Left upper division segmentectomy is not a simple procedure: experience from two high-volume centers.

Background: Whether left upper division segmentectomy (LUDS) is a simple procedure remains controversial. This study aimed to compare the outcomes of LUDS with those of simple segmentectomy (SS) (excluding LUDS) and complex segmentectomy (CS) at two high-volume centers.

Methods: We retrospectively reviewed 1565 patients who underwent thoracoscopic segmentectomy for early-stage lung cancer between February 2015 and February 2020. Patients were categorized into three groups: LUDS (n = 189), SS (n = 317), and CS (n = 1059). The primary endpoint was defined as the occurrence of any following events: intraoperative complications, postoperative complications, 30-day readmission, and local recurrence.

Results: The rate of the primary endpoint was significantly higher in the LUDS group (14.3%) than in the SS group (7.6%) (P = 0.046) but was comparable between the LUDS and CS groups (14.4%) (P = 1.000). The median operative time in the LUDS group was 135 min, compared to 120 min in the SS group (P < 0.001) and 140 min in the CS group (P = 0.180). The median blood loss and rate of vascular injury in the LUDS group were significantly higher than those in the SS and CS groups (all P < 0.05). Subgroup analysis of the LUDS group demonstrated that the high-experience group had lower rates of primary endpoint and vascular injury, shorter operative time, and reduced blood loss.

Conclusions: LUDS is an efficient but complex procedure characterized by a long operative time, considerable blood loss, and a potential risk of vascular injury. Performance by experienced surgeons should be considered, as surgical expertise tends to result in improved outcomes.