Interest of anatomical segmentectomy over lobectomy for lung cancer: a nationwide study

BACKGROUND: Anatomical segmentectomy is an alternative to lobectomy for early-stage lung cancer (LC) or in patients at high risk. The main objective of this study was to compare the morbidity and mortality associated with these two types of pulmonary resection using data from the French National Epithor database. METHODS: All patients who underwent lobectomy or segmentectomy for early-stage LC from January 1(st) 2014 to December 31(st) 2016 were identified in the Epithor database. The primary endpoint was morbidity; the secondary endpoint was postoperative mortality. Propensity score matching was implemented and used to balance groups. The results were reported as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: During the study period, 1,604 segmentectomies (9.78%) and 14,786 lobectomies (90.22%) were performed. After matching, the segmentectomy group experienced significantly less atelectasis (OR 0.54; 95% CI: 0.4–0.75, P<0.0001), pneumonia (OR 0.72; 95% CI: 0.55–0.95, P=0.02), prolonged air leaks (OR 0.75; 95% CI: 0.64–0.89, P=0.001) or bronchopleural fistula (OR 0.35; 95% CI: 0.14–0.83, P=0.017), and fewer patients had at least one complication (OR 0.7; 95% CI: 0.62–0.78, P<0.0001). According to the Clavien-Dindo classification, postoperative complications were significantly less severe in the segmentectomy group (OR 0.52; 95% CI: 0.37–0.74, P<0.0001). There was no significant difference in postoperative mortality at 30 days (OR 0.67; 95% CI: 0.38–1.20, P=0.18), 60 days (OR 0.78; 95% CI: 0.42–1.47, P=0.4), or 90 days (OR 0.77; 95% CI: 0.45–1.34, P=0.36). CONCLUSIONS: Anatomical segmentectomy is an alternative surgical approach that could reduce postoperative morbidity, but it does not appear to affect mortality.