Thoracoscopic Incomplete Anatomical Segmentectomy for Ground-Glass-Dominant Lung Cancer: Associations with Lower Postoperative Cough Burden and Faster Symptom Recovery.

Abstract

The resection of pulmonary segmental tissue involving isolation and transection of only the target segmental artery without individual dissection of the segmental bronchus is defined as an incomplete anatomic segmentectomy (IAS). Few studies have compared postoperative symptoms between complete anatomical segmentectomy (CAS) and IAS. This study aims to evaluate symptom burden after these two surgical approaches. We analyzed prospective data from patients with stage IA1-IA2 NSCLC (predominantly ground-glass opacity) undergoing segmentectomy (2021-2023). Patients were grouped into CAS or IAS. Symptoms were assessed using the Perioperative Symptom Assessment for Lung Surgery (PSA-Lung) questionnaire via electronic patient reported outcomes system during and after hospitalization. After propensity score matching, postoperative symptom burden was compared between groups. Among 184 patients, 97 patients (52.7%) underwent CAS, while 87 patients (47.3%) underwent IAS. After propensity score matching (PSM), 53 patients in each group were included in the analysis. Within 7 days postdischarge, the IAS group presented lower cough (P = 0.037) than did the CAS group. The time to recovery of postoperative cough scores to preoperative levels was significantly shorter in the IAS group than in the CAS group. The IAS group also had a shorter operative time (P = 0.012), less intraoperative blood loss (P = 0.003), and lower surgical material cost (P = 0.001). Compared with CAS, IAS simplified the surgical procedure and reduced operative time. Longitudinal analysis of PSA-Lung scores demonstrated a lower overall postoperative cough burden in the IAS group during follow-up, along with a shorter time to symptom recovery, suggesting a potential advantage in postoperative symptom experience under comparable oncologic and surgical safety conditions.