Thoracoscopic combined anatomical sublobar resection for deeply located intersegmental small-sized non-small cell lung cancer.

[INTRODUCTION] The optimal surgical approach for sublobar resection of small deep intersegmental lung cancers (DILC) remains unclear. This study compares the surgical and oncological outcomes of deep-seated DILC treated by anatomical versus non-anatomical extended sublobar resections.

[MATERIALS AND METHODS] Data from 95 patients with small (≤2 cm) cN0 DILC who underwent sublobar resection between March 2019 and November 2024 were analyzed. DILC was defined as tumors located between segments or near intersegmental veins in the inner two-thirds of the lung parenchyma. Patients were divided into two groups: combined anatomical sublobar resection (CASR) involving (sub)segmentectomy with subsegmentectomy of an adjacent segment, and combined non-anatomical extended resection (CNER) involving (sub)segmentectomy with an extended wedge resection.

[RESULTS] Of 95 patients, 38 received CNER and 57 received CASR, with no severe morbidity or perioperative mortality. CASR had lower intraoperative complication rates (0% vs. 10.5%, P = 0.023), faster chest tube removal (3.05 vs. 3.82 days, P = 0.021), and shorter hospital stays (4.23 vs. 5.21 days, P = 0.021). Surgical margins were significantly larger in the CASR group (2.34 cm vs. 1.60 cm, P < 0.001). The local recurrence rate was significantly higher in the CNER group (15.8% vs. 1.8%, P = 0.015). No significant differences were found in 5-year disease-free survival or overall survival between the groups.

[CONCLUSION] CASR provides larger surgical margins and lower recurrence rates, making it a preferable option for DILC over CNER.