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Julio Sesma, MD; Sergio Bolufer, MD, PhD; Antonio García-Valentín, MD, PhD; Raúl Embún, MD, PhD; Íker Javier López, MD, PhD; Nicolás Moreno-Mata, MD, PhD; Unai Jiménez, MD; Florentino Hernando Trancho, MD, PhD; Antonio Eduardo Martín-Ucar, MD; Juana Gallar, MD, PhD; Raul Embun; Iñigo Royo-Crespo; José Luis Recuero Díaz; Sergio Bolufer; Julio Sesma; Sergi Call; Miguel Congregado; David Gómez-de Antonio; Marcelo F. Jimenez; Nicolas Moreno-Mata; Borja Aguinagalde; Sergio Amor-Alonso; Miguel Jesús Arrarás; Ana Isabel Blanco Orozco; Marc Boada; Alberto Cabañero Sánchez; Isabel Cal Vázquez; Ángel Cilleruelo Ramos; Silvana Crowley Carrasco; Elena Fernández-Martín; Santiago García-Barajas; Maria Dolores García-Jiménez; Jose María García-Prim; Jose Alberto Garcia-Salcedo; Juan José Gelbenzu-Zazpe; Carlos Fernando Giraldo-Ospina; María Teresa Gómez Hernández; Jorge Hernández; Jennifer D. Illana Wolf; Alberto Jauregui Abularach; Unai Jiménez; Iker López Sanz; Néstor J. Martínez-Hernández; Elisabeth Martínez-Téllez; Lucía Milla Collado; Roberto Mongil Poce; Francisco Javier Moradiellos-Díez; Ramón Moreno-Balsalobre; Sergio B. Moreno Merino; Carme Obiols; Florencio Quero-Valenzuela; María Elena Ramírez-Gil; Ricard Ramos-Izquierdo; Eduardo Rivo; Alberto Rodríguez-Fuster; Rafael Rojo-Marcos; David Sanchez-Lorente; Laura Sanchez Moreno; Carlos Simón; Juan Carlos Trujillo-Reyes; Florentino Hernando Trancho
JTCVS open, 03/2022, Letnik: 9Journal Article
Objectives: The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy. Methods: From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score–matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan–Meier and competing risks method were used to compare survival. Results: In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score–matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan–Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression–related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups. Conclusions: Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.
