Uniportal Video-Assisted Thoracoscopic Surgery Simple versus Complex Segmentectomy: Mid-Term Surgical and Early Oncological Outcomes

Background: Performing complex segmentectomy via uniportal video-assisted thoracoscopic surgery (VATS) is more demanding than simple segmentectomy or lobectomy.This study evaluates the safety and feasibility of uniportal VATS complex segmentectomy by analyzing mid-term surgical outcomes and early oncological results.Methods: We retrospectively reviewed patients who underwent uniportal VATS simple or complex segmentectomy between May 2019 and December 2024.Patient and tumor characteristics, operative and postoperative outcomes, and recurrence patterns were compared.Results: Among 513 patients, 135 underwent simple segmentectomy, and 355 had complex segmentectomy via uniportal VATS.Both groups had comparable patient and tumor characteristics, operative outcomes, and postoperative outcomes, except for increased postoperative stay and bleeding in the complex segmentectomy group.Surgical margin distances were not significantly different from prior studies.Among 181 patients with at least 2 years of computed tomography surveillance, 1 recurrence occurred in the complex segmentectomy group and another 5 months postoperatively in the basal segmentectomy group.Both recurrent cases were adenocarcinomas with moderate differentiation and a C/T ratio 0.5, despite adequate margins.Conclusion: Uniportal VATS complex segmentectomy is a safe and feasible procedure with oncological outcomes comparable to simple segmentectomy.The low recurrence rate supports its viability as a surgical option.Extended follow-up is required for further validation.