Background Pivotal trials of neoadjuvant or perioperative chemoimmunotherapy for resectable NSCLC generally used 3–4 cycles, but whether response after 2 cycles can identify patients with deep pathologic regression remains unclear. Methods This multicenter retrospective cohort included 330 patients with resectable stage I-IIIC NSCLC treated with platinum-based chemotherapy plus a PD-1/PD-L1 inhibitor at three Chinese hospitals from 2019 to 2025. Patients received 2 cycles (n = 148) or 3–4 cycles (n = 182). Outcomes included major pathologic response (MPR), pathologic complete response (pCR), disease-free survival (DFS), and safety. Results Among 2-cycle patients with radiologic complete or partial response (CR/PR), MPR and pCR rates were 74.2% and 47.5%. Radiologic stable or progressive disease (SD/PD) was associated with lower odds of MPR (OR: 0.14; 95% CI: 0.07–0.32; p < 0.001) and pCR (OR: 0.22; 95% CI: 0.09–0.55; p = 0.001). MPR was the strongest DFS predictor (HR: 0.19; 95% CI: 0.08–0.43; p < 0.001); 24-month DFS was 89.2% with MPR vs. 68.0% without MPR. Any-grade myelosuppression was less frequent after 2 cycles than after 3–4 cycles (35.8% vs. 53.3%; p = 0.002). Conclusion RECIST 1.1 response was strongly associated with pathologic response after neoadjuvant chemoimmunotherapy. CR/PR after 2 cycles identified patients with high MPR and pCR rates, supporting prospective testing of response-adapted treatment duration but not routine shortening outside trials.

There is no consensus regarding whether primary tumour resection (PTR) should be performed in non-small cell lung cancer (NSCLC) patients with unexpected pleural dissemination (PD) discovered at thoracotomy. Consecutive NSCLC patients with surgically confirmed PD were retrospectively enrolled from two high-volume centres between January 2016 and December 2023. Patients were divided into the primary tumour resection (PTR) and exploratory thoracotomy (ET) group. PTR included wedge resection, segmentectomy and lobectomy. Patients in the ET group received biopsy only. Propensity score matching (PSM) was used to reduce selection bias from confounding factors. Disease-specific survival (DSS) and progression-free survival (PFS) were analysed using the Kaplan‒Meier method, and comparisons were made using the log-rank test. Multivariate Cox regression analyses were performed to identify the independent prognostic factors. A total of 223 patients were identified: 167 (74.9

Occult pleural dissemination (PD) in non-small cell lung cancer (NSCLC) patients is likely to be missed on computed tomography (CT) scans, associated with poor survival, and generally contraindicated for radical surgery. This study aimed to develop and compare the performance of radiomics-based machine learning (ML), deep learning (DL), and fusion models to preoperatively identify occult PD in NSCLC patients. A total of 326 NSCLC patients from three Chinese high-volume medical centers (2016–2023) were retrospectively collected and divided into training (n = 216), internal test (n = 54), and external test (n = 56) cohorts. Ten radiomics-based ML models and eight DL models were trained using CT images at the maximum cross-sectional slice of the primary tumor. Moreover, another two fusion models (prefusion and postfusion) were developed using feature-based and decision-based methods. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were mainly used to compare the predictive performance of the models. The GBM (AUC: 0.821) and DenseNet121 (AUC: 0.764) models achieved the highest AUC among ML and DL models in the external test cohorts, respectively. The postfusion model, integrating the output probabilities from GBM and DenseNet121 models, showed superior performance (AUC: 0.828–0.978) compared to the prefusion model (AUC: 0.817–0.877). Moreover, the postfusion model demonstrated the highest degree of sensitivity (82.1–97.2

BACKGROUND:Anatomical variations of the right middle lobe (RML) veins pose significant risks during video-assisted thoracoscopic right upper lobectomy (RUL), where unrecognised veins traversing the horizontal fissure may be injured, compromising venous drainage. While 3D reconstruction aids surgical planning, a comprehensive classification system for RML venous confluences was lacking. METHODS:This retrospective cohort study analysed 2007 patients undergoing lung surgery (2017-2023) using preoperative CT-based 3D-CT bronchography and angiography (3D-CTBA; Mimics 21.0). Two thoracic surgeons independently classified RML veins (V4a, V4b, V5a, V5b) by drainage location: horizontal fissure (H-type), anterior mediastinal (A-type), or oblique fissure (O-type). Disagreements were resolved by a radiologist. Descriptive statistics characterised anatomical patterns. RESULTS:Analysis revealed complex venous drainage, with 31.83% (n = 639) demonstrating clinically critical H-type variations (confluencing into horizontal fissure). These were subclassified as HA (30.69%), HO (0.34%), and HAO (0.79%) patterns. V4a* traversed the fissure most frequently (29.07%), draining into upper lobe veins (V3b, V3a, V2c), while V4b* (2.86%) and V5a* (5.50%) exhibited lower traversal rates. No V5b* traversed the horizontal fissure. Rare drainage into the inferior pulmonary vein (IPV; V4a: 2.59%) or left atrium (0.20%) was observed, and the two-branch venous pattern predominated (42.87%). Previously unreported variants included downward-displaced RS3 (n = 10) and V6 → superior pulmonary vein drainage (n = 2). Intraoperative validation confirmed 3D-CTBA classification accuracy. CONCLUSIONS:This large-scale study establishes the novel HAO classification system for RML venous anatomy, revealing a high prevalence (31.83%) of H-type variations that critically impact RUL safety. Preoperative 3D-CTBA using this framework enables tailored surgical strategies to preserve RML veins traversing the horizontal fissure, reducing injury risks and postoperative complications.

OBJECTIVES:The left medial basal pulmonary segment (S7) has been largely overlooked in surgical literature due to the common belief that it is typically absent. This study aimed to determine the prevalence of left S7, identify its anatomical characteristics and evaluate outcomes in patients undergoing S7 segmentectomy. METHODS:We retrospectively analysed 1440 patients who underwent thoracoscopic segmentectomy for ground-glass opacity in the left lower lobe between January 2019 and February 2022 at our hospital. Three-dimensional computed tomography bronchography and angiography (3D-CTBA) images were reconstructed for all patients. The principal outcome was the prevalence and anatomical variation of S7. Secondary outcomes included surgical feasibility and short-term outcomes of S7 segmentectomy. RESULTS:Six types of left medial basal bronchus (B7) were identified. Type 1: B7 arose from B8 (61.4%); type 2: B7 arose higher than B8-B10 (6.3%); type 3: B7 arose from B9 (5.5%); type 4: B7 arose from both B8 and B9 (1.6%); type 5: B7 arose from both B8 and B10 (0.8%); type 6: B7 was absent (24.4%). Nine (0.6%) patients with nodules in S7 underwent successful thoracoscopic segmentectomy, with no major complications or conversions to lobectomy. CONCLUSIONS:Left S7 is present in approximately 75% of patients. The complex branching patterns of B7 identified highlight the importance of preoperative 3D-CTBA for accurate surgical planning. Our findings suggest that left S7 segmentectomy is feasible and safe when performed with precise anatomical understanding, expanding surgical options for patients with early-stage lung cancer in this segment.

The natural sequential collapse method (NSCM) can be employed during surgery to reduce the duration of segmentectomy. This method avoids inflating the lung by rapidly blocking vessels within the tumor basin. It is important to note that the color of the lungs should be used to determine the surgical procedure. The NSCM is efficient and straightforward in revealing the intersegmental plane.

Following the publication of this paper, it was drawn to the Editor's attention by a concerned reader that certain of the BrdU incorporation assay data shown in Fig. 7C were strikingly similar to data that had already appeared in another article written by different authors at different research institutes [Lu M, Qin X, Zhou Y, Li G, Liu Z, Geng X and Yue H: Long non‑coding RNA LINC00665 promotes gemcitabine resistance of Cholangiocarcinoma cells via regulating EMT and stemness properties through miR‑424‑5p/BCL9L axis. Cell Death Dis 12: 72, 2021]. Owing to the fact that the contentious data in the above article had already been published prior to its submission to Oncology Reports, the Editor has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [Oncology Reports 48: 207, 2022; DOI: 10.3892/or.2022.8422].

OBJECTIVES: The trans-fissure ground-glass opacity (GGO) is a special category of lesions, with a diameter always exceeding 2 cm. It is located on a fused fissure, 'seizing' 2 neighbouring lobes simultaneously. The segmentectomy for the trans-fissure GGO is never reported. METHODS: Between August 2016 and December 2022, patients operated with a trans-fissure GGO were included. The patients' backgrounds and surgical data were summarized. All procedures were performed with the help of preoperative three-dimensional computed tomography bronchography and angiography. RESULTS: A total of 84 patients were included. The selection criteria included a consolidation tumour ratio <50% and a lesion size >2 and <= 3 cm. Thirty-six patients were operated with lobectomy + wedge (the traditional method group) and 48 patients were operated with anatomical segmentectomy + function-preserving sublobectomy (the new method group). The median operative time was 87 min in the traditional group and 98 min in the new method group, and the median blood loss was 60 ml in the traditional group and 70 ml in the new method group. The median duration of hospital stays was 4 days in the traditional group and 2 days in the new method group. In the traditional method group, there was 1 case of postoperative air leakage and 5 cases of haemoptysis. In the new method group, 2 cases of postoperative air leakage were identified. The median size of the tumour in the resected segment was 2.6 cm in the traditional group and 2.5 cm in the new method group. The median margin was 2.5 cm in the traditional group and 3.3 cm in the new method group. CONCLUSIONS: The trans-fissure GGO could be safely resected en bloc by segmentectomy with a well-designed surgical procedure and appropriate preoperative planning.

INTRODUCTION AND IMPORTANCE:Superior mesenteric artery syndrome (SMAS) is a rare medical condition resulting from vascular compression of the third part of the duodenum in the angle between the aorta and the superior mesenteric artery, leading to partial or complete intestinal obstruction and causing a series of symptoms. We now introduce a case of SMAS after lung cancer surgery, which was unique in that it was most likely caused by weight loss after surgery.CASE PRESENTATION:A 58-year-old male patient gradually developed severe nausea, vomiting, and weight loss after lung cancer surgery. A diagnosis of SMAS was made after the computed tomography of the abdomen was performed. The patient's symptoms were relieved after immediate placement of a nasojejunal nutrition tube for gastrointestinal decompression and enteral nutrition support.CLINICAL DISCUSSION:SMAS is rare and the symptoms are not specific, the clinical diagnosis of it is mostly confirmed by imaging. The presence of SMAS should be considered as a possibility when recurrent nausea and vomiting occur after lung surgery that excludes the above-mentioned causes.CONCLUSION:The signs and symptoms of SMAS are usually non-specific, which leads to misdiagnosis in all probability. SMAS should be considered when unexplained significant weight loss accompanied by recurrent nausea and vomiting happens to postoperative patients.

目的 介绍一种胸腔镜肺段切除术中利用靶段肺循环单向阻断识别段间平面的新方法.方法 回顾性分析2019年1月-2020年3月因肺结节就诊于重庆医科大学附属第一医院同一医疗组使用肺循环单向阻断法行胸腔镜下肺段切除术83例患者的临床资料,其中男33例、女50例,中位年龄54(46～65)岁.根据术中单向阻断靶段动脉或静脉的不同将患者分为两组:单向阻断静脉组(single vein group,SVG,n=31)和单向阻断动脉组(single artery group,SAG,n=52),记录两组患者的临床资料并行比较分析.结果 两组患者术中均显示出清晰段间平面.两组在段间平面离断方式(P=0.823)、手术时间(P=0.786)、术中出血量(P=0.775)、胸腔引流管引流时间(P=0.659)、术后住院时间(P=0.824)以及术后并发症发生率(P=1.000)等方面差异均无统计学意义.结论 在胸腔镜肺段切除术中使用肺循环单向阻断法进行段间平面识别简单可行,术中单向阻断靶肺动脉或静脉均能达到满意的段间平面识别效果.

We introduce a new method for sublobectomy. It utilizes the easiness and rapidity of wedge resection, and the accuracy and functional preserving of anatomical segmentectomy. It can preserve lung function with less sacrifice of lung parenchyma.

OBJECTIVES:The anatomic features and surgical techniques focusing on the right medial-basal segment (RS7) are few reported. This study aimed to accurately define the new nomenclature and classifications of B7 anatomy, elucidate its prevalence and anatomical characteristics and summarize the surgical outcomes. METHODS:Between August 2019 and February 2022, 5023 patients were admitted for pulmonary nodules. Their chest computed tomography images were obtained. All of the images were reconstructed in 3 dimensions. The RS7 were screened according to their new definition and statistically analysed for their anatomical characteristics. RESULTS:The bronchovascular anatomy of S7 can be newly classified into 6 types: B7a type, B7p type, B7o type, B7t type, BX7a type and BX7t type. The B7 anterior to the inferior pulmonary vein (IPV) was B7a (a, anterior) (3617/5023, 72%). The B7 posterior to IPV was B7p (p, posterior) (306/5023, 6.1%). The B7 over IPV was B7o (o, over) (904/5023, 18%). The B7 through IPV was B7t (t, through) (7/5023, 0.14%). An abnormal origin of B7 was named the BX7 type. The BX7 anterior to IPV sharing a common trunk with B8 was named BX7a (a, anterior) (176/5023, 3.5%). The BX7 through IPV originated from B10 and was named BX7t (t, through) (13/5023, 0.26%). 0.2% (12/5023) of patients had the nodules in RS7 and underwent RS7 surgery. CONCLUSIONS:The variation pattern of B7 is far more complex than expected. The results of this study can help surgeons better understand S7 and perform segmentectomies more accurately.

The lingular segment bronchi usually bifurcate into superior lingular (B4 ) and inferior lingular (B5 ) segmental bronchi. We report 32 horizontally bifurcated lingular segment bronchi cases, analyzing the bronchovascular variations and the perioperative outcomes. All patients with pulmonary lesions underwent three-dimensional computed tomography bronchography and angiography between January 2019 and January 2022. The bronchovascular patterns were analyzed for each patient. A consecutive 5280 patients were included, and 32 cases of this malformation were identified. The incidence of the lateral (B4 ) and medial (B5 ) lingular segmental bronchi is 0.6%. The A4 and A5 arise separately in 21 (65.6%) patients. In 9 (28.1%) patients, the A4 a arises from the common trunk of A4 + 5 . In 2 (6.3%) patients, the A4 arises from the interlobe artery, while A5 is a mediastinal lingular artery. The common trunk of V4 a + b is found in 19 (59.4%) patients. The V5 is the least changeable of the segmental bronchi veins. Among the 32 patients, five patients had an LS4 segmentectomy. The surgical details of the five patients are summarized. The laterally and medially bifurcated lingular bronchus pattern is a rare anomaly. It implies that the lingular bronchus is not only superiorly and inferiorly bifurcated.

Kirsten rat sarcoma viral oncogene homolog (KRAS) aberrations frequently occur in patients with lung cancer. Oncogenic KRAS is characterized by excessive reactive oxygen species (ROS) accumulation, thus, ROS detoxification may contribute to KRAS‑driven lung tumorigenesis. In the present study, the influence of glutathione peroxidase 2 (GPX2) on malignant progression and cisplatin resistance of KRAS‑driven lung cancer was explored. The RNA sequencing data from TCGA lung cancer samples and GEO database were downloaded and analyzed. The effects of GPX2 on KRAS‑driven lung tumorigenesis were evaluated by western blotting, cell viability assay, soft agar assay, Transwell assay, tumor xenograft model, flow cytometry, BrdU incorporation assay, transcriptome RNA sequencing, luciferase reporter assay and RNA immunoprecipitation. In the present study, GPX2 was upregulated in patients with non‑small cell lung carcinoma (NSCLC), and positively correlated with poor overall survival. Ectopic GPX2 expression facilitated malignant progression of KRASG12C‑transformed BEAS‑2B cells. Moreover, GPX2 overexpression promoted growth, migration, invasion, tumor xenograft growth and cisplatin resistance of KRAS‑mutated NSCLC cells, while GPX2 knockdown exhibited the opposite effects. GPX2 overexpression reduced ROS accumulation and increased matrix metalloproteinase‑1 (MMP1) expression in KRAS‑mutated NSCLC cells. In addition, GPX2 was directly targeted by miR‑325‑3p, while MMP1 knockdown or miR‑325‑3p overexpression partially abrogated the effects of GPX2 in NSCLC cells. In conclusion, the results indicated that GPX2 facilitated malignant progression and cisplatin resistance of KRAS‑driven lung cancer, and inhibition of GPX2 may be a feasible strategy for lung cancer treatment, particularly in patients with active KRAS mutations.

OBJECTIVES The B3 downwards-shifting malformation was first proposed by Boyden in 1950. Here, we report 14 cases of this malformation in the right lung and the first case of segmentectomy for this malformation. METHODS All patients with pulmonary lesions underwent three-dimensional computed tomography bronchography and angiography (3D-CTBA) between January 2019 and January 2020, prior to surgery. A consecutive 2356 patients were included, and 14 cases of this malformation were identified; bronchovascular patterns were analysed in each patient. RESULTS The incidence of this malformation was 0.6%. It was further divided into 3 types: over downwards-shift, partial downwards-shift and normal downwards-shift. The normal downwards-shift type was the most common (8/14), where B3 shifted downwards completely to merge with B4 + 5. In the partial downwards-shift (5/14), only part of the B3 shifted. In the over downwards-shift type (1/14), both B3 and B1b shifted downwards. A bifurcated right upper lobe （RUL) bronchus (B1 defective) was observed in 3 cases. The incidence of V1a, V1b, V2a, V2b, V2c, V3a, V3b and V3c was 100% (14/14). The incidence rates of A1, A3a and A3b were 100% (14/14). The incidence of A2 rec and A2 asc was 92.9% (13/14) and 71.4% (10/14), respectively. CONCLUSIONS The B3 downwards-shifting malformation or ‘Boyden’s triad’ is a rare anomaly. Anatomical exploration of this malformation is important for surgery.

We report the transient intersegmental plane formed by circulation single-blocking, which is consistent with the true intersegmental plane, and its formation principles, characteristics and potential applications.

Background: Segmentectomies of posterior basal segment (S10) is considered the most difficult anatomical segmentectomy.The S10 locates very deep inside the lung tissue, and far away from the oblique fissure.Besides, the cuboid-shaped intersegmental plane of S10 is hard to be fold into a two-dimensional plane with stapler.Case Description: We describe a novel method of bidirectional S10 segmentectomy with single-blocking of pulmonary circulation.The purpose is to simplify the procedure of S10 segmentectomy.The advantages of this method are that it is easy to learn and use, without requirements of special and expensive instruments like indocyanine green (ICG) method.It could save time because the target bronchus is dissected and resected by utilizing the waiting period of intersegmental plane.Because the bronchus is not resected at the moment of inflation, it is easy to achieve a full re-expansion with a relatively low pressure.This could reduce pressure-related damage of lung caused by manual ventilation.The S10 segmentectomy is considered a difficult procedure among all segmentectomies. Conclusion:Although different methods were introduced, this is the first time in literature that we combine the pulmonary circulation single-blocking method and "bidirectional" method together for S10 segmentectomy.The preliminary result shows that it might be a useful method for S10 segmentectomy.It is safe with acceptable complications.

Enucleation was commonly used in the surgery of the eye or prostate. The implication in the treatment of GGO is never reported. In this multimedia article, we described a thoracoscopic enucleation of GGO between S7 and S8 in the right lower lobe. According to the pre-operative 3D-CTBA, few bronchovascular structures were passing through the border of RS7 and RS8—a primarily pulmonary parenchyma region. Therefore, an enucleation of GGO is feasible with a low risk of injuring adjacent structures. The main utility incision and observing port were inserted in the fourth and seventh intercostal space in the anterior axillary line. Two assistant incisions were made in the seventh intercostal space in the mid-axillary line and the ninth intercostal space in the posterior axillary line. The GGO is invisible and unpalpable, so it cannot be located intraoperatively. The surgery was initiated by dividing the lung parenchyma alongside the anatomic landmark of A7 on the left. On the right, the common trunk of A8-10 was dissected until A8 was identified. The last anatomic landmark is V8b, which lies posteriorly. The lung parenchyma was dissected by electrocautery hook along with the A7, A8, and V8b to the diaphragmatic surface. Using an electrocautery hook during dissection is preferable, whose terminal is sharper and more flexible. The ultrasonic scalpel is not recommended. A glove is utilized for the specimen retrieval to avoid implantation metastasis. The operative time was 0.5 h with an estimated blood loss of 10 ml. With no chest tube, the patient was discharged on postoperative day 1. The final pathological finding was minimally invasive adenocarcinoma (pTmiN0M0). Considering the natural history and excellent prognosis of GGO, the safe margin is the primary concern for GGO resection.1,2 We use the anatomic landmark to secure a safe margin in enucleation. Besides, dissection of the anatomic intersegmental plane by electrocautery (but not by stapling) reduces unfavorable recurrent local failure at the margin and allows full expansion of the preserved adjacent segments to result in maximal pulmonary function.3

Background Colorectal cancer (CRC) has a high incidence and mortality. In CRC, the lung is the most common extra-abdominal site of metastasis. Understanding the genetic characteristics and clonal evolution of primary tumor and lung metastases (LM) will help oncologists better outline treatments. To date, few studies for CRC with LM exist. As such, revealing the genetic characteristics and clonal evolution of resectable CRC with LM was the goal of this study. Methods From January 2012 to July 2019, clinical data and formalin-fixed, paraffin-embedded samples were collected from 33 Chinese CRC patients. Nineteen (19) primary tumors and 10 matched LM samples were examined using a 450 cancer gene next-generation sequencing assay. Genomic alterations, including single base substitutions, indels, copy number variations (CNVs), and gene fusion and rearrangement, were assessed. A phylogenetic reconstruction of sequencing data using LICHeE was also performed for each patient. Results Median patient age was 60 years old (48-67 years), with most having right lung metastasis. A significant difference existed between single (21/33, 63.6%) and multiple LM (12/33, 36.4%) (P < 0.01). Median disease-free survival was 20 months (95% CI, 0-84), from primary CRC to LM. The most frequently mutated genes were TP53 (90%), APC (90%), KRAS (53%), MUC16 (26%), ARID1A (21%). A comparison of mutational profiles for primary and matched LM samples revealed that 65.70% of alterations were consistent and that the most frequently mutated genes, including APC, TP53, and KRAS, of the primary tumor were completely consistent with LM. However, some differences between metastatic and primary samples were determined. More CNVs were found in primary samples (11.4% vs. 4.6%), indicating that CNVs are early molecular events for tumorigenesis and disease progression. SMAD4 was only present in two primary samples, while LRP1B was only present in two LM samples. Clonal evolution for eight patients indicated that phylogenetic structure was similar across patients. All patients had at least seven mutations on trunks. In trunks, TP53 (87.5%), APC (87.5%), KRAS (50%), and LRP2 (37.5%) were frequently identified. A new actionable gene (BRCA2) emerged in LM sample was identified in one patient. The mean value of TMB for the primary was almost the same as that for the LM site (5.3 vs. 5 muts/Mb, P > 0.05). Conclusions Our data indicated that the genetic characteristics and clonal evolution of LM are highly consistent with those of the primary tumor, suggesting that suitable treatments can be selected based on the genetic characteristics of primary tumor in CRC patients with LM that cannot be surgically treated. Citation Format: Yong Cheng, Ming-Jian Ge, Peng Dong, Yan-Yu Qiu, Xin-Peng Shu, Jin-Dou Li, Jun-Wei Wang, Xiao-Fang Qi. Genetic characteristics & clonal evolution of Chinese resectable colorectal cancer patients with lung metastases [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5133.

Objective: The right middle lobe subsegmentectomy (including multisubsegmentectomy and subsubsegmentectomy) has never been reported. This study aimed to describe a thoracoscopic right middle lobe subsegmentectomy.Methods: This retrospective study included 94 patients who underwent thoracoscopic right middle lobe subsegmentectomy between August 2018 and February 2021. All procedures were performed with the help of the preoperative 3dimensional computed tomography bronchography and angiography.Results: Ninety-four patients underwent thoracoscopic right middle lobe subsegmentectomy. The median operative time was 56 minutes (range, 35-86 minutes) and median blood loss was 86 mL (range, 50-150 mL). The median duration of chest tube retention was 2.5 days (range, 1-4 days). There were neither cases of postoperative right middle lobe torsion nor instances of perioperative death. The median size of the tumor in the resected segment was 1.3 cm (range, 1.1-1.8 cm). The median margin was 3.3 cm (range, 2.9-4.3). There were 88 cases of lung cancer and 6 cases of benign lesions. The median number of N1 lymph nodes sampled was 3 (range, 2-4). No lymph node involvement was observed postoperatively. No recurrence or mortality was observed during the median follow-up period of 26 months (range, 6-36 months).Conclusions: Thoracoscopic right middle lobe subsegmentectomy is feasible and safe. It may be valuable to preserve the lung parenchyma in patients with noninvasive lung cancer, multiple lung cancer, and benign diseases. Long-term lung function, survival, and cancer-free data are being collected. (JTCVS Techniques 2022;13:229-36)