Complex segmentectomy is not a complex procedure relative to simple segmentectomy

Segmentectomies can be classified as simple or complex and are increasingly performed for early-stage lung cancer. Complex segmentectomy requires the creation of multiple intersegmental planes and is considered a more arduous procedure with higher risks of postoperative complications, relative to simple segmentectomy.This retrospective study evaluated patients who underwent simple or complex segmentectomy for primary lung cancer during 2012-2018. Perioperative factors were compared according to the procedure type.The 538 eligible segmentectomies included 251 complex segmentectomies and 287 simple segmentectomies. There were no significant differences in terms of age, sex, smoking history or comorbidities. The most common procedure in the complex segmentectomy group was upper-lobe segmentectomy (e.g. S1, S2, S3 and S1 + 2; n = 170), which was followed by S8 segmentectomy (n = 39) and two-segment segmentectomies (e.g. S7 + 8, S8 + 9 and S9 + 10; n = 24). Simple segmentectomies involved left upper division (n = 117), the lingular segment (n = 30) and the S6 segment (n = 140). Comparing complex and simple segmentectomies revealed equivalent median operative times (113 vs 113 min) and blood loss (20 vs 20 ml). Complex segmentectomy had fewer postoperative complications (2.0% vs 7.0%, P = 0.006), including prolonged air leak (0.8% vs 3.5%, P = 0.035) and shorter median postoperative stays (3 vs 4 days, P < 0.001). However, median surgical margins were closer for complex segmentectomy (22 vs 25 mm, P = 0.005).The perioperative outcomes of complex segmentectomy were satisfactory and comparable to those of simple segmentectomy. Surgeons should pay careful attention to the surgical margins during complex segmentectomy.