# Preoperative Factors Associated with Surgical Complexity and Postoperative Outcomes in Patients Undergoing Robotic Anatomical Segmentectomy

## TL;DR

The study identifies preoperative factors linked to the complexity of robotic lung cancer surgery and how they affect patient outcomes.

## Contribution

The study introduces a novel analysis of preoperative predictors of robotic segmentectomy complexity and their impact on surgical outcomes.

## Key findings

- 37 out of 160 robotic segmentectomies were classified as complex procedures.
- Complex cases had higher major morbidity and longer hospital stays compared to non-complex cases.
- Factors like age, transverse pleural diameter, and staple planes were associated with procedural complexity.

## Abstract

Anatomical segmentectomy is increasingly used for early-stage lung cancer due to its parenchymal-sparing benefits. However, it remains technically challenging, and procedural complexity is often inconsistently defined. Robotic-assisted surgery, offering enhanced dexterity and visualization, has become more widespread but still requires high technical expertise. This study aimed to identify preoperative factors associated with procedural complexity and evaluate its impact on postoperative outcomes.

This single-centre cohort study included 160 consecutive patients who underwent robotic segmentectomy by 2 expert surgeons between November 2018 and August 2025. Complex procedures were defined as those with operative time >125 min (75th percentile), conversion to another surgical approach, or changes in the planned resection due to intraoperative technical challenges. Logistic regression was used to identify preoperative variables associated with complexity. Postoperative outcomes were compared between complex and non-complex cases.

Thirty-seven segmentectomies (23.1%) were classified as complex. Predictors of complexity included age (odds ratio [OR] = 1.042, P = .063), transverse pleural diameter (OR = 0.716, P = .089), and number of staple planes (OR = 1.644, P = .058), while the presence of emphysema (OR = 0.428, P = .076) appeared to be protective. Mortality, overall morbidity, prolonged air leak, and readmission rates were similar between groups. However, complex cases had significantly higher rates of major morbidity (13.5% vs 1.6%, P = .008), reintervention (10.8% vs 0.8%, P = .010), and longer hospital stays (median 3 vs 2 days, P = .004).

This exploratory analysis identified preoperative factors associated with procedural complexity in robotic segmentectomy. These findings may help improve patient selection, surgical planning, resource allocation, and structured training.

Pulmonary anatomical segmentectomy has become increasingly relevant in thoracic surgery.