Gen Thorac Cardiovasc Surg. 2026 Jun 3. doi: 10.1007/s11748-026-02328-1. Online ahead of print.
ABSTRACT
OBJECTIVES: The technical complexity of complex segmentectomy for non-small cell lung cancer raises concerns regarding perioperative safety and oncologic adequacy. We evaluated whether complex segmentectomy compromises perioperative or long-term outcomes compared with simple segmentectomy.
METHODS: We retrospectively reviewed 542 consecutive patients undergoing anatomical segmentectomy for resectable non-small cell lung cancer at a single cancer center (2014-2024). Simple segmentectomy was defined as upper division, lingular, S6, or basal segmentectomies; others were classified as complex segmentectomy. Perioperative, overall, and recurrence-free survival were compared between simple (n = 284) and complex (n = 258) segmentectomies. Cox proportional hazards models identified predictors of recurrence-free survival.
RESULTS: Baseline demographics and pulmonary function were similar between groups, whereas complex segmentectomy was more frequently performed for smaller ground-glass-dominant tumors using video-assisted thoracoscopic surgery. Operative time was slightly shorter for complex segmentectomy, while rates of major complications requiring intervention and 30-/90-day mortality were similar. At a median follow-up of 49 months, the 5-year overall survival and recurrence-free survival rates for the entire cohort were 91.5% and 85.2%, respectively, with no statistically significant differences between the complex segmentectomy and simple segmentectomy groups. In multivariable analysis, age, sex, and lymphovascular invasion were independent predictors of RFS, whereas smoking history, radiological tumor appearance, ND2 dissection, and complex segmentectomy were not.
CONCLUSIONS: In this single-center cohort, complex segmentectomy achieved perioperative and long-term outcomes comparable to those of simple segmentectomy and appears to be an oncologically acceptable, parenchyma-sparing option for appropriately selected patients with resectable non-small cell lung cancer.
PMID:42234389 | DOI:10.1007/s11748-026-02328-1
