Surgical outcomes of completion lobectomy after primary segmentectomy.

Abstract

Purpose: We investigated the surgical outcomes of completion lobectomy after primary segmentectomy for lung malignancies.

Methods: A review of 1139 patients who underwent pulmonary segmentectomy for lung malignancies, identified 17 (1.5%) who underwent completion lobectomy. We analyzed the clinicopathological outcomes of completion lobectomy in these 17 patients, statistically, and evaluated the degree of surgical difficulty, using logistic regression models.

Results: The primary segmentectomy was performed on the right-side in six patients, centrally in seven, in the upper lobe in nine, and as a complex segmentectomy in ten. Lung cancer was diagnosed in 13 patients. Completion lobectomy required an intrapericardial procedure in five patients, main pulmonary artery (PA) clamping in seven, bronchial plasty in five, and PA-plasty in five. The mean operative time was 219 min, and the mean blood loss was 193 ml. Cut-end recurrence was confirmed in nine (56%) patients, and Grade III or higher morbidity occurred in six patients (38%) with no short-term mortality. Logistic regression analysis revealed that upper lobe completion lobectomy was a significant predictor of surgical difficulty (OR 23.8, 95%CI 1.742-333.3, p = 0.018).

Conclusion: Completion lobectomy is technically challenging, especially in the upper lobe, but the oncological and surgical results are acceptable. This procedure is a promising and important strategy for treating secondary lesions in the residual lobe after segmentectomy.