Related Experiment Video
Updated: Oct 19, 2026
Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer
Published on: February 27, 2026
Septum-guided segmentectomy for deep early-stage non-small cell lung cancer: A novel, margin-independent,
Qing Wang1, Xinshu Wu2, Zhexu Wen1
1Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Objective:
The application of segmentectomy for deep-located tumors remains controversial as the result of margin concerns. This study evaluated septum-guided segmentectomy, which uses intersegmental septa and veins as anatomical boundaries to ensure precise dissection independent of fixed linear margin requirements.
Methods:
We retrospectively analyzed 292 patients with deep-located cT1a-bN0M0 non-small cell lung cancer undergoing septum-guided segmentectomy (n = 130) or lobectomy (n = 162) via a minimally invasive approach (January 2019 to March 2025). To rigorously control for selection bias, propensity-score matching incorporating key physiological and anatomical confounders was performed, generating 88 well-balanced matched pairs (n = 176). Perioperative outcomes, locoregional recurrence, recurrence-free survival, and overall survival were evaluated.
Results:
After propensity-score matching, baseline balance was achieved across key covariates. Survival analysis using stratified methods revealed no significant differences in recurrence-free survival or overall survival between the groups (P> .05). Notably, despite a substantial proportion of patients in the segmentectomy group not fulfilling standard National Comprehensive Cancer Network margin criteria (>20 mm or greater tumor size)-with a mean margin distance of 14.1 mm-no locoregional recurrence was observed during follow-up. R0 resection was achieved in all patients. Although segmentectomy involved longer operative times (P< .001), perioperative complications and hospital stays were highly comparable between the 2 cohorts.
Conclusions:
Septum-guided segmentectomy demonstrates preliminary oncologic safety and perioperative outcomes comparable with lobectomy for deep-located early-stage non-small cell lung cancer. By using the intersegmental septum as a reliable anatomical barrier, this concept establishes a precise surgical paradigm that safely reduces the reliance on fixed margin distances.