Extended minimally invasive lung resections: VATS bilobectomy, bronchoplasty, and pneumonectomy

The aim of the present study was to analyze feasibility, morbidity, mortality, and oncologic outcome of extended video-assisted thoracoscopic surgery (VATS) anatomic lung resections in a single-center experience. Extended resections include bilobectomies, bronchoplasties, and pneumonectomies.

The present study is a retrospective analysis of a prospectively maintained institutional database. Between 2009 and 2014, 390 patients were scheduled for anatomical VATS resections. VATS resection was completed in 370 patients giving an overall conversion rate of 5.1 %. Extended VATS resections were performed in 29 patients (7.8 %): bilobectomy in 8, bronchoplastic resection in 15 (2 bronchial sleeve resections, 11 wedge bronchoplasties, 2 simple bronchoplasties), and pneumonectomy in 6.

Median operative time was 217 min (117-390 min). Median chest tube duration was 4 days (range, 2-50 days). Median length of hospital stay was 9 days (6-63 days). There was no in-hospital mortality. Major complications with need for reinterventions occurred in three patients (10.3 %): one air leakage from bronchial stump after pneumonectomy, one hematothorax after completion pneumonectomy, and one chylothorax. All complications were treated with VATS procedures. Minor complications included two persistent air leaks that were treated with an additional chest drain and resolved, one urinary tract infection, one atelectasis with need for bronchoscopy, and one pleural fluid collection with the need for drainage. After a median follow-up of 26 months, no local tumor recurrence occurred. Two patients had a second lung primary cancer and four patients with advanced tumor stages had distant recurrent disease.

With growing experience, extended VATS resections are feasible in selected cases with low perioperative morbidity and mortality.