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Subcostal Specimen Removal in Completely Portal Robotic Lobectomy
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"Complex segmentectomies: Comparison with simple and effect of experience on postoperative outcomes".

Carlos Galvez1, Sergio Bolufer1, Francisco Lirio1

  • 1Thoracic 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
|March 10, 2025
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.

Keywords:
Postoperative complicationsSegmentectomyVATS

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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.