Upfront uniportal anatomical segmentectomy: a propensity score-matched analysis on the early postoperative outcomes of complex and simple resections.

Background: Segmentectomy has been shown to be feasible and to convey outcomes comparable to those of lobectomy in several studies. These can be divided into simple (SS) or complex (CS), depending on the number of intersegmental planes dissected during resection. This study aimed to evaluate the postoperative outcomes of uniportal video-assisted thoracic surgery (u-VATS) in CS and SS. Methods: We conducted a retrospective study from January 2017 to January 2025, including all patients who underwent anatomical segmentectomy via u-VATS. CS and SS were propensity score-matched with a 1:1 ratio. Results: A total of 402 consecutive u-VATS segmentectomies were conducted during the studied period. After matching, 302 patients were selected. These included 151 SS and 151 CS. Overall, the median age in our study was 70 (64-75) years, with a predominance of female patients (60%, n=181). When contrasting CS with SS, we observed a larger proportion of patients with prolonged air leak [n=35 (23%) Conclusions: While small differences may arise when comparing SS and CS, these do not appear to substantially impact the early postoperative course. Ultimately, the complexity of segmentectomies is often determined by the surgeon's practical experience with each specific segment.