"Complex segmentectomies: Comparison with simple and effect of experience on postoperative outcomes"

Carlos Galvez ¹, Sergio Bolufer ¹, Francisco Lirio ¹

¹Thoracic Surgery, Hospital General Universitario Doctor Balmis, Alicante, Spain.
²Thoracic Surgery, Hospital Miguel Servet, Zaragoza, Spain.
³Thoracic Surgery, Hospital del Vinalopo, Elche, Spain.
⁴Thoracic Surgery, Northern General Hospital, Sheffield, England, UK.
⁵Thoracic Surgery, Hospital Ramón y Cajal, Madrid, Spain.
⁶Thoracic Surgery Hospital Universitario Donostia, Spain.
⁷Thoracic Surgery, Hospital Clinica de Barcelona, Spain.
⁸Thoracic Surgery, Hospital Clinico de Valencia, Spain.
⁹Thoracic Surgery, Hospital 12 de Octubre, Madrid, Spain.
¹⁰Thoracic Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
¹¹Thoracic Surgery, Hospital General Universitario de Albacete, Spain.
¹²Thoracic Surgery, Hospital Clinico San Carlos, Madrid, Spain.
¹³Thoracic Surgery, Complejo Hospitalario Universitario, Vigo, Spain.
¹⁴Thoracic Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
¹⁵Thoracic Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain.
¹⁶Thoracic Surgery, Hospital Clínico Universitario de Santiago de Compostela, Spain.
¹⁷Thoracic Surgery, Ospedale Sacro Cuore-Don Calabria, Italy.
¹⁸Thoracic Surgery, Hospital Regional Universitario Carlos Haya, Malaga, Spain.

⁰Thoracic Surgery, Hospital General Universitario Doctor Balmis, Alicante, Spain.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology +

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March 10, 2025

View abstract on PubMed

Summary

Complex segmentectomies are safe and do not increase complications compared to simple ones. High-volume centers performing complex segmentectomies show better outcomes for prolonged air leak and pulmonary complications.

Area Of Science

Thoracic Surgery
Surgical Oncology
Pulmonary Medicine

Background

Segmentectomy is a lung-sparing surgical procedure.
Comparing simple and complex segmentectomies is crucial for optimizing patient outcomes.
Understanding the impact of surgical complexity on postoperative results is essential.

Purpose Of The Study

To compare simple and complex segmentectomies regarding complications and mortality.
To investigate if a higher proportion of complex segmentectomies improves postoperative outcomes.

Main Methods

Prospective data collection from 18 hospitals between September 2018 and December 2019.
Inclusion criteria: primary peripheral lung cancer ≤2 cm, metastasis, carcinoids, benign lesions not amenable to wedge resection.
Exclusion criteria: patients <18 years, compromised patients, middle lobe lesions, neoadjuvant/adjuvant treatment, no follow-up.

Main Results

261 (72.5%) simple vs. 99 (27.5%) complex segmentectomies performed.
Complex segmentectomies had slightly longer operative times (p=0.05) but shorter chest tube duration (p=0.01).
Postoperative pneumonia was 3.4-fold higher in the simple group (p=0.02); combined respiratory morbidity doubled (p=0.02). Centers with ≥40% complex segmentectomies had lower prolonged air leak (PAL) and pulmonary complications.

Conclusions

Complex segmentectomies are safe, with no increased risk of operative or postoperative complications compared to simple procedures.
While operative time is longer, complex segmentectomies do not lead to higher complication rates.
High-volume centers performing ≥40% complex segmentectomies demonstrate superior outcomes regarding PAL and pulmonary complications.

Keywords:

Postoperative complications Segmentectomy VATS