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
Andrea Dell’Amore, Ivan Lomangino, Giorgio Cannone, Stefano Terzi, Alessandro Pangoni, Giulia Lorenzoni, Samuele Nicotra, Marco Schiavon, Andrea Zuin, Darío Gregori, Roberto Crisci, Carlo Curcio, Federico Rea, the Italian VATS Group, M Mancuso, Fausto Pernazza, M. Refai, Luigi Bortolotti, Giovanna Rizzardi, P. Solli, I Brandolini, Reinhold Perkmann, Francesco Zaraca, Mauro Roberto Benvenuti, Diego Gavezzoli, Roberto Cherchi, Paolo Albino Ferrari, Felice Mucilli, Pierpaolo Camplese, Giulio Melloni, Francesco Mazza, Giorgio Cavallesco, Pio Maniscalco, Luca Voltolini, Alessandro Gonfiotti, Franco Stella, Desideria Argnani, G L Pariscenti, S Iurilli, Corrado Surrente, C Lopez, A Droghett, Michele Giovanardi, C. Breda, Fabrizio Lo Giudice, Marco Alloisio, Edoardo Bottoni, Lorenzo Spaggiari, Roberto Gasparri, Mari C. de la Torre, A. Rinaldo, Mario Nosotti, Lorenzo Rosso, Giampiero Negri, Alessandro Bandiera, Alessandro Stefani, P. G. Natali, Marco Scarci, Emanuele Pirondini, Carmen‐Lucía Curcio, D Amore, Guido Baietto, Chiara Casadio, Alessandro Bertani, Emanuele Russo, Luca Ampollini, Paolo Carbognani, Francesco Puma, Damiano Vinci, Claudio Andreetti, Camilla Poggi, Giuseppe Cardillo, S Margaritora, Elisa Meacci, Luca Luzzi, Marco Ghisalberti, Roberto Crisci, Gino Zaccagna, Paolo Olivo Lausi, Francesco Guerrera, D Fontana, V Della Beffa, Angelo Morelli, Francesco Londero, N Imperatori, Antonia Rotolo, Alberto Terzi, Andrea Viti, Maurizio Infante, Cristiano Benato
Abstract
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.