tong University, Shanghai Chest Hospital, University of Szeged, Klinikum Ernst von Bergmann, Universidad de Salamanca, Philipps University of Marburg, University of Belgrade, Univerzitetski Klinički Centar Srbije, University of Pisa, University of Pittsburgh, University of Pittsburgh Medical Center, Cleveland Clinic, Chinese University of Hong Kong, Prince of Wales Hospital, Klinikum Mittelbaden, Hospital Universitario Puerta de Hierro Majadahonda, Université Libre de Bruxelles, Erasmus Hospital, University of Milan, Brigham and Women's Hospital, Harvard University, Ospedale di Bolzano
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funder: Ministero della Salute
Award: G2636645585
OpenAlex ID: W4402891552