Objective: The optimal extent of segmentectomy for clinical T1N0 non-small cell lung cancer (NSCLC) remains unclear. This study compared perioperative and oncological outcomes of video-assisted thoracoscopic surgery (VATS) single segmentectomy (SS) versus multiple segmentectomy (MS) for tumors ≤ 3 cm. Methods: This single center study retrospectively analyzed all consecutive patients who underwent VATS anatomic segmentectomy for cT1N0 NSCLC between 2017 and 2022. Patient demographics, perioperative outcomes, and survival were compared between SS and MS groups. Results: In total, 334 patients underwent pulmonary segmentectomy: single in 211 (63%) and multiple in 123 patients (37%). In the SS group, 83 (39%) were simple and 128 (61%) complex segmentectomies; while in the MS group, 67 (54%) were simple and 56 (46%) were complex. Baseline characteristics were similar between groups. SS was associated with shorter operative time (117 vs. 132 min;p= 0.007), reduced length of drainage (1 vs. 3 days;p< 0.001), reduced hospital stay (5 vs. 6 days;p< 0.001), and lower atrial fibrillation (1.4% vs. 5.7%;p= 0.042). Total mean tumor size was 14.3 mm, with no statistical difference between groups (14.3 vs. 15.5 mm;p= 0.115). Surgical margins were larger in SS (median 13 vs. 11 mm;p= 0.038), while the number of lymph nodes dissected was similar. After a median follow-up of 30 months, no significant differences were observed in overall survival (OS) (94.5% vs. 90.7%) and disease-free survival (DFS) (83.2% vs. 79.1%). Conclusions: SS and MS provide equivalent short-term oncological outcomes in cT1N0 NSCLC ≤ 3 cm. SS may be preferred when adequate margins are achievable, offering equivalent oncologic outcomes with better perioperative recovery.
目的：对于临床T1N0期非小细胞肺癌（NSCLC），肺段切除的最佳范围仍不明确。本研究比较了肿瘤≤3 cm的患者接受电视辅助胸腔镜手术（VATS）下单肺段切除（SS）与多肺段切除（MS）的围手术期及肿瘤学结果。方法：这项单中心研究回顾性分析了2017年至2022年间连续接受VATS解剖性肺段切除术的cT1N0 NSCLC患者。比较了SS组与MS组患者的人口统计学特征、围手术期结果及生存情况。结果：共有334例患者接受了肺段切除术：单肺段切除211例（63%），多肺段切除123例（37%）。SS组中，83例（39%）为简单肺段切除，128例（61%）为复杂肺段切除；MS组中，67例（54%）为简单肺段切除，56例（46%）为复杂肺段切除。两组基线特征相似。SS组手术时间更短（117 vs. 132分钟；p=0.007）、引流管留置时间更短（1 vs. 3天；p<0.001）、住院时间更短（5 vs. 6天；p<0.001）、心房颤动发生率更低（1.4% vs. 5.7%；p=0.042）。平均肿瘤大小为14.3 mm，组间无统计学差异（14.3 vs. 15.5 mm；p=0.115）。SS组手术切缘更宽（中位数13 vs. 11 mm；p=0.038），而淋巴结清扫数量相似。中位随访30个月后，两组总生存率（OS）（94.5% vs. 90.7%）和无病生存率（DFS）（83.2% vs. 79.1%）均无显著差异。结论：对于≤3 cm的cT1N0 NSCLC，SS与MS提供了相当的短期肿瘤学结果。在能够获得足够切缘的情况下，SS可能更受青睐，因其在提供同等肿瘤学结果的同时，围手术期恢复更佳。
Outcomes After VATS Single Versus Multiple Segmentectomy for cT1N0 Non-Small-Cell Lung Cancer
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