title: Completion lobectomy after radical segmentectomy for pulmonary malignancies.
abstract: OBJECTIVE
  Completion lobectomy after radical segmentectomy is relatively rare, with no systematic evaluation of this challenging procedure. We aimed to clarify the details of this operation performed in 3 Japanese institutions.
  
  
  METHODS
  Completion lobectomy after segmentectomy in the same lobe was performed in 11 patients (9 lung cancers and 2 metastatic lung tumors) between 2007 and 2013. Surgical outcomes were analyzed retrospectively.
  
  
  RESULTS
  The 11 patients accounted for 1.37% of the 805 segmentectomies performed in the 3 institutions. The reasons for completion lobectomy were postoperative complications in the remaining lobe (n = 3), positive pathological lymph node metastasis found by permanent section (n = 3), and malignancy in the remaining lobe (n = 5). The patients were divided into two groups according the interval between segmentectomy and completion lobectomy: group A (3-35 days, n = 5) and group B (56-1470 days, n = 6). There was a tendency for more severe adhesions around the hilum (p = 0.061) in group B, resulting in increased operative bleeding (p = 0.055), more usage of fibrin glue (p = 0.080), and significantly longer operative time (p = 0.036). Injury to the pulmonary arteries was experienced only in group B (3/6 cases). There was no operation-related mortality.
  
  
  CONCLUSIONS
  Completion lobectomy may become more difficult approximately 5 weeks after segmentectomy, due to severe adhesions, but it can be performed safely with careful manipulation.
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan omasa@kuhp.kyoto-u.ac.jp.
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Omasa
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Takamochi
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyata
authors.affiliation: Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
authors.forename: Morihito
authors.initials: M
authors.lastname: Okada
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D007564:Japan; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: Lung neoplasms; Neoplasms; Pneumonectomy; Postoperative complications; Reoperation; Tissue adhesions; second primary