Contemporary outcomes of en bloc stapling of the pulmonary artery, bronchus, and lymph nodes during lobectomy for non-small cell lung cancer: a retrospective study
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Background This study investigates the safety and postoperative outcomes of en bloc stapling of the pulmonary artery branches, bronchial branches, and lymph nodes using an auto-stapler during lobectomy for non-small cell lung cancer. Methods A retrospective chart review was conducted to identify consecutive patients who underwent lobectomy for non-small cell lung cancer with en bloc stapling of the pulmonary artery branches, bronchial branches, and lymph nodes using an auto-stapler between 2019 and 2024. Patient characteristics, perioperative outcomes, and long-term survival rates were analyzed. Results Eighteen patients were included, with the median age of 76.5 years and the median follow-up of 35.1 months. Thirteen patients underwent complete resection, whereas five patients had incomplete resection due to adherent metastatic lymph nodes around the pulmonary artery and bronchus. The incidences of grade ≥ 3 intraoperative and postoperative complications were 0% and 11%, respectively, with no procedure-related events such as bronchovascular fistula. The five-year overall survival rates in patients who underwent complete and incomplete resections were 44.0% and 50.0%, respectively. Among patients with incomplete resection, four experienced disease progression, and two died of lung cancer. Two patients receiving targeted therapies remained alive at 31.4 and 73.8 months postoperatively, without any evidence of disease progression. Conclusions En bloc stapling of the pulmonary artery branches, bronchial branches, and lymph nodes using an auto-stapler during lobectomy for non-small cell lung cancer is feasible and safe. Even in cases involving lymph node metastases near the stapling site, multimodal therapy guided by genetic profiling of surgical specimens may contribute to acceptable long-term outcomes in carefully selected patients. Trial registration Not applicable.
