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

Abstract

Background Completion lobectomy (CL) after anatomical segmentectomy is technically challenging and rarely performed. Here, we aimed to report perioperative outcomes of a single center real‐world CL data. Methods Seven patients who underwent CL after segmentectomy were retrospectively evaluated between 2015–2021. Additionally, 34 patients were included in the review based on relevant studies in the literature until March 2022. A total of 41 patients were finally analyzed and classified into groups, according to surgical approach (video‐assisted thoracic surgery [VATS] and thoracotomy; 12 and 29 patients, respectively) or interval‐to‐CL following initial segmentectomy (≤8 weeks [short] and >8 weeks [long]; 11 and 30 patients, respectively). Results There were no significant differences in estimated blood loss, postoperative hospital stay, or complications between the predefined groups. However, a longer operative time was observed in the long interval‐to‐CL group than in the short interval‐to‐CL group (267 vs. 226 min, p = 0.02). The rate of severe hilar adhesions was higher in the thoracotomy versus VATS groups (72 vs. 42%, p = 0.06) and in the long versus short interval‐to‐CL groups (70 vs. 45%, p = 0.15). On multivariable logistic regression analysis of a subgroup ( n = 30), completion lobectomy of upper lobes may be associated with severe hilar adhesions ( p = 0.02, odds ratio: 13.98; 95% confidence interval [CI]: 1.36–143.71). Conclusion Completion lobectomy after segmentectomy can be performed securely by either VATS or thoracotomy. Although the thoracotomy and long interval‐to‐CL groups retained a greater percentage of severe hilar adhesions, the perioperative outcomes were similar to those of VATS and short interval‐to‐CL groups, respectively.

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

“…In this study, 10 patients (14.3%) had converted thoracotomy in secondary surgery, which was better compared with the 20% previously reported. [8][9][10][11] In addition, the postoperative complication rate in this study was lower compared with previous studies, such as 29% reported by Hamaji et al, 12 34.3% in a study by Yang et al, 13 and 36.5% reported by Abid et al 14 The most common complication of secondary pulmonary resection was air leakage, which agreed with the findings of Sun et al 6 The main cause of air leakage was intraoperative adhesion. At present, there is no uniform standard for the evaluation of pleural adhesion.…”

“…In this study, 10 patients (14.3%) had converted thoracotomy in secondary surgery, which was better compared with the 20% previously reported. 8 , 9 , 10 , 11 In addition, the postoperative complication rate in this study was lower compared with previous studies, such as 29% reported by Hamaji et al, 12 34.3% in a study by Yang et al, 13 and 36.5% reported by Abid et al 14 …”

Outcomes of Completion Lobectomy for Locoregional Recurrence after Sublobar Resection in Patients with Non-small Cell Lung Cancer

“…To the best of our knowledge, this study included the largest number of patients who underwent CL for locoregional recurrences after sublobar resection [ 12 , 13 , 15 ]. Previous studies on CL included patients who underwent surgery not only for recurrence, but also for other reasons, such as complications, and included fewer than 10 patients.…”

“…CL is a potential surgical option for locoregional recurrence. However, performing CL after sublobar resection in the same lobe or hemithorax may be complicated by severe adhesions around the hilar structures, especially the pulmonary artery [ 12 , 13 ]. Only a few studies, which included a low number of patients, have reported the outcomes of CL after locoregional recurrence [ 9 , 12 - 15 ].…”

“…However, performing CL after sublobar resection in the same lobe or hemithorax may be complicated by severe adhesions around the hilar structures, especially the pulmonary artery [ 12 , 13 ]. Only a few studies, which included a low number of patients, have reported the outcomes of CL after locoregional recurrence [ 9 , 12 - 15 ]. Therefore, the purpose of this study was to determine the surgical and oncologic outcomes of CL in patients with locoregionally recurrent stage I NSCLC.…”