Completion lobectomy after thoracoscopic segmentectomy on the left side should be approached with thoracotomy

Lung segmentectomy is widely used to treat early-stage non-small cell lung cancer (NSCLC), but the risk of local recurrence in the ipsilateral lobe is increased and the surgical treatment of the local recurrence could be a real challenge. The aim of this study is to report our experience in a consecutive series of patients undergoing completion lobectomy (CL) after thoracoscopic segmentectomy.

We retrospectively reviewed all the medical charts of the patients who underwent thoracoscopic segmentectomy for early-stage NSCLC (cIA) between January 2015 and December 2023, focusing on patients who had NSCLC recurrence in the ipsilateral lobe treated with CL.

Among the 263 segmentectomies performed, 13 patients (4.9%) experienced local recurrence in the ipsilateral remaining lobe, of whom 9 (3.4%) underwent CL, including 5 in the left upper lobe, with a median interval of 31 months between procedures. All patients underwent CL through thoracotomy with the need of central isolation in 5/9 (55.5%); rupture of the pulmonary artery occurred two patients and vascular sleeve resection was necessary in one. No postoperative deaths were observed, complications occurred in 5/9 patients with major complications, defined as Clavien-Dindo grade >3b, in 2/9 (22.2%) patients. Median hospital stay was 11 days. At the end of follow-up 2 patients had distant recurrence 12 median months after the CL.

CL in the left side could be considered a challenging procedure also after minimally invasive segmentectomy and we consider safe to perform CL with thoracotomy due to a scar tissue formation between the bronco-vascular structures leading the need for extensive hilar dissection and central isolation of the pulmonary artery.