Textbook outcome after minimally invasive pulmonary resection for clinical stage I lung cancer: A retrospective...

This study aimed to assess the textbook outcomes (TO) after minimally invasive lung cancer surgery and identify factors associated with TO failure.

This retrospective study included 853 patients with clinical stage I lung cancer who underwent minimally invasive resection between 2015 and 2025 at our institution. TO was defined using predefined perioperative events. A logistic regression analysis was performed to identify the factors associated with TO failure. Cause-specific mortality was evaluated using a competing risk analysis.

Of the 853 patients, 647 (75.8%) achieved TO. Prolonged air leaks, reintervention, arrhythmia, prolonged hospital stay, and pneumonia were the main factors associated with TO failure. Smoking history and respiratory comorbidities were independent risk factors for TO failure. Segmentectomy was associated with a higher likelihood of achieving TO in the present study. At 5 years, no significant difference in the incidence of cancer-related death was observed between the TO and non-TO groups (5.4% vs. 4.2%, P = 0.841). However, the incidence of noncancer-related death was significantly higher in the non-TO group (13.5% vs. 10.5%, P = 0.004).

TO was achieved in most patients who underwent minimally invasive surgery. TO failure was significantly associated with a smoking history, respiratory comorbidities, surgical procedures, and an increased incidence of noncancer-related death after minimally invasive surgery.