Mitsugu Omasa1, Hiroshi Date2, Kazuya Takamochi3, Kenji Suzuki3, Yoshihiro Miyata4, Morihito Okada4. 1. Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan omasa@kuhp.kyoto-u.ac.jp. 2. Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 3. Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan. 4. Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Abstract
OBJECTIVE: Completion lobectomy after radical segmentectomy is relatively rare, with no systematic evaluation of this challenging procedure. We aimed to clarify the details of this operation performed in 3 Japanese institutions. METHODS: Completion lobectomy after segmentectomy in the same lobe was performed in 11 patients (9 lung cancers and 2 metastatic lung tumors) between 2007 and 2013. Surgical outcomes were analyzed retrospectively. RESULTS: The 11 patients accounted for 1.37% of the 805 segmentectomies performed in the 3 institutions. The reasons for completion lobectomy were postoperative complications in the remaining lobe (n = 3), positive pathological lymph node metastasis found by permanent section (n = 3), and malignancy in the remaining lobe (n = 5). The patients were divided into two groups according the interval between segmentectomy and completion lobectomy: group A (3-35 days, n = 5) and group B (56-1470 days, n = 6). There was a tendency for more severe adhesions around the hilum (p = 0.061) in group B, resulting in increased operative bleeding (p = 0.055), more usage of fibrin glue (p = 0.080), and significantly longer operative time (p = 0.036). Injury to the pulmonary arteries was experienced only in group B (3/6 cases). There was no operation-related mortality. CONCLUSIONS: Completion lobectomy may become more difficult approximately 5 weeks after segmentectomy, due to severe adhesions, but it can be performed safely with careful manipulation.
OBJECTIVE: Completion lobectomy after radical segmentectomy is relatively rare, with no systematic evaluation of this challenging procedure. We aimed to clarify the details of this operation performed in 3 Japanese institutions. METHODS: Completion lobectomy after segmentectomy in the same lobe was performed in 11 patients (9 lung cancers and 2 metastatic lung tumors) between 2007 and 2013. Surgical outcomes were analyzed retrospectively. RESULTS: The 11 patients accounted for 1.37% of the 805 segmentectomies performed in the 3 institutions. The reasons for completion lobectomy were postoperative complications in the remaining lobe (n = 3), positive pathological lymph node metastasis found by permanent section (n = 3), and malignancy in the remaining lobe (n = 5). The patients were divided into two groups according the interval between segmentectomy and completion lobectomy: group A (3-35 days, n = 5) and group B (56-1470 days, n = 6). There was a tendency for more severe adhesions around the hilum (p = 0.061) in group B, resulting in increased operative bleeding (p = 0.055), more usage of fibrin glue (p = 0.080), and significantly longer operative time (p = 0.036). Injury to the pulmonary arteries was experienced only in group B (3/6 cases). There was no operation-related mortality. CONCLUSIONS: Completion lobectomy may become more difficult approximately 5 weeks after segmentectomy, due to severe adhesions, but it can be performed safely with careful manipulation.
Authors: Waseem Lutfi; Matthew J Schuchert; Rajeev Dhupar; Chigozirim Ekeke; Inderpal S Sarkaria; Neil A Christie; James D Luketich; Olugbenga T Okusanya Journal: Clin Lung Cancer Date: 2019-04-01 Impact factor: 4.785