Completion lobectomy after anatomical segmentectomy for thoracic malignancy

Completion lobectomy after segmentectomy is technically challenging because of dense hilar adhesions and altered anatomy. We evaluated perioperative outcomes and factors associated with extensive hilar adhesions.

We retrospectively reviewed 21 patients who underwent completion lobectomy after anatomical segmentectomy between April 2010 and March 2026. Hilar adhesions were classified as limited or extensive according to the technical difficulty of hilar dissection. Perioperative factors were compared between the two groups.

Extensive hilar adhesions were encountered in 16 patients (76.2%). Pulmonary artery taping was performed in five (23.8%), vascular injury occurred in six (28.6%), and postoperative complications occurred in five (23.8%), with no 30- or 90-day mortality at completion lobectomy. At initial segmentectomy, ND2 lymph node dissection (100% vs. 40.0%, p = 0.008), fibrin glue use around the hilum (62.5% vs. 0%, p = 0.035), and polyglycolic acid sheet coverage (56.3% vs. 0%, p = 0.045) were more frequent in the extensive adhesion group. The interval between operations (median, 39.2 vs. 6.0 months, p = 0.011) and operative time at completion lobectomy (251 vs. 150 min, p = 0.018) were significantly longer in the extensive adhesion group.

Completion lobectomy after anatomical segmentectomy is technically demanding but can be performed safely with meticulous hilar dissection and appropriate vascular control. ND2 lymph node dissection, fibrin glue or PGA sheet use around the hilum, and a longer interval between operations may help anticipate technical difficulty and guide surgical planning.