Segmentectomy is gaining popularity as a parenchyma sparing alternative for anatomic lung resection. We sought to investigate temporal changes in patient selection, case volume and outcomes for segmentectomy using the STS national database.
The STS General Thoracic Database was queried for patients who had undergone segmentectomy as the primary procedure between years 2002-2018. The ACOSOG definition of high-risk patients based on pulmonary function and major cardiovascular comorbidities was applied. Annual trends of case volume, patient risk profile, surgical indication, approach and outcomes were analyzed.
A total of 10,629 patients were analyzed from 310 contributing centers. The annual segmentectomy volume more than doubled from <4/center in 2009 to 8.6/center by 2017. Lung cancer was the most common indication (70.1%), followed by benign disease (15.6%), and metastatic tumors (14.3%). While the operative indication remained constant, the subset of high-risk patients (24.5%) decreased gradually over time (slope -0.6% per year, p=0.001). After 2012, segmentectomies were most commonly performed minimally invasively (VATS 58.3%, robotic 19.4%), with a steadily declining use of thoracotomy (overall 22.3%, slope -2.4%/year, p=0.001). Overall complication rates decreased over the study period from 41.7% to 26.1% (slope -0.57%/year p=0.001). The overall major complication rate was 4.6% (range 2.0-7.1%) and 30-day mortality was 1.0% (range 0.7-5.0%), and both were down trending since 2009 (p=0.01).
Segmentectomies are increasingly performed nationally, with a steady decline in the subset of high-risk patients over time. Complication rates have decreased significantly, parallel to the increasing use minimally-invasive techniques by VATS and robotic surgery.

Copyright © 2021. Published by Elsevier Inc.