Outcomes of completion lobectomy long after segmentectomy

Yuki Takahashi,Ryunosuke Maki,Masahiro Miyajima,Atsushi Watanabe,Taijiro Mishina,Makoto Tada

doi:10.1186/s13019-019-0941-8

Abstract

BackgroundCompletion 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.MethodsWe 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.ResultsTen 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.ConclusionsVATS completion lobectomy long after segmentectomy for lung cancer could be performed without fatal complications unless severe adhesions are observed around each main pulmonary artery.

Highlights

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
Data on surgical outcomes of each patient who underwent VATS or thoracotomy Completion lobectomy (CL) at least a month after radical segmentectomy for lung cancer are shown in Table 2 and Table 3
The present study shows that the surgical outcomes of VATS CL and thoracotomy CL were not significantly different

Summary

Introduction

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. Completion lobectomy (CL) involves resection of the remaining pulmonary lobe after wedge resection or segmentectomy. CL long after segmentectomy in the same lobe could be complicated by severe adhesions around hilar structures, especially the pulmonary artery. The number of radical and anatomical pulmonary segmentectomies performed in cases of early lung cancers with peripherally located small-sized tumors has recently been increasing in Japan [5, 6]. CL is considered in cases involving local recurrence and/or a second primary lung cancer and/or metastatic lung cancer after lung cancer segmentectomy

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Discussion

Conclusion