Feasibility and safety of secondary video‐assisted thoracoscopic surgery for ipsilateral lung cancer after prior pulmonary resection

Abstract

Background Video‐assisted thoracoscopic surgery (VATS) is the preferred treatment for resectable non‐small cell lung cancer. The increased survival of patients after a first operation has caused increases in the incidence of locoregional recurrence or second primary lung cancer and a concomitant increase in the number of patients who require secondary surgery. Ipsilateral secondary operation is also commonly practiced, albeit with enhanced difficulty. Therefore, it is necessary to evaluate the feasibility and safety of VATS for ipsilateral lung cancer after pulmonary resection. Methods Patients who underwent ipsilateral secondary VATS in the West China Hospital, Sichuan University from 2012 to 2021 were assessed retrospectively. All included patients had a pulmonary resection. Clinical characteristics, perioperative outcomes, and survival data were collected, with an emphasis on conversion to thoracotomy, postoperative complications, 30‐day mortality, and survival. Logistic regression analysis was used to identify predictors of postoperative complications. Results Seventy patients were enrolled, of which 10 (14.3%) had converted thoracotomy, 17 (24.3%) had postoperative complications, and two (2.9%) had grade III complications. No patient died within 30 days after surgery. High Charlson comorbidity index (CCI) and severe pleural adhesion were independent predictors for complications. The median follow‐up was 50 months (range: 3–120), and the 5‐year overall survival was 78.2%. Conclusion Secondary VATS for ipsilateral lung cancer for patients who had pulmonary resection was feasible and safe. Strict preoperative evaluation and careful management of pleural adhesion are crucial for the success of the surgery.

Uniportal Video-Assisted Thoracoscopic Surgery Completion Lobectomy Long after Wedge Resection or Segmentectomy in the Same Lobe: A Bicenter Study

“…Similarly, as in our series, the most common complication of secondary pulmonary resection is shown to be air leakage [26,27]. Conversely, the development of severe hilar adhesion subsequent to a prior segmentectomy underscores the importance of securing the main PA before starting hilar dissection to prevent catastrophic bleeding, especially when it is challenging to expose and divide the PA.…”

“…Recently, several studies have described successful CL procedures, [4,8,[15][16][17][18][19][20][21][22][23][24][25][26][27] without increasing postoperative complications [17,18]. However, only a few studies, which evaluated a small number of patients or isolated case reports, have explored the role of VATS reoperations [4,8,[19][20][21].…”

A Retrospective Analysis Comparing VATS Cost Discrepancies and Outcomes in Primary Lung Cancer vs. Second Primary Lung Cancer Patients

“…Other authors demonstrated that secondary VATS was both feasible and safe for patients who had previously undergone pulmonary resection. The median duration for secondary surgery was 120 min, and the median blood loss was 50 mL [ 44 ]. Nevertheless, several complications and observations were found in patients with a secondary intervention for lung cancer using VATS.…”