Uniportal video-assisted thoracic S9+10 segmentectomy using a single-direction approach is good for pulmonary function

Abstract

Background: Uniportal video-assisted thoracic surgery is still a technical challenge, especially anatomical segmentectomy for the lateral basal segment (S9), posterior basal segment (S10), or both (S9+10). Different surgical procedures determine a variable pulmonary functional reduction depending on the extent of the resection. This study aimed to compare the efficiency of uniportal video-assisted thoracic surgery S9+10 segmentectomy with video-assisted thoracic surgery basal segmentectomy in preserving pulmonary function.

Methods: The patients who had undergone single-port video-assisted thoracic surgery S9+10 segmentectomy using a single-direction approach were age, sex, and pulmonary function matched with those undergoing video-assisted thoracic surgery basal segmentectomy. The pulmonary function tests were performed preoperatively, and at 3 and 6 months postoperatively. The operative details, postoperative complications, and pulmonary function were statistically analyzed.

Results: After matching, a total of 46 patients undergoing video-assisted thoracic surgery S9+10 segmentectomy and 58 patients undergoing video-assisted thoracic surgery basal segmentectomy were eligible for analysis. There was no significant difference in the average blood loss, the duration of chest tube, intensive care unit stay, or hospital stay between these 2 groups. There were no major postoperative complications and surgical mortality was found in the 2 groups. The uniportal video-assisted thoracic surgery S9+10 segmentectomy group had a greater preserved pulmonary function (concerning the values of the forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second %, and diffusion capacity of carbon monoxide %) than video-assisted thoracic surgery basal segmentectomy group at 1 and 3 months postoperatively.

Conclusion: Uniportal video-assisted thoracic surgery anatomic S9+10 segmentectomy using a single-direction approach was safe and feasible for early stages of nonsmall cell lung cancer, and it offered significantly better functional preservation compared with basal segmentectomy.