Agathe Seguin-Givelet, Jon Lutz, Madalina Grigoroiu, Emmanuel Brian, Dominique Gossot
Institution : Département thoracique, institut mutualiste Montsouris, Paris
Objectives : Thoracoscopic sublobar anatomical resections (TSLR) are gaining popularity, but are still considered challenging. However, despite technical difficulties, the reported rate of adverse events, complications and unplanned procedures is low. In order to understand this paradox, we have studied our series of TSLRaccording to an intention-to-treat analysis
Methods : From January 2007 to July 2016, 284 thoracoscopic anatomical segmentectomies have been performed in 280 patients. There were 124 males and 156 females with a mean age of 64 (range: 18-86). Indication for segmentectomy was a proven or suspected non-small cell lung carcinoma (NSCLC) in 184, suspected metastasis in 51 and benign lesion in 49 patients.Intraoperative and postoperative data were recorded in a prospective manner.
Unplanned procedures were defined as a conversion into thoracotomy and/or an unplanned additional pulmonary resection. Segmentectomies were performed according to a full thoracoscopic and fissure-based approach
Results : There were 10 unplanned thoracotomies mainly for vascular injuries (3.1%) (9 conversion and 1 reintervention), and 15 unplanned additional resection (5.1%) distributed among oncological reasons (n=7), technical issues (n=6) and postoperative adverse events (2 lingularischemias). Considering only the 235 patients operated on for cancer (primary NSCLC in 184 or metastasis in 51), the unplanned additional pulmonary resection rate for an oncological reason was 3%. In total, 23 patients had an unplanned procedure (8 %).
Conclusion : Although lower than for thoracoscopic lobectomies, the rate of unplanned procedure during TSLR is of concern. It could most likely be reduced by technical and technological refinements, such as a better preoperative planning.
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