Roles and outcomes of thoracoscopic anatomic lung subsegmentectomy for lung cancer

We performed sublobar resections, including thoracoscopic segmentectomy and subsegmentectomy for small lung cancers, and analysed the results of indications and outcomes of thoracoscopic subsegmentectomy.

Between March 2005 and May 2020, 357 consecutive patients underwent thoracoscopic anatomic sublobar resections for lung cancer, including 68 patients undergoing subsegmentectomy. These patients were compared with 289 patients who underwent segmentectomy during the same period.

Subsegmentectomies included mono-/bi-/tri-subsegmentectomies for 34/23/11 of 68 patients, respectively. The median tumour size was 13.5 mm, significantly smaller than tumours in patients who underwent a segmentectomy (P < 0.001). Tumours obtained by mono-subsegmentectomy (11.0 mm) were significantly smaller than bi-/tri-subsegmentectomy (P = 0.028). The proportion of ground-glass opacity-dominant tumours obtained by subsegmentectomy (85.3%) was higher than that obtained by segmentectomy. The proportion of intentional cases satisfying the criteria for sublobar resection was higher than that of segmentectomy cases. Although tumour locations in 40 patients were not identified during surgery, tumours were correctly resected in 39 patients without tumour markers. The median operative time and blood loss were 167 min and 13 ml, significantly shorter and less, respectively, in subsegmentectomy than in segmentectomy patients (P = 0.005, P = 0.006). Duration of drainage and hospitalization were 1 and 5 days, respectively, for subsegmentectomy patients; complications occurred in 6 (8.8%). Outcomes were similar to those of the segmentectomy patients. Although 4 subsegmentectomy patients died of other diseases, none showed cancer recurrence during a mean follow-up of 50 months.

Thoracoscopic subsegmentectomy can be used for patients with ground-glass opacity-dominant lung cancers <1.5 cm if adequate margins can be secured.