J Surg Res. 2025 Jan;305:237-245. doi: 10.1016/j.jss.2024.11.031. Epub 2024 Dec 27.
ABSTRACT
INTRODUCTION: This study aimed to compare the outcomes of three-dimensional (3D) image-guided video-assisted thoracic surgery (VATS) segmentectomy performed with and without preoperative localization for the resection of small pulmonary nodules.
METHOD: Between July 2015 and December 2022, 439 patients who underwent 3D image-guided VATS segmentectomy for early-stage lung cancer were enrolled. Based on whether preoperative localization was performed, the patients were divided into two groups as follows: the localization (n = 96) and nonlocalization groups (n = 343). The primary endpoints were the resection success rate and surgical margins.
RESULTS: Resection was successfully performed in 95 (99.0%) and 340 (99.1%) patients in the localization and nonlocalization groups, respectively (P = 1.000). One and three patients in the localization and nonlocalization groups, respectively, required conversion to extended segmentectomy due to inadequate surgical margins. The median surgical margins were 20 (range, 14-30) mm and 22 (range, 14-30) mm in the localization and nonlocalization groups, respectively (P = 0.410). However, overall complications were significantly more frequent in the localization group (9.4%) than in the nonlocalization group (4.1%; P = 0.040). This result was further supported by findings from multivariate logistic regression analysis. A subgroup analysis of high-risk small pulmonary nodules indicated no statistically significant differences between the groups concerning the primary endpoints.
CONCLUSIONS: 3D image-guided VATS segmentectomy performed with and without preoperative localization had comparable resection success rates and surgical margins. However, the procedure without preoperative localization was associated with fewer postoperative complications.
PMID:39937556 | DOI:10.1016/j.jss.2024.11.031
