Comparison of treatment outcomes between single-port video-assisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage: a retrospective observational study

Abstract

Background: There are few reports of single-port video-assisted thoracoscopic surgery (S-VATS) anatomic segmentectomy and S-VATS lobectomy for early-stage non-small cell lung cancer (NSCLC) and no comparisons between them have yet been reported. Therefore, the aim of this study was to compare the safety and efficacy of S-VATS anatomic segmentectomy and S-VATS lobectomy for early-stage NSCLC.Methods: In this retrospective observational study, the outcomes of 79 consecutive patients who had undergone S-VATS anatomic segmentectomy (32 patients) or S-VATS lobectomy (47 patients) for earlystage NSCLC from April 2014 to June 2015 were examined. The operation time, intraoperative blood loss, numbers of dissected lymph nodes and mediastinal nodal stations, numbers of staples used, postoperative drainage volume and duration, duration of hospital stay, costs, postoperative complications, local recurrence, and survival were compared between these two groups.Results: The postoperative drainage volume was smaller and the postoperative drainage duration shorter in the S-VATS segmentectomy than the lobectomy group (P<0.05). There were no significant differences in operation time, intraoperative blood loss, number of staples used, number and stations of dissected mediastinal lymph nodes, duration of hospital stay, costs, or postoperative complications. At the time of writing, no deaths or local recurrences had occurred in either group.Conclusions: S-VATS segmentectomy is as safe and effective as S-VATS lobectomy. Patients who undergo S-VATS segmentectomy seem to recover faster. in local tumor recurrence rate and total 5-year survival rate between these two surgical options (5-7). Anatomic segmentectomy is clearly the less invasive. The Non-small Cell Lung Cancer Clinical Practice Guidelines issued by the National Comprehensive Cancer Network in 2010 recommend anatomic segmentectomy as a suitable operative procedure for treating early-stage non-small cell lung cancer (NSCLC) (8). The size and number of operative incisions can be used as an index of the severity of operative wounds (9,10). In accordance with the above data, surgeons have gradually begun to attempt single-port video-assisted thoracoscopic surgery (S-VATS), which is less invasive than previously performed procedures. Although Gonzalez et al. have reported outcomes of S-VATS lobectomy (11) and anatomic segmentectomy (12) and Zhu et al. have reported the comparison of the feasibility and safety between singleport and triple-port complete thoracoscopic lobectomy for NSCLC (13), there are few reports comparing S-VATS anatomic segmentectomy and lobectomy for early stage NSCLC.In this study we retrospectively analyzed data on 32 patients who had undergone S-VATS anatomic segmentectomy and 47 patients who had undergone S-VATS lobectomy for early stage NSCLC in our institution and explored the safety, efficacy, advantages, and disadvantages of these two operative procedures. MethodsIn this study, data for 79 patients who had undergone S-VATS procedures [32 anatomic segment...

Comparison of postoperative complications between segmentectomy and lobectomy by video-assisted thoracic surgery: a multicenter study

“…Neither the dissection of the intersegmental plane nor the parenchymal compression during segmentectomy seem to increase the risk of pulmonary complications. A few retrospective studies compared postoperative complication rate after VATS anatomical resections and found contradictory results [9–13]. Our finding of no difference between segmentectomy and lobectomy in incidence of cardiopulmonary complications contrasts with the findings of Deng et al [9] This study shown a higher incidence of PAL and pulmonary complications after VATS segmentectomy.…”

“…Recently, Song et al reported similar rates of postoperative pulmonary complications (15.3%) between segmentectomy ( N = 41) and lobectomy ( N = 122) [10]. Finally, Lin et al compared segmentectomy ( N = 32) and lobectomy ( N = 47) by a single-port approach, finding no difference in the postoperative complication rate ( P = 0.19) [13].…”

“…Furthermore, the use of staplers to divide the intersegmental plane can induce compression of the adjacent lung and may cause atelectasis and pneumonia of the remnant lobe. Few studies that reported incidence and severity of postoperative complications following segmentectomy and lobectomy by VATS, and other retrospective studies that have yielded contradictory results and had study limitations (e.g., small sample or single-center cohort; incomplete data about complications; analysis of patients with early-stage cancer; lack of analysis of predictive factors for complications) [9–13].…”

Uniportal versus Multiportal Thoracoscopic Complex Segmentectomy: Propensity Matching Analysis

“…Oncological adequacy is a major concern in cancer surgery. The prognosis of patients who undergo lobectomies versus segmentectomies for primary lung cancer less than 2 cm has been shown to be similar [12][13][14] and that of complex versus simple segmentectomies was also comparable. 3,15) For UP-VATS, we yielded similar stations and numbers of mediastinal LNs as for when we performed MP-VATS.…”

The arterial-ligation-alone method for identifying the intersegmental plane during thoracoscopic anatomic segmentectomy

“…Compared with wedge resection, segmentectomy is preferred because of its sufficient surgical margin, its evaluation of lymph nodes, and its superiority oncological outcomes (14,15). As a lung-sparing procedure, segmentectomy was shown to achieve equal short-term surgical results and long-term oncological outcomes compared with lobectomy (16,17). However, most of these studies were retrospective, and some results are contradictory (18) There are 2 on-going prospective randomized controlled clinical trials regarding segmentectomy, whose long-term outcome data are not yet available (19,20).…”