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Retrospective comparative study of thoracoscopic lobectomy vs. segmentectomy: Enhancing recovery and lung function in early-stage non-small cell lung cancer

Year: 2025

Type: article

Abstract: Surgical resection remains the key treatment for early stage non-small cell lung cancer (NSCLC), with thoracoscopic lobectomy and segmentectomy being the primary surgical techniques. However, evidence comparing the efficacy, safety, and effects on postoperative recovery and lung function is limited. This study aimed to examine the clinical outcomes associated with these 2 strategies in patients diagnosed with early stage NSCLC. We conducted a retrospective analysis of 180 patients diagnosed with early stage NSCLC who were treated between February 2021 and February 2023. These patients were equally divided into 2 groups of 90 each; one group underwent thoracoscopic lobectomy, while the other underwent segmentectomy. The key outcomes included perioperative factors (operative time, blood loss, drainage volume, and hospital stay), postoperative complications, inflammatory markers (C-reactive protein and procalcitonin), and pulmonary function (forced vital capacity and forced expiratory volume in 1 second) assessed at the 1-year follow-up. Compared with lobectomy, segmentectomy resulted in longer operative times (135.7 ± 15.3 vs 112.4 ± 12.8 minutes, P < .001) but shorter hospital stays (5.4 ± 1.2 vs 7.6 ± 1.5 days, P < .001) and reduced drainage volumes (P < .001). The intraoperative blood loss, lymph node yield, and resection margins were similar between the groups. Complication rates did not differ significantly (8.9% for segmentectomy vs 12.2% for lobectomy, P = .472). On postoperative days 1 and 3, C-reactive protein and procalcitonin levels were markedly lower in the segmentectomy group (P < .05). At the 1-year follow-up, segmentectomy patients had better preservation of pulmonary function, with an forced expiratory volume in 1 second of 84.2% of the preoperative level, than lobectomy patients 69.9% (P < .001), especially elderly patients and those with chronic obstructive pulmonary disease. Multivariate analysis confirmed that the surgical approach was an independent predictor of lung function preservation. Thoracoscopic segmentectomy and lobectomy offer similar safety and oncological outcomes in patients with early stage NSCLC. However, segmentectomy provides benefits such as shorter hospital stay, reduced postoperative inflammation, and better preservation of lung function, making it a favorable choice for high-risk patients. Larger prospective studies are needed to confirm these findings and evaluate long-term results.

Source: Medicine

DOI: 10.1097/md.0000000000045655