Completion lobectomy after radical segmentectomy for pulmonary malignancies. (June 2016)

• Record Type: Journal Article
• Authors: Omasa, Mitsugu; Date, Hiroshi; Takamochi, Kazuya; Suzuki, Kenji; Miyata, Yoshihiro; Okada, Morihito
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 24:Number 5(2016)
• Page Start: 450
• Page End: 454
• Publication Date: 2016-06
• Subjects: Lung neoplasms -- Neoplasms -- second primary -- Pneumonectomy -- Postoperative complications -- Reoperation -- Tissue adhesions; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492316648863
• Languages: English
• ISSNs: 0218-4923

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.