Segmentectomies in patients with primary malignant lung tumors

Objective. To study the immediate and long-term outcomes of segmentectomy and lobectomy for malignant lung tumors. Material and methods. A retrospective study included patients with primary malignant lung tumors who underwent anatomical lung resection, including segmentectomy (335 patients) and lobectomy (1.238 patients) via thoracoscopic and open approaches between January 01, 2009 and December 31, 2022. Patients who required conversion to thoracotomy were included in the open surgery group. We enrolled 240 patients for analysis (120 after segmentectomy for non-small cell lung cancer (NSCLC) and 120 after lobectomy for NSCLC, ratio 1:1). Results. The total number of complications in thoracoscopic segmentectomies differed from lobectomy (4.2% and 9%, respectively; p=0.047). The same trend was observed for open segmentectomies and lobectomies (4.8% and 9.6%, respectively; p=0.05). Recovery of external respiratory function occurred significantly faster after thoracoscopic segmentectomies compared to thoracoscopic lobectomies. Thus, preoperative forced expiratory volumes in 1 second (FEV1) were 85% (42–120) and 89% (80–97), respectively. After 6 months and 1 year, FEV1 after thoracoscopic segmentectomy reached 80% (40–111) and 84% (42–116), after thoracoscopic lobectomy — 80% (70–90) and 82% (72–94), respectively. The same trend was observed in groups of open segmentectomy and lobectomies. Preoperative FEV1 was 79% (39–125) and 90% (43–136), after 6 months — 75% (36–117) and 82% (36–121), after 1 year — 78% (37–123) and 83% (39–130), respectively. The overall 5-year survival rates for patients with stage Ia1 and Ia2 NSCLC after thoracoscopic segmentectomy and lobectomy were 90.4% and 91.5% (p=0.940), 5-year disease-free survival rates — 83.3% and 89.4%, respectively (p=0.949). The overall 5-year survival rates for patients with stage Ia1 and Ia2 NSCLC after open segmentectomy and lobectomy were 79.7% and 83.5% (p=0.951), 5-year disease-free survival rates — 74.5% and 76.9%, respectively (p=0.457). Conclusion. Segmentectomy is associated with lower complication rate than lobectomy, and long-term outcomes are comparable to those of lobectomy in patients with NSCLC <2 cm.