Outcomes of completion lobectomy long after segmentectomy

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 295min, thoracotomy 339min, p=0.55), intraoperative blood loss volumes (VATS 350mL, thoracotomy 500mL, p=0.84), intervals between initial segmentectomy and completion lobectomy (VATS 40months, thoracotomy 48months, 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.