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Left upper division segmentectomy is not a simple procedure: experience from two high-volume centers.

Fei Yao1, Xianglong Pan2, Weibing Wu2

  • 1Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.

Surgical Endoscopy
|April 8, 2025
PubMed
Summary

Left upper division segmentectomy (LUDS) is complex, with higher complication rates than simple segmentectomy (SS). Experienced surgeons improve LUDS outcomes, reducing operative time and vascular injury risks.

Keywords:
Complex segmentectomyLeft upper division segmentectomySimple segmentectomyThoracic surgery

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Area of Science:

  • Thoracic Surgery
  • Surgical Oncology
  • Minimally Invasive Procedures

Background:

  • The complexity of left upper division segmentectomy (LUDS) is debated.
  • Comparison of LUDS outcomes with simple segmentectomy (SS) and complex segmentectomy (CS) is needed.

Purpose of the Study:

  • To compare the outcomes of LUDS with SS (excluding LUDS) and CS.
  • To evaluate the complexity and safety of LUDS in early-stage lung cancer.

Main Methods:

  • Retrospective review of 1565 patients undergoing thoracoscopic segmentectomy for early-stage lung cancer (Feb 2015-Feb 2020).
  • Patients categorized into LUDS (n=189), SS (n=317), and CS (n=1059) groups.
  • Primary endpoint: intraoperative/postoperative complications, 30-day readmission, local recurrence.

Main Results:

  • LUDS had a higher primary endpoint rate (14.3%) than SS (7.6%, P=0.046), comparable to CS (14.4%).
  • LUDS showed longer median operative time (135 min vs. 120 min for SS, P<0.001) and higher blood loss and vascular injury rates than SS and CS (all P<0.05).
  • Experienced surgeons in LUDS had lower complication rates, shorter operative times, and less blood loss.

Conclusions:

  • Left upper division segmentectomy is an efficient but complex procedure.
  • LUDS is associated with increased operative time, blood loss, and potential vascular injury.
  • Surgical expertise is crucial for optimizing LUDS outcomes.