Complex versus simple segmentectomy in non-small cell lung cancer: a single-center, retrospective study

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Complex segmentectomy for non-small cell lung cancer (NSCLC) presents challenges in perioperative safety and oncologic outcomes.
• Evaluating the safety and efficacy of complex segmentectomy versus simple segmentectomy is crucial for patient selection and treatment planning.

Purpose of the Study:

• To compare perioperative and long-term outcomes of complex segmentectomy versus simple segmentectomy in patients with resectable NSCLC.
• To determine if complex segmentectomy compromises safety or oncologic adequacy compared to simple segmentectomy.

Main Methods:

• Retrospective review of 542 patients undergoing anatomical segmentectomy for NSCLC (2014-2024).
• Classification of segmentectomies into simple (upper division, lingula, S6, basal) and complex categories.
• Comparison of perioperative complications, 30-/90-day mortality, overall survival, and recurrence-free survival between groups using Cox proportional hazards models.

Main Results:

• Complex segmentectomy was associated with shorter operative times but similar rates of major complications and mortality compared to simple segmentectomy.
• Five-year overall survival (91.5%) and recurrence-free survival (85.2%) were comparable between complex and simple segmentectomy groups.
• Multivariable analysis identified age, sex, and lymphovascular invasion as predictors of recurrence-free survival, but not complex segmentectomy.

Conclusions:

• Complex segmentectomy demonstrates comparable perioperative and long-term oncologic outcomes to simple segmentectomy in NSCLC.
• Complex segmentectomy is an oncologically acceptable, parenchyma-sparing option for carefully selected patients with resectable NSCLC.