Uniportal video-assisted thoracoscopic surgery simple versus complex segmentectomy: a retrospective comparative study on mid-term surgical and early oncological outcomes.

Background: Undertaking a complex segmentectomy using uniportal video-assisted thoracoscopic surgery (VATS) involves greater technical complexity compared to a simple segmentectomy or lobectomy. This study aimed to investigate a series of cases wherein uniportal VATS complex segmentectomy was performed more frequently than uniportal VATS simple segmentectomy, to evaluate the safety and feasibility of the complex procedure by presenting mid-term surgical and early oncological outcomes. Methods: A retrospective analysis was conducted on patients who underwent either simple or complex segmentectomy using uniportal VATS from May 2019 to December 2024. Patient and tumor characteristics, as well as operative and postoperative outcomes, were compared between simple and complex segmentectomy groups. Recurrence patterns and early oncological outcomes were also assessed. Results: Of the 513 patients analyzed, 135 received a simple segmentectomy and 355 underwent a complex segmentectomy, both performed using the uniportal VATS approach. While most clinical, tumor-related, and perioperative variables did not differ significantly between the two groups, notable differences were observed in the duration of postoperative hospitalization and the incidence of postoperative bleeding. Contrary to our previous observations, uniportal VATS complex segmentectomy did not result in shorter surgical margin distances. In subgroup analysis, among 181 patients who underwent postoperative surveillance with chest computed tomography for at least 2 years, we noted one recurrence, with an additional case of recurrence identified 5 months postoperatively. One case occurred in the complex segmentectomy group, and the other occurred in the basal segmentectomy group. Both recurrent cases consisted of moderately differentiated adenocarcinomas with a consolidation to tumor ratio (C/T ratio) ≥0.5 despite achieving adequate surgical margins. Conclusions: Uniportal VATS complex segmentectomy demonstrated a favorable safety profile and oncological efficacy comparable to simple segmentectomy. The low incidence of recurrence observed in this study suggests that complex segmentectomy represents a viable surgical option with acceptable mid-term surgical and early oncological outcomes. Further studies with longer follow-up periods are warranted to validate these findings.