JTCVS Open (Mar 2022)

Thoracoscopic segmentectomy versus lobectomy: A propensity score–matched analysisCentral MessagePerspective

  • Julio Sesma, MD,
  • Sergio Bolufer, MD, PhD,
  • Antonio García-Valentín, MD, PhD,
  • Raúl Embún, MD, PhD,
  • Íker Javier López, MD, PhD,
  • Nicolás Moreno-Mata, MD, PhD,
  • Unai Jiménez, MD,
  • Florentino Hernando Trancho, MD, PhD,
  • Antonio Eduardo Martín-Ucar, MD,
  • Juana Gallar, MD, PhD,
  • Raul Embun,
  • Iñigo Royo-Crespo,
  • José Luis Recuero Díaz,
  • Sergio Bolufer,
  • Julio Sesma,
  • Sergi Call,
  • Miguel Congregado,
  • David Gómez-de Antonio,
  • Marcelo F. Jimenez,
  • Nicolas Moreno-Mata,
  • Borja Aguinagalde,
  • Sergio Amor-Alonso,
  • Miguel Jesús Arrarás,
  • Ana Isabel Blanco Orozco,
  • Marc Boada,
  • Alberto Cabañero Sánchez,
  • Isabel Cal Vázquez,
  • Ángel Cilleruelo Ramos,
  • Silvana Crowley Carrasco,
  • Elena Fernández-Martín,
  • Santiago García-Barajas,
  • Maria Dolores García-Jiménez,
  • Jose María García-Prim,
  • Jose Alberto Garcia-Salcedo,
  • Juan José Gelbenzu-Zazpe,
  • Carlos Fernando Giraldo-Ospina,
  • María Teresa Gómez Hernández,
  • Jorge Hernández,
  • Jennifer D. Illana Wolf,
  • Alberto Jauregui Abularach,
  • Unai Jiménez,
  • Iker López Sanz,
  • Néstor J. Martínez-Hernández,
  • Elisabeth Martínez-Téllez,
  • Lucía Milla Collado,
  • Roberto Mongil Poce,
  • Francisco Javier Moradiellos-Díez,
  • Ramón Moreno-Balsalobre,
  • Sergio B. Moreno Merino,
  • Carme Obiols,
  • Florencio Quero-Valenzuela,
  • María Elena Ramírez-Gil,
  • Ricard Ramos-Izquierdo,
  • Eduardo Rivo,
  • Alberto Rodríguez-Fuster,
  • Rafael Rojo-Marcos,
  • David Sanchez-Lorente,
  • Laura Sanchez Moreno,
  • Carlos Simón,
  • Juan Carlos Trujillo-Reyes,
  • Florentino Hernando Trancho

Journal volume & issue
Vol. 9
pp. 268 – 278

Abstract

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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.

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