Thoracoscopic Segmentectomy Within an Enhanced Recovery Pathway Improves Days Alive and Out of Hospital Compared with Lobectomy

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Abstract
Objectives: This study aims to investigate the first 90 days alive and out of hospital (DAOH90) following enhanced recovery thoracoscopic segmentectomy versus lobectomy. Methods: A retrospective analysis for consecutive thoracoscopic segmentectomies and lobectomies for clinical stage IA1-2 non-small cell lung cancer (cIA1-2 NSCLC) was performed between January 2018 and March 2024. All factors contributing to reduced DAOH90 were analyzed individually. The association between surgical extent and DAOH90 was assessed using a multivariable logistic regression model. Sensitivity analyses were performed after propensity score matching. Results: Of 720 patients, 591 underwent lobectomy and 129 underwent segmentectomy. Compared with lobectomy, patients undergoing segmentectomy had poorer lung function and exercise capacity, more comorbidities, slightly longer operative duration, and less blood loss. The median DAOH90 was 1 day longer after segmentectomy than lobectomy (87 vs 86 days, P = .049). Air leak > 1 day (38.3% vs 40.0%), pneumonia (13.3% vs 18.3%), and pain (13.3% vs 23.3%) were important reasons to reduce DAOH90, all occurring more frequently in the lobectomy group. Social factors (37.5% vs 25.8%) were also a predominant cause in both groups, particularly after segmentectomy. Other causes were less common. In multivariable analysis, lobectomy (vs segmentectomy, OR 1.44, P = .048) was identified as an independent predictor of shorter DAOH90, along with body mass index, lung function, and cardiac comorbidity. The results of the sensitivity analysis were consistent with these findings. Conclusions: Following an enhanced recovery thoracoscopic protocol, segmentectomy for well-selected patients with cIA1-2 NSCLC may result in longer DAOH and less postoperative complications compared to lobectomy.

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