Perioperative Outcomes of Complex Versus Simple Segmentectomy Via Uniportal Video-Assisted Thoracoscopic Surgery for Lung Lesions: A Systematic Review and Meta-Analysis

Abstract

OBJECTIVES: Uniportal video-assisted thoracoscopic surgery (U-VATS) has been increasingly adopted for anatomical segmentectomy because of its minimally invasive nature and favourable recovery profile. However, whether perioperative outcomes differ between complex and simple segmentectomy when performed via U-VATS remains uncertain. This study compared perioperative outcomes between complex and simple U-VATS segmentectomy. METHODS: A systematic review and meta-analysis were conducted according to PRISMA 2020 and AMSTAR 2 guidelines, and the study was registered in PROSPERO (CRD420251151464). Six databases were searched for studies comparing complex and simple U-VATS segmentectomy for pulmonary lesions. Primary outcomes were operative time, intraoperative blood loss, and conversion to thoracotomy. Secondary outcomes included chest tube duration, hospital stay, and postoperative complications. Random-effects models were used for pooled analyses. RESULTS: Five retrospective studies, including 1051 patients (707 complex; 344 simple), were analysed. No statistically significant differences were detected in operative time (MD = 15.25 min, 95% CI: -1.25 to 31.75; P = .07; I2 = 88%), intraoperative blood loss (MD = -1.33 mL, 95% CI: -11.95 to 9.29; P = .81; I2 = 58%), or conversion to thoracotomy (OR = 0.46, 95% CI: 0.10-1.99; P = .30; I2 = 0%). Secondary outcomes also showed no significant differences, including chest tube duration (MD = -0.15 days, 95% CI: -0.41 to 0.11; P = .25; I2 = 26%), hospital stay (MD = -0.16 days, 95% CI: -0.73 to 0.40; P = .57; I2 = 66%). CONCLUSIONS: No statistically significant differences were detected in key perioperative outcomes between complex and simple U-VATS segmentectomy; however, given substantial clinical heterogeneity and limited retrospective evidence, findings should be interpreted cautiously and are most applicable to selected patients treated in experienced, high-volume centres.