Outcomes of completion lobectomy long after segmentectomy

Abstract

Background Completion lobectomy long after segmentectomy in the same lobe is extremely difficult because of severe adhesions around hilar structures, especially in cases involving video-assisted thoracoscopic surgery (VATS) completion lobectomy. We report and compare the surgical outcomes of patients who underwent VATS or thoracotomy completion lobectomy long after radical segmentectomy for lung cancer. Methods We retrospectively evaluated the surgical outcomes of completion lobectomies performed at our institute long after radical segmentectomies for lung cancer in the same lobe. The efficacy and safety of VATS completion lobectomy was compared to that of thoracotomy completion lobectomy. Results Ten of 228 patients who underwent radical segmentectomy for lung cancer between 2009 and 2018 underwent completion lobectomy at least a month after segmentectomy; five patients underwent VATS completion lobectomy. None of the patients underwent VATS left upper completion lobectomy, and conversion to thoracotomy was required in one patient. There were no significant differences between VATS and thoracotomy completion lobectomies in the median operative times (VATS 295 min, thoracotomy 339 min, p = 0.55), intraoperative blood loss volumes (VATS 350 mL, thoracotomy 500 mL, p = 0.84), intervals between initial segmentectomy and completion lobectomy (VATS 40 months, thoracotomy 48 months, p = 0.55), and number of patients with pulmonary artery injury (VATS 1, thoracotomy 2, p = 0.49). There was no operation-related mortality. Conclusions VATS completion lobectomy long after segmentectomy for lung cancer could be performed without fatal complications unless severe adhesions are observed around each main pulmonary artery.

Four cases of completion lobectomy for locally relapsed lung cancer after segmentectomy

“…In their summary of 10 completion lobectomies (six completion upper lobectomies and four completion lower lobectomies), Takahashi et al reported that there were tight hilar adhesions in only one out of four completion lower lobectomies (25%). This was in contrast to the presence of hilar adhesions in all six completion upper lobectomies [5].…”

“…Although they did not provide details regarding the patients and respective perioperative data, 5 of their 11 patients underwent completion lobectomy after segmentectomy due to the appearance of malignancy. Takahashi et al reported 10 patients (7 primary lung cancer, 3 metastatic lung cancer) who underwent completion lobectomy due to the appearance of malignancy (4 local recurrence, 6 new malignancy) [5]. They reported a patient who underwent completion lower lobectomy after superior segmentectomy, where there was no tight hilar adhesion, and showed that it can be performed without intraoperative vessel injury, as in our 3 patients who underwent completion lower lobectomy after superior segmentectomy.…”

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

“…In one of our patients who underwent completion right upper lobectomy after apical segmentectomy and superior mediastinal nodal dissection, we injured the superior pulmonary vein inadvertently due to the hilar adhesions. Takahashi et al reported that pulmonary artery injury occurred in two of ve (40%) completion lobectomies after upper lobe segmentectomy and superior mediastinal nodal dissection [5]. Table 1 summarizes previously reported cases of completion lobectomy after segmentectomy for pulmonary malignancy [4,5].…”

“…Takahashi et al reported that pulmonary artery injury occurred in two of ve (40%) completion lobectomies after upper lobe segmentectomy and superior mediastinal nodal dissection [5]. Table 1 summarizes previously reported cases of completion lobectomy after segmentectomy for pulmonary malignancy [4,5]. We excluded reports of completion lobectomy after wedge resection [6] or after segmentectomy due to a short surgical margin [7] or unanticipated lymph node metastasis [8].…”

“…Some studies have shown a local recurrence rate of 4.9 to 5.5% after segmentectomy in patients with stage IA NSCLC [1][2][3]. Although completion lobectomy is the treatment of choice for staple line recurrence of NSCLC after segmentectomy, few cases have been reported [4,5]. We report four patients who underwent completion lobectomy for local relapsed NSCLC after segmentectomy and discuss the differences in technical di culties among them.…”