Comparison of operative and postoperative characteristics and outcomes between thoracoscopic segmentectomy and lobectomy for non-small-cell lung cancer: a propensity score matching study from the Italian VATS Group Registry
Authors: Dell’Amore Andrea , Lomangino Ivan , Cannone Giorgio , Terzi Stefano , Pangoni Alessandro , Lorenzoni Giulia , Nicotra Samuele , Schiavon Marco , Zuin Andrea , Gregori Dario , Crisci Roberto , Curcio Carlo , Rea Federico ,   the Italian VATS Group, Mancuso M , Pernazza F , Refai M , Bortolotti L , Rizzardi G , Solli P , Brandolini I , Perkmann R , Zaraca F , Benvenuti M , Gavezzoli D , Cherchi R , Ferrari P , Mucilli F , Camplese P , Melloni G , Mazza F , Cavallesco G , Maniscalco P , Voltolini L , Gonfiotti A , Stella F , Argnani D , Pariscenti G L , Iurilli S , Surrente C , Lopez C , Droghett A , Giovanardi M , Breda C , Lo Giudice F , Alloisio M , Bottoni E , Spaggiari L , Gasparri R , Torre M , Rinaldo A , Nosotti M , Rosso L , Negri G P , Bandiera A , Stefani A , Natali P , Scarci M , Pirondini E , Curcio C , Amore D , Baietto G , Casadio C , Bertani A , Russo E , Ampollini L , Carbognani P , Puma F , Vinci D , Andreetti C , Poggi C , Cardillo G , Margaritora S , Meacci E , Luzzi L , Ghisalberti M , Crisci R , Zaccagna G , Lausi P , Guerrera F , Fontana D , Della Beffa V , Morelli A , Londero F , Imperatori N , Rotolo A , Terzi A , Viti A , Infante M , Benato C 
Published: September 2021

OBJECTIVES

Only few studies compared the surgical morbidity and mortality of thoracoscopic segmentectomy versus lobectomy for non-small-cell lung cancer, in particular, by relating the segmental resections with the corresponding anatomical lobes.

METHODS

We enrolled a total of 7487 patients who underwent VATS lobectomy (7269) or segmentectomy (218) from January 2014 to July 2019. A propensity score matching approach was used to account for potential confounding factors between the 2 groups. After matching, 349 lobectomies and 208 segmentectomies were included in the analysis. We analysed the operative and postoperative outcomes of video-assisted anatomical segmentectomy compared with video-assisted lobectomy and, in details, the results of segmentectomy with its corresponding lobectomy in a large cohort of patients from the Italian VATS Group Registry.

RESULTS

The overall conversion rate to thoracotomy was not statistically different between the groups (27 patients 8% vs 7 patients 3%, P = 0.1). The lobectomy group had a greater number of resected lymph nodes (median 11 vs 8, P = 0.006). No significant differences were detected in 30-day mortality (1.4%, 5 patients vs 0.9%, 2 patients), overall complications (18%, 62 patients vs 14%, 29 patients) and prolonged air leakage (31 patients, 9% vs 12 patients, 6%) between lobectomy and segmentectomy, respectively. No statistical differences were found regarding the median duration of drainage (3.2 days, P = 1) and the overall median length of hospital stay (6.4 days, P = 0.1) between the 2 groups. In the context of segmentectomy versus corresponding lobectomy, the right upper lobectomy compared with right upper segmentectomy showed a higher number of resected lymph nodes (P = 0.027). No statistical differences were reported in terms of conversion rate and postoperative complication and mortality.

CONCLUSIONS

Segmentectomy could be considered a safe procedure without significant differences compared to thoracoscopic lobectomy in terms of postoperative morbidity and mortality.