Comparative study on efficacy of thoracoscopic anatomic segmentectomy and lobectomy in treating pulmonary...

To compare the efficacy and safety of thoracoscopic anatomic segmentectomy and lobectomy in the treatment of pulmonary ground-glass nodules (GGNs).

The clinical data of patients with pulmonary GGNs who were treated with thoracoscopic anatomic segmentectomy (n=58, Segmentectomy group) or thoracoscopic lobectomy (n=58, Lobectomy group) were collected and retrospectively analyzed. Next, the operative time, intraoperative blood loss, number of lymph nodes dissected, indwelling time of postoperative thoracic drainage tube, thoracic drainage volume, length of postoperative hospital stay, perioperative complications and preoperative and postoperative changes in pulmonary function were compared between the two groups of patients. Additionally, patients were followed up and their survival status was recorded.

The operative time was obviously longer in the Segmentectomy group than in the Lobectomy group. The intraoperative blood loss was smaller in the Segmentectomy group than in the Lobectomy group, showing no statistically significant difference. The number of lymph nodes dissected, the indwelling time of postoperative thoracic drainage tube, the thoracic drainage volume and the length of postoperative hospital stay were significantly increased in the Lobectomy group compared with those in the Segmentectomy group. The numerical rating scale (NRS) score of patients in the Segmentectomy group was similar to that in the Lobectomy group at 1, 3 and 7 d after surgery. The Karnofsky performance status (KPS) score was dramatically higher in the Segmentectomy group than in the Lobectomy group 1 year after surgery. Compared with that before surgery, the pulmonary function of patients was prominently weakened in both groups after surgery. At 3 and 12 months after surgery, the pulmonary function indexes forced vital capacity (FVC), the percentage of forced expiratory volume in one second (FEV1%) and maximal voluntary ventilation (MVV) were remarkably better in the Segmentectomy group than in the Lobectomy group. The disease-free survival (DFS) rate was 89.7% (52/58) in the Segmentectomy group and 93.4% (54/58) in the Lobectomy group.

Thoracoscopic anatomic segmentectomy for the treatment of pulmonary GGNs is able to achieve similar short-term and long-term outcomes to those of lobectomy. Besides, it has advantages such as short duration of postoperative thoracic drainage, less drainage volume, short length of hospital stay, better postoperative recovery of pulmonary function and higher quality of life, without increase in the incidence rate of postoperative complications.