|
1
|
Meacci E, Refai M, Nachira D, Salati M, Kuzmych K, Tabacco D, Zanfrini E, Calabrese G, Napolitano AG, Congedo MT, Chiappetta M, Petracca-Ciavarella L, Sassorossi C, Andolfi M, Xiumè F, Tiberi M, Guiducci GM, Vita ML, Roncon A, Nanto AC, Margaritora S. Uniportal Video-Assisted Thoracoscopic Surgery Completion Lobectomy Long after Wedge Resection or Segmentectomy in the Same Lobe: A Bicenter Study. Cancers (Basel) 2024; 16:1286. [PMID: 38610964 PMCID: PMC11011079 DOI: 10.3390/cancers16071286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Completion lobectomy (CL) following a prior resection in the same lobe may be complicated by severe pleural or hilar adhesions. The role of uniportal video-assisted thoracoscopic surgery (U-VATS) has never been evaluated in this setting. METHODS Data were collected from two Italian centers. Between 2015 and 2022, 122 patients (60 men and 62 women, median age 67.7 ± 8.913) underwent U-VATS CL at least 4 weeks after previous lung surgery. RESULTS Twenty-eight (22.9%) patients were affected by chronic obstructive pulmonary disease (COPD) and twenty-five (20.4%) were active smokers. Among the cohort, the initial surgery was performed using U-VATS in 103 (84.4%) patients, triportal-VATS in 8 (6.6%), and thoracotomy in 11 (9.0%). Anatomical segmentectomy was the initial surgery in 46 (37.7%) patients, while hilar lymphadenectomy was performed in 16 (13.1%) cases. CL was performed on 110 (90.2%) patients, segmentectomy on 10 (8.2%), and completion pneumonectomy on 2 (1.6%). Upon reoperation, moderate pleural adhesions were observed in 38 (31.1%) patients, with 2 (1.6%) exhibiting strong adhesions. Moderate hilar adhesions were found in 18 (14.8%) patients and strong adhesions in 11 (9.0%). The median operative time was 203.93 ± 74.4 min. In four (3.3%) patients, PA taping was performed. One patient experienced intraoperative bleeding that did not require conversion to thoracotomy. Conversion to thoracotomy was necessary in three (2.5%) patients. The median postoperative drainage stay and postoperative hospital stay were 5.67 ± 4.44 and 5.52 ± 2.66 days, respectively. Postoperative complications occurred in 34 (27.9%) patients. Thirty-day mortality was null. Histology was the only factor found to negatively influence intraoperative outcomes (p = 0.000). Factors identified as negatively impacting postoperative outcomes at univariate analyses were male sex (p = 0.003), age > 60 years (p = 0.003), COPD (p = 0.014), previous thoracotomy (p = 0.000), previous S2 segmentectomy (p = 0.001), previous S8 segmentectomy (p = 0.008), and interval between operations > 5 weeks (p= 0.005). In multivariate analysis, only COPD confirmed its role as an independent risk factor for postoperative complications (HR: 5.12, 95% CI (1.07-24.50), p = 0.04). CONCLUSIONS U-VATS CL seems feasible and safe after wedge resection and anatomical segmentectomy.
Collapse
Affiliation(s)
- Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| | - Majed Refai
- Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy; (M.R.); (M.S.); (M.A.); (F.X.); (M.T.); (G.M.G.); (A.R.); (A.C.N.)
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| | - Michele Salati
- Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy; (M.R.); (M.S.); (M.A.); (F.X.); (M.T.); (G.M.G.); (A.R.); (A.C.N.)
| | - Khrystyna Kuzmych
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| | - Diomira Tabacco
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| | - Edoardo Zanfrini
- Service of Thoracic Surgery, University Hospital of Lausanne, 1005 Lausanne, Switzerland;
| | - Giuseppe Calabrese
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| | - Antonio Giulio Napolitano
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| | - Marco Chiappetta
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| | - Leonardo Petracca-Ciavarella
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| | - Carolina Sassorossi
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| | - Marco Andolfi
- Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy; (M.R.); (M.S.); (M.A.); (F.X.); (M.T.); (G.M.G.); (A.R.); (A.C.N.)
| | - Francesco Xiumè
- Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy; (M.R.); (M.S.); (M.A.); (F.X.); (M.T.); (G.M.G.); (A.R.); (A.C.N.)
| | - Michela Tiberi
- Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy; (M.R.); (M.S.); (M.A.); (F.X.); (M.T.); (G.M.G.); (A.R.); (A.C.N.)
| | - Gian Marco Guiducci
- Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy; (M.R.); (M.S.); (M.A.); (F.X.); (M.T.); (G.M.G.); (A.R.); (A.C.N.)
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| | - Alberto Roncon
- Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy; (M.R.); (M.S.); (M.A.); (F.X.); (M.T.); (G.M.G.); (A.R.); (A.C.N.)
| | - Anna Chiara Nanto
- Department of Thoracic Surgery, Ospedali Riuniti, 60126 Ancona, Italy; (M.R.); (M.S.); (M.A.); (F.X.); (M.T.); (G.M.G.); (A.R.); (A.C.N.)
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy; (K.K.); (D.T.); (G.C.); (A.G.N.); (M.T.C.); (M.C.); (L.P.-C.); (C.S.); (M.L.V.); (S.M.)
| |
Collapse
|
|
2
|
Piccoli J, Seitlinger J, Streit A, Wollbrett C, Siat J, Renaud S. Place of robotic surgery in completion lobectomy after anatomical segmentectomy. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad137. [PMID: 37572306 PMCID: PMC10663049 DOI: 10.1093/icvts/ivad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/11/2023] [Accepted: 08/11/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES Although segmentectomy is steadily increasing in early-stage non-small-cell lung cancer, recurrence in the ipsilateral lobe is also increasing. Completion lobectomy (CL) is a challenging procedure that has already been described in a few studies using video-assisted thoracic surgery or thoracotomy. In this study, we aimed to show the feasibility and safety of robot-assisted thoracic surgery in cases of CL. METHODS Among 2073 major resections performed between January 2018 and september 2022 in the Department of Thoracic Surgery at Nancy University Regional Hospital, we retrospectively included patients who underwent CL by robot-assisted thoracic surgery after previous segmentectomy for non-small-cell lung cancer. Data and perioperative results were described and analysed. RESULTS Seventeen patients underwent CL with a median recurrence time after previous segmentectomy of 18 months [interquartile range (IQR): 12]. Four patients (23.5%) had a pulmonary artery injury that was controlled, and no conversion to open thoracotomy was needed. The operative time was 150 min (IQR: 20), and blood loss was 300 ml (IQR: 150). The median postoperative chest tube duration was 2 days (IQR: 1), and the length of hospital stay was 3 days (IQR: 3), with no postoperative deaths. CONCLUSIONS Completion lobectomy is a challenging procedure due to severe adhesions surrounding vessels, which potentially could cause higher rate of PA bleeding than conventional surgeries. With experienced team and surgeons, CL with robotic surgery may be reported as a safe and feasible procedure.
Collapse
Affiliation(s)
- Juliette Piccoli
- Department of Cardiac Surgery, Nancy Regional University Hospital, Institut Lorrain du Cœur et des Vaisseaux. Rue du Morvan, Vandœuvre-lès-Nancy, France
| | - Joseph Seitlinger
- Department of Thoracic Surgery, Nancy Regional University Hospital, Institut Lorrain du Cœur et des Vaisseaux. Rue du Morvan, Vandœuvre-lès-Nancy, France
| | - Arthur Streit
- Department of Thoracic Surgery, Nancy Regional University Hospital, Institut Lorrain du Cœur et des Vaisseaux. Rue du Morvan, Vandœuvre-lès-Nancy, France
| | - Christophe Wollbrett
- Department of Thoracic Surgery, Nancy Regional University Hospital, Institut Lorrain du Cœur et des Vaisseaux. Rue du Morvan, Vandœuvre-lès-Nancy, France
| | - Joelle Siat
- Department of Thoracic Surgery, Nancy Regional University Hospital, Institut Lorrain du Cœur et des Vaisseaux. Rue du Morvan, Vandœuvre-lès-Nancy, France
| | - Stéphane Renaud
- Department of Thoracic Surgery, Nancy Regional University Hospital, Institut Lorrain du Cœur et des Vaisseaux. Rue du Morvan, Vandœuvre-lès-Nancy, France
| |
Collapse
|
|
3
|
Liu YW, Kao CN, Chiang HH, Lee JY, Li HP, Chang PC, Chou SH. Pulmonary completion lobectomy after segmentectomy: An integrated analysis of perioperative outcomes. Thorac Cancer 2022; 13:2331-2339. [PMID: 35790895 PMCID: PMC9376176 DOI: 10.1111/1759-7714.14565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background Completion lobectomy (CL) after anatomical segmentectomy is technically challenging and rarely performed. Here, we aimed to report perioperative outcomes of a single center real‐world CL data. Methods Seven patients who underwent CL after segmentectomy were retrospectively evaluated between 2015–2021. Additionally, 34 patients were included in the review based on relevant studies in the literature until March 2022. A total of 41 patients were finally analyzed and classified into groups, according to surgical approach (video‐assisted thoracic surgery [VATS] and thoracotomy; 12 and 29 patients, respectively) or interval‐to‐CL following initial segmentectomy (≤8 weeks [short] and >8 weeks [long]; 11 and 30 patients, respectively). Results There were no significant differences in estimated blood loss, postoperative hospital stay, or complications between the predefined groups. However, a longer operative time was observed in the long interval‐to‐CL group than in the short interval‐to‐CL group (267 vs. 226 min, p = 0.02). The rate of severe hilar adhesions was higher in the thoracotomy versus VATS groups (72 vs. 42%, p = 0.06) and in the long versus short interval‐to‐CL groups (70 vs. 45%, p = 0.15). On multivariable logistic regression analysis of a subgroup (n = 30), completion lobectomy of upper lobes may be associated with severe hilar adhesions (p = 0.02, odds ratio: 13.98; 95% confidence interval [CI]: 1.36–143.71). Conclusion Completion lobectomy after segmentectomy can be performed securely by either VATS or thoracotomy. Although the thoracotomy and long interval‐to‐CL groups retained a greater percentage of severe hilar adhesions, the perioperative outcomes were similar to those of VATS and short interval‐to‐CL groups, respectively.
Collapse
Affiliation(s)
- Yu-Wei Liu
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, National Health Research Institutes, Kaohsiung, Taiwan
| | - Chieh-Ni Kao
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Hsing Chiang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, National Health Research Institutes, Kaohsiung, Taiwan
| | - Jui-Ying Lee
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsien-Pin Li
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
|
4
|
Suzuki S, Asakura K, Masai K, Kaseda K, Hishida T, Asamura H. Four cases of completion lobectomy for locally relapsed lung cancer after segmentectomy. World J Surg Oncol 2021; 19:47. [PMID: 33573659 PMCID: PMC7879527 DOI: 10.1186/s12957-021-02165-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although completion lobectomy is the treatment of choice for local recurrence of non-small cell lung cancer after segmentectomy, few cases have been reported. We report four patients who underwent completion lobectomies for staple line recurrence after segmentectomy for stage I non-small cell lung cancer. Case presentation Three women aged 65, 82, and 81 years underwent completion lower lobectomy after superior segmentectomy of the same lobe for local recurrence of stage I non-small cell lung cancer. A 67-year-old man, who had a tumor recurrence on the staple line after apical segmentectomy with superior mediastinal nodal dissection for stage I non-small cell lung cancer, underwent completion right upper lobectomy. These four patients underwent segmentectomy because of comorbidities or advanced age. Local recurrence was confirmed by computed tomography-guided needle biopsy. The interval between the two operations was 37, 39, 41, and 16 months, respectively. Although minimal hilar adhesion was seen for the three completion lower lobectomies, tight adhesions after apical segmentectomy made completion right upper lobectomy quite difficult to dissect, which led to injury of the superior pulmonary vein. No recurrence was recorded after completion lobectomies for 62, 70, 67, and 72 months, respectively. Conclusions Although completion lobectomy is one of the most difficult modes of resection, among several completion lobectomies, completion lower lobectomy after superior segmentectomy without superior mediastinal nodal dissection was relatively easy to perform because of fewer hilar adhesions. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02165-x.
Collapse
Affiliation(s)
- Shigeki Suzuki
- Division of Thoracic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Keisuke Asakura
- Division of Thoracic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kyohei Masai
- Division of Thoracic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kaoru Kaseda
- Division of Thoracic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|