Features and outcomes of bilateral anatomical lung resections in patients with lung cancer

Abstract

The aim of this study was to evaluate the feasibility and safety of sequential bilateral anatomical lung resections performed via video-assisted thoracic surgery (VATS) or thoracotomy approaches in lung cancer patients, as well as to identify factors affecting the postoperative period. Material and Methods. Of 534 NSCLC patients undergoing anatomical lung resection in Center for Intensive Pulmonology and Thoracic Surgery from 2014 to 2022, 14 patients with consecutive bilateral anatomical lung resections were included in the retrospective study. The patients were divided into two groups depending on a surgical approach used during the first surgery: group I – 5 patients underwent thoracotomy and group II – 9 patients underwent videoassisted thoracic surgery (VATS). The groups were matched for gender, age, smoking, Charlson Comorbidity Index, lung resection, functional status and stage of the disease. Surgical treatment included anatomical lung resection and ipsilateral systematic lymph dissection. Results. There were significant differences in intraoperative blood loss between the groups. Postoperative complications after surgery on the contralateral lung were observed more often in group 1 patients than in group II patents. The overall 5-year survival rates in patients of groups 1 and 2 were 60 % and 86 %, respectively. Respiratory function indicators three months after surgery corresponded to preoperative prognosis, and their decrease did not depend on the surgical approach used. In comparison with patients who underwent standard unilateral lung resection, bilateral anatomical lung resection was not associated with increased number of “major” complications, however, an increase in the frequency of prolonged air discharge was noted (26 % vs 6 %; p<0.05). Conclusion. Sequential bilateral anatomical lung resections are feasible and safe after thorough preoperative assessment of the functional reserves of the cardio-respiratory system. Mini-invasive technologies make it possible to reduce the frequency of complications in the early postoperative period. The use of the VATS approach makes it possible to safely perform anatomical resection of the contralateral lung.