At present, surgical treatment is the first choice for patients with early and middle stage lung cancer. The traditional posterolateral thoracotomy requires the help of distractors, which easily leads to excessive traction causing chest wall injury, affecting thoracic movement and limiting diaphragmatic activity. In addition, lung cancer patients generally have physical dysfunction and poor tolerance. If the injury is severe, it can cause restrictive respiratory disorder [8,9,10], further affecting the therapeutic effect. Therefore, it is important to improve the surgical methods of early lung cancer to improve the efficacy and prognosis of patients.

At present, patients with lung cancer are mainly treated with lobectomy combined with lymph node dissection [11], but some patients with such patterns cannot tolerate it. On this basis, segmentectomy has emerged, and the main purpose of its treatment is to dissect and remove lymph nodes and lesion sites as much as possible [12]. At present, the method of thoracoscopic segmentectomy has been gradually recognized by more people, and in terms of small pulmonary nodules, the surgeon can not only confirm the pathological diagnosis, but also free the segmental vessels and bronchi that need to be removed and perform radical resection of the lesion in a timely manner without prolonging the surgical incision [13, 14]. In this study, patients with lung cancer less than 2 cm in diameter in our hospital were selected as the study subjects and underwent segmentectomy and lobectomy, respectively, but three-hole thoracoscopic segmentectomy was used because it had less angle limitation in operation, and could more clearly identify the exposure of the surgical field and hilar structure, and then timely solve the intractable problems encountered during the operation [15], so as to avoid interference with perioperative indicators. The results of this study showed that the differences in the operation time and the number of dissected lymph nodes between the two groups had no statistical significance, while the drainage volume and intraoperative blood loss in the segmentectomy group were lower than those in the lobectomy group, and the drainage time and hospital stay were shorter than those in the lobectomy group, and the differences had statistical significance, suggesting that thoracoscopic segmentectomy was beneficial to postoperative recovery. Clinically, it is pointed out that the scar tissue formed by intercostal muscle flesh injury after lobectomy is irreversible and will cause permanent respiratory muscle injury [16], while the greatest advantage of thoracoscopic segmentectomy is that it has its own anatomical theoretical basis and according to the characteristics of dual supply of qi and blood in lung tissue, anatomical resection of one or two segments of the lung is performed independently, and lymph nodes that may metastasize between segments can be treated, and then effectively protect postoperative residual pulmonary function [17,18,19]. This study compared postoperative blood gas levels and pulmonary function-related indicators between the two groups. The results showed that after treatment, PaCO2 in segmentectomy group was lower than that in lobectomy group, PaO2 and OI were higher than those in lobectomy group, while FVC, FEV1 and FEV1/FVC in segmentectomy group had different amplitude changes, and the differences had statistical significance, suggesting that thoracoscopic segmentectomy had better therapeutic effect in protecting postoperative residual pulmonary function. The analysis suggests that thoracoscopic segmentectomy can well relieve the patient ‘s condition may be related to both the minimally invasive advantages of thoracoscopic surgery and the relatively less destruction of lung tissue by this surgery [20]. Thoracoscopic surgery is less invasive and does not cause greater damage to tissues such as ribs and nerves, while segmentectomy requires only attention to the safe distance from the tumor margin during the procedure [21, 22]. Therefore, thoracoscopic segmentectomy can preserve more normal lung tissue while ensuring systematic lymph node dissection, reduce the damage caused by surgery to lung volume, and then shorten the length of lung recruitment, which is helpful for postoperative rehabilitation. Studies have shown that compensatory expansion of the remaining lobe after lobectomy can gradually replace the original resected lobe space, and the expansion of this lobe is uncontrollable and easily squeezes the remaining healthy lobe, resulting in changes in lobar bronchial angle, airway torsion and increased airway resistance, which in turn affects pulmonary ventilation and ventilation function, while segmentectomy only removes part of the lung segment without causing growth expansion and avoiding bronchial angle and airway effects [23,24,25]. Segmentectomy requires the surgeon to have higher operating skills and anatomical knowledge, so this surgeon is more complex than thoracoscopic lobectomy [26]. However, the results of this study showed that there was no significant difference in the incidence rate of total complications between the two groups, and the clinical effective rate of the segmentectomy group was significantly higher than that of the lobectomy group, and the difference was statistically significant, suggesting that the safety of thoracoscopic segmentectomy in early lung cancer with the maximum diameter < 2 cm is equivalent to thoracoscopic lobectomy, which can avoid postoperative complications caused by pulmonary interstitial and alveolar membrane edema caused by contusion, and can achieve better short-term efficacy. The analysis suggests that this may be related to the fact that patients undergoing thoracoscopic segmentectomy must have negative margins and intraoperative lymph node biopsy is clearly negative. It has been proposed that hilar and mediastinal lymph node metastasis rates are high in lung cancer < 2 cm in diameter, and timely dissection is required here to ensure staging accuracy [27]. In this study, the segmentectomy group underwent intersegmental, interlobar, hilar and mediastinal lymph node sampling sent for frozen pathological examination, and routine hilar and mediastinal lymph node dissection, so the surgical results were good.

The study presented in this passage investigates the safety and efficacy of thoracoscopic segmentectomy as a surgical treatment for patients with pulmonary malignant tumors less than 2 cm in diameter, as compared to traditional thoracoscopic lobectomy. The study finds that thoracoscopic segmentectomy has several advantages, including reduced drainage volume and intraoperative blood loss, shorter drainage time and hospital stay, and better preservation of postoperative pulmonary function. The minimally invasive nature of thoracoscopic surgery, combined with the anatomical resection of specific lung segments, allows for the preservation of more normal lung tissue, thus contributing to faster postoperative recovery. Furthermore, the study suggests that thoracoscopic segmentectomy is as safe as thoracoscopic lobectomy in terms of postoperative complications and short-term efficacy.

However, there are limitations to this study. First, the sample size is relatively small, and the study population has a relatively high average age, which may limit the generalizability of the results to a broader range of patients, including younger individuals with different physiological profiles. Second, the study’s short observation period may not provide a complete understanding of the long-term outcomes and potential complications associated with thoracoscopic segmentectomy. Additionally, the study lacks a comprehensive assessment of various postoperative outcomes and might benefit from a more extensive set of outcome measures to thoroughly evaluate the efficacy and safety of the procedure. In conclusion, this study provides valuable insights into the benefits of thoracoscopic segmentectomy for small pulmonary tumors but requires further research with larger and more diverse samples, longer follow-up periods, and a more comprehensive range of outcome measures to validate its findings and generalize the results to a broader patient population.

In summary, thoracoscopic segmentectomy is safe and feasible for patients with pulmonary malignant tumors less than 2 cm in diameter, has little effect on pulmonary function after operation, and can accelerate postoperative rehabilitation, which has important clinical application value. However, there are still shortcomings in this study. First, due to the limitation of disease source, the age of enrolled subjects is relatively high, the physiological function of younger patients is decreased, and the degree of statistical freedom is limited. The study results need to be further verified. Second, due to the limitation of follow-up hospital test items, more indicators failed to be included in the study before and after treatment changes, and the efficacy assessment was not comprehensive enough. In this study, the observation cycle was short and its long-term outcome could not be clarified. Future prospective disease studies with larger parallel sample sizes continue to be followed up to obtain more representative overall study data and thus more generalizable study results.