JTCVS Open (Jun 2023)

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

Journal volume & issue
Vol. 14
pp. 483 – 501

Abstract

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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.

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