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Introduction
Pulmonary segmentectomy is an option for the treatment of non-invasive lung cancer or small metastatic pulmonary tumors; it is a less invasive procedure than lobectomy due to preservation of the lung parenchyma. There are two types of segmentectomies; one is simple segmentectomy, which is performed frequently because of its technical simplicity, such as segmental resection of segment 6, the basal segment, the left upper division (LUD), and the lingular segment [1, 2]. The other is complex segmentectomy. A recent prospective study has shown that complex segmentectomy is a stronger risk factor than lobectomy for pulmonary complications [2]. Indeed, the lung parenchyma must be cut extensively in complex segmentectomy, which can cause pulmonary complications, such as prolonged air leakage (AL). Therefore, thoracic surgeons may choose LUD segmentectomy (S1+2+ + S3) for tumors located in the LUD because of its procedural simplicity and reduced concern for postoperative complications, even if the surgical margin can be secured by single-segment resection, such as apicoposterior (S1+2) segmentectomy or anterior (S3) segmentectomy. However, LUD segmentectomy itself is a risk factor for pulmonary complications [3, 4]. Moreover, S1+2 and S3 have three subsegments, which may be more suitable for securing the surgical margin than the other segments with only two subsegments.
This study aimed to compare the surgical outcomes and risks of complex segmentectomy for postoperative pulmonary complications with those of simple segmentectomy for lesions located in the LUD using consecutive patient data from a single institution. In addition, we aimed to clarify the prognosis after segmentectomy depending on the type of segmentectomy (intentional or passive; simple or complex).
Patients and methods
Patients
Among the 439 patients who underwent segmentectomy or subsegmentectomy between January 2010 and March 2021, we included 118 consecutive patients who underwent LUD segmentectomy (Fig. 1). The patient data were retrospectively analyzed. This study was approved by the Institutional Review Board of Gunma University Hospital (No. HS2019-279) and conducted in accordance with the principles of the Declaration of Helsinki.
Fig. 1 [Images not available. See PDF.]
Cohort diagram of this study
Segmentectomy was performed in patients who were considered to have either an early stage lung cancer or metastatic lung lesion, or when a patient had an undetermined lung nodule...