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Complex vs. simple segmentectomy: comparing surgical outcomes in the left upper division

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Abstract

Background

Lung segmentectomy is an option for the treatment of noninvasive or minimally invasive lung cancer. For tumors located in the left upper division (LUD), LUD trisegmentectomy (S1+2 + S3) is frequently performed as a sublobar resection because of its technical simplicity. However, the differences in surgical outcomes between simple and complex segmentectomies remain unclear.

Methods

We compared the surgical outcomes and frequency of postoperative complications of LUD trisegmentectomy (simple group) with those of complex segmentectomy (other than LUD trisegmentectomy; complex group) for pulmonary lesions using three-dimensional computed tomography between 2010 and 2021.

Results

In total, 118 patients were included: 65 in the simple group and 53 in the complex group (S1+2: 25, S3: 15, others: 13). There were no significant differences in surgical time or duration of postoperative chest drainage. However, the blood loss volume was significantly smaller in the complex group than in the simple group (12 vs. 36 mL, p = 0.023), and major complications tended to occur less frequently in the complex group than in the simple group (3.8 vs. 13.8%, p = 0.061). Among patients who underwent intentional segmentectomy for primary lung cancer (n = 61), major complications were significantly less common in the complex group (p = 0.006).

Conclusions

Complex segmentectomy can be performed safely under the guidance of three-dimensional CT. Complex segmentectomy itself is not a risk factor for postoperative complications when the intersegmental planes are sufficiently recognized and accurately cut.

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Abbreviations

3D:

Three-dimensional

AL:

Air leakage

CT:

Computed tomography

LUD:

Left upper division

NSCLC:

Non-small cell lung cancer

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Acknowledgements

The authors are grateful to Yasuhiro Fukushima, Junya Fukuda, and Hiroyuki Takei, Department of Radiology, Gunma University Hospital, for obtaining 3D-CT images. We would like to thank Editage (http://ww.editage.com) for English language editing.

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Authors and Affiliations

  1. Division of General Thoracic Surgery, Department of General Surgical Science, Integrative Center of General Surgery, Gunma University Hospital, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan

    Yoichi Ohtaki, Toshiki Yajima, Toshiteru Nagashima, Seshiru Nakazawa, Natsuko Kawatani, Kai Obayashi, Tomohiro Yazawa & Ken Shirabe

  2. Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan

    Toshiki Yajima

  3. Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan

    Kimihiro Shimizu

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  1. Yoichi Ohtaki
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  2. Toshiki Yajima
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  3. Toshiteru Nagashima
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  4. Seshiru Nakazawa
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  6. Kai Obayashi
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  8. Kimihiro Shimizu
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  9. Ken Shirabe
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Correspondence to Toshiki Yajima.

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Ohtaki, Y., Yajima, T., Nagashima, T. et al. Complex vs. simple segmentectomy: comparing surgical outcomes in the left upper division. Gen Thorac Cardiovasc Surg 70, 962–970 (2022). https://doi.org/10.1007/s11748-022-01816-4

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  • DOI: https://doi.org/10.1007/s11748-022-01816-4

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