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

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Lung segmentectomy is a common treatment for early-stage non-small cell lung cancer (NSCLC).
• Local recurrence in the ipsilateral lobe after segmentectomy presents significant surgical challenges.
• Completion lobectomy (CL) is an option for managing such recurrences.

Purpose of the Study:

• To report the experience and outcomes of patients undergoing completion lobectomy (CL) after thoracoscopic segmentectomy for early-stage NSCLC recurrence.
• To evaluate the safety and feasibility of CL in this specific patient cohort.

Main Methods:

• Retrospective review of medical charts of patients who underwent thoracoscopic segmentectomy for early-stage NSCLC between January 2015 and December 2023.
• Focus on patients who experienced ipsilateral local recurrence and were treated with CL.
• Analysis of surgical approach, complications, and outcomes.

Main Results:

• Out of 263 segmentectomies, 13 patients (4.9%) had local recurrence, with 9 (3.4%) undergoing CL.
• CL was performed via thoracotomy, requiring central isolation in 55.5% of cases.
• No postoperative deaths occurred; 22.2% experienced major complications (Clavien-Dindo grade >3b).

Conclusions:

• Completion lobectomy, particularly on the left side, is a challenging procedure following minimally invasive segmentectomy.
• Thoracotomy is considered a safe approach for CL due to potential scar tissue and the need for extensive hilar dissection.
• CL can be safely performed, with manageable complication rates, for recurrent NSCLC after segmentectomy.