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

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.