Resection of 4 or more pulmonary segments increases the risk of non-cancer-related mortality.

OBJECTIVES

This study retrospectively analysed the effect of the number of resected pulmonary segments on surgical outcomes of patients with non-small-cell lung cancer undergoing anatomical pulmonary resection.

METHODS

We examined patients who underwent lobectomy or segmentectomy for non-small-cell lung cancer between January 2016 and June 2021. We compared the surgical outcomes between the ≤3 segment group (group A) and the ≥4 segment group (group B). Lung functions were evaluated by comparing the preoperative and 6-month postoperative periods. Comprehensive preoperative status, including osteoporosis, sarcopenia and lung function, was incorporated into the propensity score matching analysis.

RESULTS

Propensity score matching for 420 patients yielded 310 for evaluation (1:1 matching), with a median follow-up of 57.6 months. Fifty-four patients (17.5%) died (17 from lung cancer and 37 from other diseases), and 50 patients (16.1%) experienced cancer recurrence. The 2 groups had no significant differences in surgical outcomes, including operation time, blood loss and postoperative complications. However, group B showed the worst reduction in vital capacity and forced expiratory volume in 1 s (all P < 0.05). Additionally, there were no significant differences in cancer recurrence or lung cancer mortality between the groups, although group B was significantly associated with increased deaths from other causes (P = 0.007, Gray's test; adjusted subdistribution hazard ratio 2.392; 95% confidence interval 1.170-5.167). Subgroup analyses revealed adverse effect modification in male patients regarding non-cancer-related deaths (P-value for interaction = 0.044).

CONCLUSIONS

The ≥4 segment group exhibited poorer postoperative pulmonary function and more deaths from other causes, indicating the need for careful postoperative management.