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.
背景：同一肺叶既往切除术后行肺叶补充切除术（CL）可能因严重的胸膜或肺门粘连而复杂化。单孔胸腔镜手术（U-VATS）在此背景下的作用尚未得到评估。方法：数据收集自两个意大利中心。2015年至2022年间，122例患者（男性60例，女性62例，中位年龄67.7±8.913岁）在既往肺部手术后至少4周接受了U-VATS CL。结果：28例（22.9%）患者患有慢性阻塞性肺疾病（COPD），25例（20.4%）为当前吸烟者。在该队列中，初次手术采用U-VATS的有103例（84.4%），三孔VATS 8例（6.6%），开胸手术11例（9.0%）。46例（37.7%）患者的初次手术为解剖性肺段切除术，16例（13.1%）进行了肺门淋巴结清扫术。CL在110例（90.2%）患者中实施，肺段切除术10例（8.2%），补充性全肺切除术2例（1.6%）。再次手术时，38例（31.1%）患者观察到中度胸膜粘连，2例（1.6%）存在重度粘连。发现中度肺门粘连18例（14.8%），重度粘连11例（9.0%）。中位手术时间为203.93±74.4分钟。4例（3.3%）患者进行了肺动脉套带。1例患者发生术中出血，但无需中转开胸。3例（2.5%）患者需要中转开胸。术后引流管留置时间和术后住院时间的中位数分别为5.67±4.44天和5.52±2.66天。34例（27.9%）患者出现术后并发症。30天死亡率为零。组织学类型是唯一被发现对术中结局有负面影响的因子（p=0.000）。单变量分析中，被确定为对术后结局有负面影响的因子包括：男性（p=0.003）、年龄>60岁（p=0.003）、COPD（p=0.014）、既往开胸手术史（p=0.000）、既往S2段切除术（p=0.001）、既往S8段切除术（p=0.008）以及两次手术间隔时间>5周（p=0.005）。在多变量分析中，仅COPD被证实是术后并发症的独立危险因素（HR：5.12，95% CI 1.07–24.50，p=0.04）。结论：在楔形切除和解剖性肺段切除术后，U-VATS CL似乎是可行且安全的。
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