Thoracoscopic segmentectomy versus lobectomy: A propensity score–matched analysis

• DOI: 10.1016/j.xjon.2022.01.009
• Publication Date: 2022-01-22T02:29:32Z
• Authors: Julio Sesma; Sergio Bolufer; Antonio García-Va...; Raúl Embún; Íker Javier López; Nicolás Moreno-Mata; Unai Jiménez; Florentino Hernan...; Antonio Eduardo M...; Juana Gallar; Raul Embun; Iñigo Royo-Crespo; José Luis Recuero...; Sergio Bolufer; Julio Sesma; Sergi Call; Miguel Congregado; David Gómez-de An...; Marcelo F. Jimenez; Nicolas Moreno-Mata; Borja Aguinagalde; Sergio Amor-Alonso; Miguel Jesús Arrarás; Ana Isabel Blanco...; Marc Boada; Alberto Cabañero ...; Isabel Cal Vázquez; Ángel Cilleruelo ...; Silvana Crowley C...; Elena Fernández-M...; Santiago García-B...; Maria Dolores Gar...; Jose María García...; Jose Alberto Garc...; Juan José Gelbenz...; Carlos Fernando G...; María Teresa Góme...; Jorge Hernández; Jennifer D. Illan...; Alberto Jauregui ...; Unai Jiménez; Iker López Sanz; Néstor J. Martíne...; Elisabeth Martíne...; Lucía Milla Collado; Roberto Mongil Poce; Francisco Javier ...; Ramón Moreno-Bals...; Sergio B. Moreno ...; Carme Obiols; Florencio Quero-V...; María Elena Ramír...; Ricard Ramos-Izqu...; Eduardo Rivo; Alberto Rodríguez...; Rafael Rojo-Marcos; David Sanchez-Lor...; Laura Sanchez Moreno; Carlos Simón; Juan Carlos Truji...; Florentino Hernan...
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Thoracic: Lung Cancer; 3. Good health

The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy.From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score-matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan-Meier and competing risks method were used to compare survival.In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score-matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan-Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression-related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups.Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.