Pursuit of Precision: Lobar Split Cone-Shaped Subsegmentectomy for Lung Nodules in Complex Positioning

Abstract Background Thoracoscopic segmentectomy is the main surgical method for the treatment of early lung cancer. With the promotion of technology and increasingly accurate criteria for lung subsegments, lung nodules with complex positions involving intersegmental and multisegments have become technical bottlenecks. This study aimed to verify whether lobar split cone-shaped subsegmentectomy could solve this bottleneck problem. Methods The clinical data of patients with lung nodules ≤ 2 cm located in the complex position in the Department of Thoracic Surgery of Jiangsu Provincial People's Hospital from January 2019 to August 2023 were collected. We analyzed the characteristics of patients who underwent lobar split cone-shaped subsegmentectomy and compared the surgical outcomes and complications between these patients and lobectomy patients at similar locations. Results A total of 22 patients underwent lobar split cone-shaped subsegmentectomy, and 47 patients were treated with lobectomy. Lobar split cone-shaped subsegmentectomy for patients with lung nodules in complex positions can yield satisfactory surgical margins under some conditions (in this study, the nodule diameter was 0.98 ± 0.31 mm, the depth ratio was 0.43 ± 0.13, and the consolidation tumor ratio was 0.27 ± 0.19). Compared to those in the lobectomy group, surgical outcomes were better (p > 0.05 for surgical complications and p < 0.05 for postoperative hospital stay and the number of resected subsegments). Conclusion Lobar split cone-shaped subsegmentectomy is a promising method for performing true lung segmentectomy with safe resection margins for patients with lung nodules in complex positions involving multiple segments. It can be used as a true lung segmentectomy method.