Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study

Abstract

Background Compared to lobectomy by video-assisted thoracic surgery (VATS), segmentectomy by VATS has a potential higher risk of postoperative atelectasis and air leakage. We compared postoperative complications between these two procedures, and analyzed their risk factors. Methods We reviewed the records of all patients who underwent anatomical pulmonary resections by VATS from January 2014 to March 2018 in two Swiss university hospitals. All complications were reported. A logistic regression model was used to compare the risks of complications for the two interventions. Adjustment for patient characteristics was performed using a propensity score, and by including risk factors separately. Results Among 690 patients reviewed, the major indication for lung resection was primary lung cancer (86.4%) followed by metastasis resection (5.8%), benign lesion (3.9%), infection (3.2%) and emphysema (0.7%). Postoperatively, there were 80 instances (33.3%) of complications in 240 segmentectomies, and 171 instances (38.0%) of complications in 450 lobectomies (P = 0.73). After adjustment for the patient’s propensity to be treated by segmentectomy rather than lobectomy, the risks of a complication remained comparable for the two techniques (odds ratio for segmentectomy 0.91 (0.61–1.30), p = 0.59). Length of hospital stay and drainage duration were shorter after segmentectomy. On multivariate analysis, an American Society of Anesthesiologists score above 2 and a forced expiratory volume in one second below 80% of predicted value were significantly associated with the occurrence of complications. Conclusions The rate of complications and their grade were similar between segmentectomy and lobectomy by VATS.

Short‐term local control after VATS segmentectomy and lobectomy for solid NSCLC of less than 2 cm

“…We found no differences with regard to intra‐ or postoperative outcomes between both groups. This corroborates previous work by our group and other multicentric studies, which compared postoperative VS and VL complications rates 34–37 …”

Lobectomy Versus Segmentectomy in Patients with Stage T (>2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

“…With the cancer screening and the wide use of LDCT, more and more patients tend to be younger [25]. Recently, some researchers suggested that postoperative complications are similar between the two procedures [26]. Therefore, whether segmentectomy can be safely and effectively applied to early NSCLC, surgical treatments require further research.…”

How I do VATS segmentectomy: the uniportal approach

“…In addition, a similar rate of complications was reported in a multicenter study that compared complications between VATS intentional segmentectomies and lobectomies. It also showed that the chest tube duration and the length of stay were shorter in the VATS segmentectomy group (6).…”

“…The inferior vein is dissected to expose its segmental branches. Care is taken to identify V 6 , which must be preserved. The inferior basal vein that drains V 9 and V 10 is cleared.…”