Segmentectomies: 5-Year Experience Of A Center.

Abstract

Introduction: Segmental anatomical resections have been a subject of debate in recent years. There is increasing evidence that these procedures may offer some advantages in the treatment of early-stage lung cancer, with overall survival (OS) and disease-free survival (DFS) similar to those seen in lobar anatomical resections.

Materials and methods: We conducted a retrospective analysis of patients who underwent segmentectomy at Santa Marta Hospital (HSM) between January 2018 and September 2022. Patients undergoing trauma-related segmentectomy or as a secondary procedure were excluded.

Results: 37 segmentectomies were performed, of which 34 were included in this analysis. 29 (85.3%) were performed for malignancies, 5 (14.7%) for benign conditions. Of the malignancies, 24 (82.8%) were primary lung cancer (PLC): 18 (75%) adenocarcinomas (ADC), 2 (8.3%) squamous cell carcinomas (SCC), 4 (16.7%) typical carcinoids (TC); 5 (17.2%) were colorectal-origin metastases. Among the benign cases: 3 (60%) were aspergillomas. Mean age of PLC patients was 71 years (min=56;max=88), with 9 (37.5%) females and 15 (62.5%) males. In 11 (45.8%), FEV1 or DLCO was <60%. 18 (75%) were smokers. Lesions were mostly solid nodules (N=12;50%). Others included subsolid lesions (N=11;45%) and 1 (4.2%) cystic formation. At surgery, only 3 (12.5%) patients had a pre-operative histological diagnosis (ADC=2; SCC=1). 21 (87.5%) were stage IA, 2 (8.33%) patients were stage IB and 1 (8.33%) patient was stage IIA. Procedures were performed via VATS (N=17;70.8%), via thoracotomy (N=5;20.8%) and via RATS (N=2;8.3%). 23 (95.8%) were R0 resections. Postoperatively: 19 (79.2%) were stage IA; 3 (12.5%) IB; ,1 (4.2%) IIB, and 1 (4.2%) IIIA. 3 (12.5%) had upstaging. 2 (8.3%) patients underwent adjuvant chemotherapy, 1 (4.2%) had completion lobectomy. 2 (8.3%) experienced recurrence. DFS was 100% at 3, 6, and 12 months, and at 3 and 5 years, was 88.9% and 66.7% respectively. OS was 100% at 3, 6, and 12 months and 95% at 3 and 5 years. Median follow up time was 29 months (IQR: 18 - 44).

Conclusion: This study reinforces the idea that segmental resections should be considered a viable option for patients with early-stage lung cancer. Although this analysis has some limitations, such as a limited number of preoperative histological diagnoses and postoperative upstaging, our results demonstrate promising OS and DFS, in accordance with recent literature.