Thoracoscopic Segmentectomy Within an Enhanced Recovery Pathway Improves Days Alive and Out of Hospital Compared with Lobectomy

TL;DR

Thoracoscopic segmentectomy in an enhanced recovery pathway leads to more days alive and out of hospital than lobectomy for early-stage lung cancer.

Contribution

Demonstrates that segmentectomy improves postoperative recovery metrics compared to lobectomy in a real-world setting.

Findings

Segmentectomy resulted in 1 more median day alive and out of hospital than lobectomy.

Lobectomy was an independent predictor of shorter DAOH90 in multivariable analysis.

Segmentectomy had lower rates of air leak, pneumonia, and pain compared to lobectomy.

Abstract

This study aims to investigate the first 90 days alive and out of hospital (DAOH90) following enhanced recovery thoracoscopic segmentectomy versus lobectomy.

A retrospective analysis for consecutive thoracoscopic segmentectomies and lobectomies for clinical stage IA1-2 non-small cell lung cancer (cIA1-2 NSCLC) was performed between January 2018 and March 2024. All factors contributing to reduced DAOH90 were analyzed individually. The association between surgical extent and DAOH90 was assessed using a multivariable logistic regression model. Sensitivity analyses were performed after propensity score matching.

Of 720 patients, 591 underwent lobectomy and 129 underwent segmentectomy. Compared with lobectomy, patients undergoing segmentectomy had poorer lung function and exercise capacity, more comorbidities, slightly longer operative duration, and less blood loss. The median DAOH90 was 1 day longer after segmentectomy than lobectomy (87 vs 86 days, P = .049). Air leak > 1 day (38.3% vs 40.0%), pneumonia (13.3% vs 18.3%), and pain (13.3% vs 23.3%) were important reasons to reduce DAOH90, all occurring more frequently in the lobectomy group. Social factors (37.5% vs 25.8%) were also a predominant cause in both groups, particularly after segmentectomy. Other causes were less common. In multivariable analysis, lobectomy (vs segmentectomy, OR 1.44, P = .048) was identified as an independent predictor of shorter DAOH90, along with body mass index, lung function, and cardiac comorbidity. The results of the sensitivity analysis were consistent with these findings.

Following an enhanced recovery thoracoscopic protocol, segmentectomy for well-selected patients with cIA1-2 NSCLC may result in longer DAOH and less postoperative complications compared to lobectomy.

On the basis of the JCOG0802 and CALGB140503 trials,1,2 segmentectomy has been established and recommended as a standard surgical treatment for peripheral cIA1-2 non-small cell lung cancer (NSCLC).

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