En bloc upper and lower lobe bisegmentectomy for non-small-cell lung cancer invading the fissure

The optimal surgical procedure for tumors extending deep into the lung parenchyma of the opposite lobe beyond the fissure remains controversial. The current study aimed to examine whether en bloc upper and lower lobe bisegmentectomy can be an option for such tumors.

This study included patients who underwent surgery for cN0 non-small-cell lung cancer invading the adjacent lobe beyond the fissure between the upper and lower lobes. The perioperative and long-term outcomes of the bisegmentectomy and extended lobectomy/pneumonectomy groups were compared.

The bisegmentectomy group included five patients who underwent right S2 + S6 segmentectomy and four patients who underwent left S1 + 2 + S6 segmentectomy. The bisegmentectomy and extended lobectomy/pneumonectomy groups had similar perioperative outcomes. The median surgical duration, volume of blood loss and length of hospital stay of the bisegmentectomy group were 175 min, 79 mL and 5 days, respectively. In the bisegmentectomy group, one patient with a tumor without a ground-glass component on computed tomography scan had brain metastasis and died. The remaining eight patients with tumors with ground-glass components on computed tomography scan were alive without recurrence at a median follow-up of 7.2 years. In the extended lobectomy/pneumonectomy group, all patients experienced recurrence and died at a median follow-up of 3.9 years.

En bloc upper and lower lobe bisegmentectomy can be a safe and feasible option for tumors with a ground-glass component on computed tomography scan in patients with non-small-cell lung cancer invading the adjacent lobe beyond the fissure.