Evaluation of Air Leak-related Complications in Segmentectomy: A Comparative Study with Lobectomy Using Goddard Score

The relative incidence of postoperative air leak between lobectomy and segmentectomy remains unclear. This study aimed to examine how the presence and severity of emphysema-an established risk factor for air leak-affect the incidence of this complication in each surgical procedure.

This retrospective study included patients who underwent lobectomy or segmentectomy for non-small cell lung cancer between April 2009 and March 2024. Patients were stratified into 2 groups based on the Goddard score (GS), a visual evaluation method for quantifying radiologic findings of emphysema on computed tomography (CT)with a maximum of 24 points: GS 0-5 and GS ≥6. The incidences of postoperative air leak-related complications (prolonged air leak, pleurodesis, reinsertion of the chest tube, or reoperation for air leak) were compared between the lobectomy and segmentectomy groups.

Overall, 747 patients were included in the study. Among 564 patients with GS 0-5, there were no significant differences in the incidence of postoperative air leak-related complications between lobectomy (5.7%) and segmentectomy (8.2%) groups (P = .275). Conversely, in 183 patients with GS ≥6, the incidence of such complications was significantly lower in the segmentectomy group (7.0%) compared to the lobectomy group (18.3%) (P = .036).

In patients with moderate to severe emphysema (GS ≥6), segmentectomy was associated with a lower incidence of postoperative air leak-related complications than lobectomy. This may reflect the advantage of greater parenchymal preservation; however, these findings should be interpreted cautiously given the observational study design.