Short-term outcomes of mini-thoracotomy, multiportal video-assisted thoracic surgery, and multiportal robot-assisted thoracic surgery for complex segmentectomy.

This study examined the association of surgical approach with operative and postoperative outcomes as well as margin and nodal outcomes after complex segmentectomy, comparing mini-thoracotomy (MT) with multiportal minimally invasive thoracic surgery (mMITS) and, within mMITS, video-assisted thoracic surgery (mVATS) with multiportal robot-assisted thoracic surgery (mRATS), using propensity score matching (PSM). The study cohort comprised 808 consecutive patients treated with complex segmentectomy for suspected malignant pulmonary tumors from January 2015 through July 2026. Of these, 138 underwent MT and 670 mMITS, including 605 mVATS and 65 mRATS. PSM (1:2) was performed for MT versus mMITS (n = 126 vs. 252) and mVATS versus mRATS (n = 126 vs. 63). We assessed operative outcomes, postoperative complications, pain-related outcomes only for the mVATS-mRATS comparison, and margin and nodal outcomes. Blood loss was lower with mMITS than with MT (5 vs. 20 mL, p < 0.001), and chest tube duration was shorter (p = 0.002). Margin and nodal outcomes did not differ significantly between MT and mMITS. mRATS was associated with less blood loss than mVATS (3 vs. 5 mL, p = 0.006), a shorter duration of regular oral analgesic use (20 vs. 31 days, p = 0.007), and greater hilar and mediastinal lymph node yields (hilar, p = 0.037; mediastinal, p = 0.025). For complex segmentectomy, mMITS was associated with less blood loss and shorter chest tube duration than MT, without significant differences in margin and nodal outcomes. Within mMITS, mRATS was associated with shorter regular oral analgesic use and greater hilar and mediastinal lymph node yields than mVATS.