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

We compared simple and complex segmentectomies in terms of complications and mortality. We hypothesized which proportion of complex segmentectomies might improve postoperative outcomes.

Patients from 18 hospitals operated since september 2018 to December 2019 were prospectively collected. Primary peripheral lung cancer or peripheral solitary nodules ≤2 cm, lung metastasis, carcinoids and benign lesions not amenable to wedge resection were included. Patients less than 18 years old, compromised patients, middle lobe lesions, preoperative induction or adjuvant treatment and patients without follow-up were excluded.

261 (72.5 %) and 99 (27.5 %) were simple and complex segmentectomies. Median operative time was 146.5 min being slightly higher in complex segmentectomies (p = 0.05) while mean chest tube duration was 1 day, higher in simple than in complex (p = 0.01). 102 patients presented complications (28 %), with pulmonary complications accounting 21 %, prolonged air leak (PAL) 9.7 % and pneumonia 8.3 % as the most common. Postoperative pneumonia was 3.4-fold higher in the simple segmentectomy group (p = 0.02) and the combined respiratory morbidity almost doubled that of the complex (p = 0.02). After propensity-score matching, only operative time was shorter in the simple group (p = 0.02). Centers performing at least 40 % complex segmentectomies, presented significantly lower rate of PAL and pulmonary complications.

Complex segmentectomies are safe but longer procedures compared to simple and there is no risk of higher rate of operative or postoperative complications. Centers experienced in complex segmentectomies accomplishing at least 40 % from the total, present better outcomes in terms of prolonged air leak and pulmonary complications.