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. 2022 Jan 22:9:268-278.
doi: 10.1016/j.xjon.2022.01.009. eCollection 2022 Mar.

Thoracoscopic segmentectomy versus lobectomy: A propensity score-matched analysis

Julio Sesma  1   2 , Sergio Bolufer  1   2 , Antonio García-Valentín  1   2 , Raúl Embún  3 , Íker Javier López  4 , Nicolás Moreno-Mata  5 , Unai Jiménez  6 , Florentino Hernando Trancho  7 , Antonio Eduardo Martín-Ucar  8   9 , Juana Gallar  2   9 ; Spanish Video-Assisted Thoracic Surgery Group
Collaborators, Affiliations

Thoracoscopic segmentectomy versus lobectomy: A propensity score-matched analysis

Julio Sesma et al. JTCVS Open. .

Abstract

Objectives: The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy.

Methods: From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score-matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan-Meier and competing risks method were used to compare survival.

Results: In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score-matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan-Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression-related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups.

Conclusions: Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.

Keywords: CI, confidence interval; IQR, interquartile range; RR, relative risk; VASG, VATS anatomic segmentectomy group; VATS; VATS, video-assisted thoracic surgery; VLG, VATS lobectomy group; anatomic segmentectomy; lobectomy; lung cancer; sublobar resection; thoracoscopy.

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Figures

None
Graphical abstract
None
VATS anatomic segmentectomy is a suitable treatment for select patients with lung cancer.
Figure 1
Figure 1
Overall survival in the VASG versus VLG. CI, Confidence interval; HR, hazard ratio;
Figure 2
Figure 2
Relapse-related mortality in the VASG versus VLG. CI, Confidence interval; SHR, subdistribution hazard ratio.
Figure 3
Figure 3
Disease-free survival in the VASG versus VLG. CI, Confidence interval; SHR, subdistribution hazard ratio.
Figure 4
Figure 4
VATS segmentectomy has similar postoperative and midterm survival compared with lobectomy. Air leak was decreased in the segmentectomy group. CI, Confidence interval; HR, hazard ratio; RR, relative risk.
See this image and copyright information in PMC

References

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