Thoracoscopic segmentectomy versus lobectomy: A propensity score-matched analysis

Julio Sesma, Sergio Bolufer, Antonio García-Valentín, Raúl Embún, Íker Javier López, Nicolás Moreno-Mata, Unai Jiménez, Florentino Hernando Trancho, Antonio Eduardo Martín-Ucar, Juana Gallar, Spanish Video-Assisted Thoracic Surgery Group, 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, Julio Sesma, Sergio Bolufer, Antonio García-Valentín, Raúl Embún, Íker Javier López, Nicolás Moreno-Mata, Unai Jiménez, Florentino Hernando Trancho, Antonio Eduardo Martín-Ucar, Juana Gallar, Spanish Video-Assisted Thoracic Surgery Group, 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

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.

© 2022 The Author(s).

Figures

Graphical abstract
Graphical abstract
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9390783/bin/fx2.jpg
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.

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Source: PubMed

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