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Background <p>Segmentectomy performed via a uniportal thoracoscopic approach is considered technically more challenging than lobectomy, and its adoption in Japan has not yet been well characterized. This study aimed to assess the safety and feasibility of uniportal thoracoscopic segmentectomy compared with lobectomy through a multicenter retrospective analysis conducted by the Japan Uniportal Video-assisted Thoracoscopic Surgery Interest Group.</p> Methods <p>We retrospectively analyzed patients who underwent uniportal thoracoscopic anatomical lung resection at 43 institutions in Japan between April 2018 and March 2023. Patients with clinical stage 0/IA non-small-cell lung cancer were included. Stabilized inverse probability of treatment weighting (IPTW) based on propensity scores was used to adjust for differences in baseline characteristics between the segmentectomy and lobectomy groups. The primary endpoint was the rate of surgical procedure-related complications, and secondary endpoints included other perioperative outcomes.</p> Results <p>A total of 2,530 eligible patients were identified, including 1,807 who underwent lobectomy and 723 who underwent segmentectomy. Both the overall number of cases and the proportion of segmentectomies increased annually during the study period. After stabilized IPTW, postoperative drainage duration (<i>P</i> = 0.005) and postoperative hospital stay (<i>P</i> = 0.002) favored segmentectomy, whereas operative time (<i>P</i> = 0.527) and blood loss (<i>P</i> = 0.347) were not significantly different. Clavien–Dindo grade ≥ III morbidity (OR: 0.69, 95% CI: 0.49–0.97, <i>P</i> = 0.031) and 30-day readmission (OR: 0.19, 95% CI: 0.06–0.62, <i>P</i> = 0.006) were lower after segmentectomy. Surgical procedure-related complications were comparable between groups after IPTW (OR: 0.89, 95% CI: 0.69–1.16, <i>P</i> = 0.398).</p> Conclusions <p>In this nationwide multicenter registry, uniportal thoracoscopic segmentectomy was associated with short-term perioperative outcomes comparable to lobectomy after IPTW adjustment. These findings should be interpreted as real-world perioperative evidence within the registry setting and do not address long-term oncologic outcomes.</p>

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Comparison of the perioperative outcomes between uniportal thoracoscopic lobectomy and segmentectomy for early-stage non-small-cell lung cancer in Japan

  • 期刊论文

  • 发表日期：

    2026年7月7日

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  • Hitoshi Igai,
  • Takuya Watanabe,
  • Takahiro Homma,
  • Takashi Suda,
  • Toshiaki Morikawa

摘要

Background

Segmentectomy performed via a uniportal thoracoscopic approach is considered technically more challenging than lobectomy, and its adoption in Japan has not yet been well characterized. This study aimed to assess the safety and feasibility of uniportal thoracoscopic segmentectomy compared with lobectomy through a multicenter retrospective analysis conducted by the Japan Uniportal Video-assisted Thoracoscopic Surgery Interest Group.

Methods

We retrospectively analyzed patients who underwent uniportal thoracoscopic anatomical lung resection at 43 institutions in Japan between April 2018 and March 2023. Patients with clinical stage 0/IA non-small-cell lung cancer were included. Stabilized inverse probability of treatment weighting (IPTW) based on propensity scores was used to adjust for differences in baseline characteristics between the segmentectomy and lobectomy groups. The primary endpoint was the rate of surgical procedure-related complications, and secondary endpoints included other perioperative outcomes.

Results

A total of 2,530 eligible patients were identified, including 1,807 who underwent lobectomy and 723 who underwent segmentectomy. Both the overall number of cases and the proportion of segmentectomies increased annually during the study period. After stabilized IPTW, postoperative drainage duration (P = 0.005) and postoperative hospital stay (P = 0.002) favored segmentectomy, whereas operative time (P = 0.527) and blood loss (P = 0.347) were not significantly different. Clavien–Dindo grade ≥ III morbidity (OR: 0.69, 95% CI: 0.49–0.97, P = 0.031) and 30-day readmission (OR: 0.19, 95% CI: 0.06–0.62, P = 0.006) were lower after segmentectomy. Surgical procedure-related complications were comparable between groups after IPTW (OR: 0.89, 95% CI: 0.69–1.16, P = 0.398).

Conclusions

In this nationwide multicenter registry, uniportal thoracoscopic segmentectomy was associated with short-term perioperative outcomes comparable to lobectomy after IPTW adjustment. These findings should be interpreted as real-world perioperative evidence within the registry setting and do not address long-term oncologic outcomes.