Outcomes After VATS Single Versus Multiple Segmentectomy for cT1N0 Non-Small-Cell Lung Cancer

The optimal extent of segmentectomy for clinical T1N0 non-small cell lung cancer (NSCLC) remains unclear. This study compared perioperative and oncological outcomes of video-assisted thoracoscopic surgery (VATS) single segmentectomy (SS) versus multiple segmentectomy (MS) for tumors ≤ 3 cm.

This single center study retrospectively analyzed all consecutive patients who underwent VATS anatomic segmentectomy for cT1N0 NSCLC between 2017 and 2022. Patient demographics, perioperative outcomes, and survival were compared between SS and MS groups.

In total, 334 patients underwent pulmonary segmentectomy: single in 211 (63%) and multiple in 123 patients (37%). In the SS group, 83 (39%) were simple and 128 (61%) complex segmentectomies; while in the MS group, 67 (54%) were simple and 56 (46%) were complex. Baseline characteristics were similar between groups. SS was associated with shorter operative time (117 vs. 132 min; p = 0.007), reduced length of drainage (1 vs. 3 days; p < 0.001), reduced hospital stay (5 vs. 6 days; p < 0.001), and lower atrial fibrillation (1.4% vs. 5.7%; p = 0.042). Total mean tumor size was 14.3 mm, with no statistical difference between groups (14.3 vs. 15.5 mm; p = 0.115). Surgical margins were larger in SS (median 13 vs. 11 mm; p = 0.038), while the number of lymph nodes dissected was similar. After a median follow-up of 30 months, no significant differences were observed in overall survival (OS) (94.5% vs. 90.7%) and disease-free survival (DFS) (83.2% vs. 79.1%).

SS and MS provide equivalent short-term oncological outcomes in cT1N0 NSCLC ≤ 3 cm. SS may be preferred when adequate margins are achievable, offering equivalent oncologic outcomes with better perioperative recovery.