Asia expert consensus on segmentectomy in non–small cell lung cancer: A modified Delphi studyCentral MessagePerspective
Lunxu Liu, MD, PhD,
Keiju Aokage, MD, PhD,
Chang Chen, MD,
Chun Chen, MD,
Liang Chen, MD,
Yong-Hee Kim, MD, PhD,
Chang Young Lee, MD, PhD,
Chengwu Liu, MD, PhD,
Chia-Chuan Liu, MD,
Wataru Nishio, MD, PhD,
Kenji Suzuki, MD,
Lijie Tan, MD,
Yau-Lin Tseng, MD, PhD,
Masaya Yotsukura, MD, PhD,
Shun-ichi Watanabe, MD, PhD
Affiliations
Lunxu Liu, MD, PhD
Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Address for reprints: Lunxu Liu, MD, PhD, Department of Thoracic Surgery, West China Hospital of Sichuan University, No 37 Guoxue Alley, Chengdu, Sichuan, China 610041.
Keiju Aokage, MD, PhD
Division of Thoracic Surgery, National Cancer Centre Hospital East, Chiba, Japan
Chang Chen, MD
Division of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
Chun Chen, MD
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
Liang Chen, MD
Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
Yong-Hee Kim, MD, PhD
Division of Thoracic Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Chang Young Lee, MD, PhD
Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
Chengwu Liu, MD, PhD
Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
Chia-Chuan Liu, MD
Division of Thoracic Surgery, KOO Foundation Cancer Centre, Taipei, Taiwan
Wataru Nishio, MD, PhD
Department of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
Kenji Suzuki, MD
Department of General Thoracic Surgery, Juntendo University, Tokyo, Japan
Lijie Tan, MD
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
Yau-Lin Tseng, MD, PhD
Division of Thoracic Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
Masaya Yotsukura, MD, PhD
Department of Thoracic Surgery, National Cancer Centre Central Hospital, Tokyo, Japan
Shun-ichi Watanabe, MD, PhD
Department of Thoracic Surgery, National Cancer Centre Central Hospital, Tokyo, Japan
Objective: Segmentectomy as a parenchymal-sparing surgical approach has been recommended over lobectomy in select patients with early-stage non–small cell lung cancer. This study aimed to address 3 aspects of segmentectomy (“patient indication”; “segmentectomy approaches”; “lymph node assessment”) where there is limited clinical guidance. Methods: A modified Delphi approach comprising 3 anonymous surveys and 2 expert discussions was used to establish consensus on the aforementioned topics among 15 thoracic surgeons (2 Steering Committee; 2 Task Force; 11 Voting Experts) from Asia who have extensive segmentectomy experience. Statements were developed by the Steering Committee and Task Force based on their clinical experience, published literature (rounds 1-3), and comments received from Voting Experts through surveys (rounds 2-3). Voting Experts indicated their agreement with each statement on a 5-point Likert scale. Consensus was defined as ≥70% of Voting Experts selecting either “Agree”/“Strongly Agree” or “Disagree”/“Strongly Disagree.” Results: Consensus from the 11 Voting Experts was reached on 36 statements (11 “patient indication” statements; 19 “segmentation approaches” statements; 6 “lymph node assessment” statements). In rounds 1, 2, and 3, consensus was reached on 48%, 81%, and 100% of drafted statements, respectively. Conclusions: A recent phase 3 trial reported significantly improved 5-year overall survival rates for segmentectomy compared with lobectomy, proposing thoracic surgeons to consider segmentectomy as a surgical option in suitable patients. This consensus serves as a guidance to thoracic surgeons considering segmentectomy in patients with early non–small cell lung cancer, outlining key principles that surgeons should consider in surgical decision-making.
