According to data from the National Cancer Center, lung cancer has the highest incidence and mortality rates among malignant tumors in our country. The 5-year survival rate for late-stage lung cancer patients is only 6%, whereas early-stage lung cancer patients can achieve a 60% survival rate. Therefore, early detection and intervention are effective means of reducing the mortality rate of lung cancer and the disease burden. Currently, surgical resection is the most effective method for treating early-stage lung cancer, and in-situ adenocarcinoma and micro-invasive adenocarcinoma can be cured through radical resection. A randomized controlled study conducted in North America in 1995 revealed that for peripheral T1N0 stage non-small cell lung cancer, limited lung resections (such as segmental resection and wedge resection) were associated with higher mortality and local recurrence rates. As a result, lobectomy has become the gold standard in surgical treatment.

With the widespread use of low-dose helical CT, there has been a significant shift in the disease spectrum of lung cancer, with an increasing number of small lung cancers and ground-glass opacities (GGOs) being detected. Some researchers believe that preoperative thin-slice CT imaging for early-stage lung cancer can effectively predict the malignancy of nodules and the presence of lymph node metastasis. This may obviate the need for mandatory lymph node examination during surgery. In this context, the gold standard status of lobectomy with systematic lymph node dissection is becoming increasingly controversial. In recent years, there has been a proliferation of research on segmentectomy. Studies like JCOG1211, JCOG0802, and CALGB140503, published in top international journals, have confirmed that for patients with peripheral non-small cell lung cancer (NSCLC) with no lymph node metastasis, sublobar resection can be considered a standard treatment method.

The Shanghai Pulmonary Hospital Department of Thoracic Surgery was founded in 1953 and is currently a nationally recognized key clinical specialty, a key discipline in Shanghai, and a key clinical specialty in Shanghai. It is the world's largest thoracic surgery diagnosis and treatment center and was one of the first institutions in China to conduct large-scale single-port thoracoscopic surgery. The department has established comprehensive standards for single-port thoracoscopic surgery. Each year, lung segment resection surgery accounts for approximately 25% of the procedures performed.

In 2021, our center conducted a further comparison of the safety and effectiveness of single-port and multi-port lung segment surgeries. This study was published in the “European Journal of Cardio-Thoracic Surgery.” The article included 1,056 patients who underwent VATS lung segment resection surgery between January 2014 and December 2015. Among them, 375 cases were simple segment resections, and 681 cases were complex segment resections. Propensity score matching analysis was used to compare perioperative and survival data. Our data confirms that single-port thoracoscopic lung segment resection is safe and effective, even for complex lung segment surgeries. The short-term and long-term outcomes of single-port VATS are comparable to multi-port VATS, as demonstrated in our study.

Furthermore, our Department of Thoracic Surgery was invited to contribute to the English textbook “Atlas of Uniportal VATS”, specifically focusing on the chapter related to Uniportal Video-Assisted Thoracoscopic Segmentectomy. We summarized key technical points related to lung segment resection:

(1) The importance of identifying and delineating segmental and/or sub-segmental branches of blood vessels and bronchi for lung segment resection surgery.

(2) The recognition and dissection along intersegmental veins to properly delineate the intersegmental plane.

(3) The identification and delineation of the intersegmental plane surrounding the segments to ensure an adequate surgical margin.

This underscores the strong technical expertise of our center.

After summarizing the patients who underwent lung segment resection surgery at our hospital, it was found that right upper lobe apical, posterior, apicoposterior segments, and left upper lobe intrinsic segments have a relatively higher proportion in lung segment resections (Eur J Cardiothorac Surg. 2018). To further ensure the safety of single-port thoracoscopic lung segment surgery, our center has improved single-port thoracoscopic instruments, including extensions, dual articulations, and tip curvature, among other modifications. We have obtained several related patents with a high rate of achievement transfer (Ann Thorac Surg. 2018). In order to expand the widespread adoption of single-port VATS lung segmentectomy in more medical centers, our center conducted an analysis of the learning curve for our surgeons in performing lung segment resection procedures. It was found that after independently performing 64-71 cases, proficiency is achieved, and after 90-100 cases, surgeons can perform the procedure with ease and confidence (J Surg Oncol. 2021).

In 2020, our center reported on the learning curve of subxiphoid single-port thoracoscopic lung segment surgery (SU-VATs), and the article was published in the "European Journal of Cardio-Thoracic Surgery." This study included 300 cases of SU-VATs patients from September 2014 to May 2018. Our data confirmed that in 148 cases, the post-operative surgical time was significantly reduced.

Furthermore, our center also utilizes artificial intelligence IQQA-QMR (Quantitative Imaging Real Virtual) technology for precise lung segment resection. This technology allows for the thorough removal of lesions while offering advantages such as minimal trauma, rapid recovery, reduced complications, improved post-operative quality of life, and the preservation of normal lung tissue. It is primarily aimed at elderly patients, those with reduced lung function, as well as patients with small malignant lung nodules and multiple primary small lung cancers.

Through a retrospective analysis of patients with lung adenocarcinoma who underwent surgery in the Department of Thoracic Surgery at Shanghai Pulmonary Hospital with tumor diameters ≤2cm between 2009 and 2013, our center found that the proportion of micropapillary and solid components was an independent risk factor for recurrence after sublobar resection. Consequently, Professor Chang Chen initiated a comprehensive study in June 2020 titled "A Prospective, Multicenter RCT Study Comparing Segmentectomy and Lobectomy for Invasive Lung Adenocarcinoma with Tumor Size ≤2 cm and Intraoperative Frozen-Confirmed Negative Micropapillary and Solid Subtypes: STAR001." This study aims to explore whether segmentectomy is the optimal surgical approach for patients with invasive lung adenocarcinoma with tumor diameters ≤2 cm and without high-risk pathological subtypes. It is worth noting that this is the first clinical research project undertaken since the establishment of the Surgical Thoracic Alliance of Rising Star (STAR) (Project Registration Number: Chi CTR 1800017322, NCT 04937283). The study involves 18 medical centers, with an anticipated enrollment of 690 cases and a 5-year postoperative follow-up. Patient recruitment is expected to be completed by September 2023, surgical outcomes will be released in 2024, and preliminary analysis of follow-up results will be conducted in 2029.

The Department of Thoracic Surgery at Shanghai Pulmonary Hospital has been continuously exploring and researching minimally invasive techniques, transitioning from multi-port to single-port procedures, and extending from whole lung lobes to specific lung segments. Our goal is to develop personalized treatment plans for every patient with lung nodules, which include meticulous preoperative planning and precise and gentle intraoperative lung segment dissection. We also provide comprehensive and attentive postoperative care to facilitate recovery. Our aim is to ensure that patients not only achieve a favorable prognosis but also experience improved respiratory function and an enhanced quality of life.