Safety and efficacy of delayed completion lobectomy following wedge resection vs. segmentectomy-a retrospective cohort study

Yimu Wu; Kaiqi Jin; Linlin Qin; Zhaoxun Li; Xiaoxiong Xu; Jie Dai; Xiaogang Liu; Xinnan Xu; Xiao Zhou; Gening Jiang

doi:10.21037/jtd-23-1780

Safety and efficacy of delayed completion lobectomy following wedge resection vs. segmentectomy-a retrospective cohort study

J Thorac Dis. 2024 Apr 30;16(4):2379-2393. doi: 10.21037/jtd-23-1780. Epub 2024 Apr 24.

Authors

Yimu Wu^#¹, Kaiqi Jin^#¹, Linlin Qin^#^{1

2}, Zhaoxun Li¹, Xiaoxiong Xu¹, Jie Dai¹, Xiaogang Liu¹, Xinnan Xu¹, Xiao Zhou¹, Gening Jiang¹

Affiliations

¹ Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
² Department of Thoracic Surgery, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China.

^# Contributed equally.

Abstract

Background: Data regarding the safety and efficacy of delayed completion lobectomy (CL) following sublobar resections remain scant. We evaluated the technical difficulty and short-term outcomes of CL occurring at least 3 months following the anatomical segmentectomy or wedge resection.

Methods: Consecutive non-small cell lung cancer (NSCLC) patients who underwent a second resection within the same lobe at least 3 months after their initial resection from January 2013 to December 2019 at the Shanghai Pulmonary Hospital were retrospectively included. The patients were divided into a segmentectomy group (SG group) and a wedge resection group (WR group) based on their initial resection strategy. Baseline characteristics and short-term outcomes after CL between the two groups were compared.

Results: Twenty-five patients undergoing CL were included, nine in the SG group and 16 in the WR group. No deaths occurred within 30 days postoperatively, and the rate of overall postoperative complications was 28.0% (7/25). Statistically significant differences were found in rates of postoperative complications between the two groups (SG: 55.6% vs. WR: 12.5%, P=0.03) and in the use of bronchoplasty or angioplasty during the CL (SG: 33.3% vs. WR: 0.0%, P=0.04). After CL, no significant differences were found in 5-year recurrence-free survival (RFS) (WR: 66.7% vs. SG: 61.0%, P=0.31) or overall survival (OS) (WR: 93.8% vs. SG: 66.7%, P=0.06) between two groups.

Conclusions: Delayed CL occurring over 3 months after sublobar resection is a safe and effective procedure, with no deaths occurring within 30 days postoperatively. As compared to a segmentectomy at the time of the index operation, a wedge resection may portend less morbidity, with a decreased risk of needing adjunctive bronchoplasty or angioplasty procedures during CL. After CL, 5-year RFS and OS were comparable between WR and SG groups.

Keywords: Completion lobectomy (CL); non-small cell lung cancer (NSCLC); segmentectomy; wedge resection.