Four Cases of Completion Lobectomy for Locally Relapsed Lung Cancer after Segmentectomy

Abstract

Background: Although completion lobectomy is the treatment of choice for local recurrence of non-small cell lung cancer after segmentectomy, few cases have been reported. We report four patients who underwent completion lobectomies for staple line recurrence after segmentectomy for stage I non-small cell lung cancer. Case presentation: Three women aged 65, 82, and 81 years underwent completion lower lobectomy after superior segmentectomy of the same lobe for local recurrence of stage I non-small cell lung cancer. A 67-year-old man, who had a tumor recurrence on the staple line after apical segmentectomy with superior mediastinal nodal dissection for stage I non-small cell lung cancer, underwent completion right upper lobectomy. These four patients underwent segmentectomy because of comorbidities or advanced age. Local recurrence was confirmed by computed tomography-guided needle biopsy. The interval between the two operations was 37, 39, 41, and 16 months, respectively. Although minimal hilar adhesion was seen for the three completion lower lobectomies, tight adhesions after apical segmentectomy made completion right upper lobectomy quite difficult to dissect, which led to injury of the superior pulmonary vein. No recurrence was recorded after completion lobectomies for 62, 70, 67, and 72 months, respectively.Conclusions: Although completion lobectomy is one of the most difficult modes of resection, among several completion lobectomies, completion lower lobectomy after superior segmentectomy without superior mediastinal nodal dissection was relatively easy to perform because of fewer hilar adhesions.

Pulmonary completion lobectomy after segmentectomy: An integrated analysis of perioperative outcomes

“…Notably, despite the fact that it is often recommended to open the pericardium and secure the main PA to prevent catastrophic bleeding when it is difficult to expose and divide the PA due to adhesion in the hilum, only 29% (12/41 patients) received PA taping during the CL. As previous studies have reported, completion upper lobectomy is technically tougher than completion lower lobectomy because of anatomical features, presence of adhesions around the main PA at the hilum, and effect of previous superior mediastinal nodal dissection 7 . In terms of technical issues, some authors have addressed the use of simultaneous division of the PA and lung parenchyma with a stapler to manage tight adhesions 8,9 .…”

“…15 Only a handful of studies have reported the surgical outcomes of CL after segmentectomy. [5][6][7][8][9][10] Completion lobectomy after segmentectomy has been associated with rare adverse circumstances, including complications or local recurrences in the remaining lobe, as well as unexpected nodal involvement, which was first proposed by Omasa et al 5 In the current study, we used a similar classification for the included 41 patients. A greater percentage of complications (64%) occurred in the short interval-to-CL group, while a higher rate of local recurrence (93%) occurred in the long interval-to-CL group.…”

“…As previous studies have reported, completion upper lobectomy is technically tougher than completion lower lobectomy because of anatomical features, presence of adhesions around the main PA at the hilum, and effect of previous superior mediastinal nodal dissection. 7 In terms of technical issues, some authors have addressed the use of simultaneous division of the PA and lung parenchyma with a stapler to manage tight adhesions. 8,9 Simultaneous stapling of the bronchus and PA is generally not preferred because of the risk of staple line bursts, bronchopleural fistula, and massive bleeding; however, no adverse events resulting from simultaneous stapling have been reported in the literature.…”

“…Among the wide array of reoperation options, completion lobectomy (CL) after segmentectomy in the same lobe is particularly difficult because of dense adhesions that are generated from hilar dissections and destroyed hilar structures. So far, few studies have reported surgical outcomes on CL after segmentectomy 5–10 . However, it is unknown whether this challenging procedure affects patient safety and recovery.…”

“…So far, few studies have reported surgical outcomes on CL after segmentectomy. [5][6][7][8][9][10] However, it is unknown whether this challenging procedure affects patient safety and recovery. In this study, we aimed to retrospectively investigate the single-institutional experience of patients undergoing CL after VATS segmentectomy.…”