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Thoracoscopic segmentectomy with simple routine bronchoscopic inflation for intersegmental plane identification: short and mid-term outcomes compared with lobectomy.

Abstract：

Background:The technical concepts of thoracoscopic segmentectomy are still evolving. In this study we present a simple bronchoscopy-based intersegmental demarcation technique with short- and mid-term outcomes compared between thoracoscopic segmentectomy and lobectomy. Methods:All 105 consecutive patients with lung cancer intended to treat with video-assisted thoracoscopic surgery (VATS) segmentectomy were compared to 110 consecutive VATS lobectomies. Short- and mid-term outcome comparison included complications, length of hospital stay, pulmonary functions, and 3-year progression-free and overall survival. Mid-term outcomes were adjusted for age, sex, comorbidities, pulmonary functions, histology, stage and adjuvant treatment. Results:Segmentectomy patients had more comorbidities (P=0.006), worse pulmonary functions (FEV1%, P=0.005; DLCO/va, P=0.011), poor exercise capacity (P=0.043) and were considered high-risk patients more often (41.9% vs. 25.5%, P=0.011). Major complication rates did not differ between the groups (P=0.718). Mean length of hospital stay decreased after segmentectomy (4.7 vs. 5.9 days, P=0.033). Following segmentectomy, FEV1% slightly improved (1.0%). After lobectomy, the mean decline of FEV1% was 8.1% (P<0.001). Respectively, in high-risk patients, 2.1% improvement and 9.9% decline (P=0.027) were observed. Overall mortality hazard after segmentectomy was similar to that for lobectomy (unadjusted HR 0.80, 95% CI: 0.45-1.44, adjusted HR 0.87, 95% CI: 0.43-1.76). When considering only stage I non-small cell lung cancer, 3-year overall survival after segmentectomy and lobectomy were 86.8% vs. 79.8% (P=0.412) and 3-year recurrence-free survival 93.0% vs. 89.7%, P=0.450. Conclusions:Following segmentectomy, regardless of worse surgical candidates, hospital stay was shorter. Furthermore, preservation of lung function also in high-risk patients, was observed without compromising mid-term oncologic outcomes.

journal_name

J Thorac Dis

journal_title

Journal of thoracic disease

authors

Helminen O,Valo J,Andersen H,Lautamäki A,Räsänen J,Sihvo E

doi

10.21037/jtd-20-656

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

3073-3084

issue

eissn

2072-1439

issn

2077-6624

pii

jtd-12-06-3073

journal_volume

pub_type

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Thoracoscopic segmentectomy with simple routine bronchoscopic inflation for intersegmental plane identification: short and mid-term outcomes compared with lobectomy.