Thoracoscopic segmentectomy versus lobectomy: A propensity score–matched analysis

Sesma, Julio ; Bolufer, Sergio ; García-Valentín, Antonio ; Embún, Raúl (Universidad de Zaragoza) ; López, Íker Javier ; Moreno-Mata, Nicolás ; Jiménez, Unai ; Trancho, Florentino Hernando ; Martín-Ucar, Antonio Eduardo ; Gallar, Juana

Resumen: 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.

Idioma: Inglés

DOI: 10.1016/j.xjon.2022.01.009

Año: 2022

Publicado en: JTCVS Open 9 (2022), 268-278
ISSN: 2666-2736

Factor impacto CITESCORE: 1.6 - Medicine (Q3)

Factor impacto SCIMAGO: 0.291 - Cardiology and Cardiovascular Medicine (Q3) - Surgery (Q3) - Pulmonary and Respiratory Medicine (Q3)

Tipo y forma: Article (Published version)

Área (Departamento): Área Cirugía (Dpto. Cirugía)