Single-port thoracoscopic complex vs simple lung segmentectomy: Comparative outcomes and feasibility

BACKGROUND: Complex lung segmentectomy, although effective for early-stage lung cancer, is less widely adopted because of its technical complexity. OBJECTIVES: This study aimed to compare perioperative outcomes, quality of life (QoL), and survival between complex and simple lung segmentectomy performed using single-port thoracoscopy to determine its clinical feasibility. MATERIAL AND METHODS: This retrospective analysis screened 218 patients; after exclusions, 210 patients underwent complex (n = 100) or simple (n = 110) segmentectomy at Zhanjiang Central Hospital. Propensity score matching resulted in 92 patients per group. Single-port thoracoscopic surgery was performed, and perioperative outcomes, complications, QoL assessed using the 36-Item Short Form Health Survey (SF-36), and survival evaluated using Kaplan-Meier curves were analyzed. Statistical analyses were performed using t-tests, χ2 tests, and log-rank tests (p < 0.05). RESULTS: Complex segmentectomy was associated with longer operative time, greater postoperative drainage, and longer hospital stays (p < 0.001). Cough (60.87% vs 32.61%; p = 0.007) and air leakage (54.35% vs 19.57%; p < 0.001) were more common in the complex group. No significant differences were observed in postoperative lung function, other complications, such as infection or arrhythmia, or QoL at 6 months (p = 0.071). Survival curves showed comparable prognosis (p = 0.860). CONCLUSIONS: Despite increased perioperative demands, complex lung segmentectomy achieves lung function, QoL, and survival outcomes similar to those of simple segmentectomy, supporting its role in the treatment of early-stage lung cancer. These findings support its broader application in specialized settings and may inform optimized surgical approaches.