How to facilitate concurrent lower lobectomy after coronary artery bypass grafting via median sternotomy without adding anterolateral thoracotomy?

Background And Aim: Median sternotomy is an unfavourable approach for performing lung resection and mediastinal lymphadenectomy. Some studies have speculated that concurrent pulmonary resections other than upper lobectomy, necessitate anterolateral thoracotomy in addition to sternotomy. In this study, we aimed to discuss the feasibility and advantages of concomitant video-thoracoscopy (VATS) assisted lower lobectomy after coronary artery bypass grafting (CABG).

Methods: We analysed 21 patients who underwent a single combined procedure that includes CABG followed by anatomical pulmonary resection and divided them into two groups: patients who underwent upper lobectomy via median sternotomy incision (Group A, n = 12) and patients who underwent lower lobectomy with video-thoracoscopic assistance (VATS) next to sternotomy incision (Group B, n = 9).

Results: There were no significant differences between the groups in age, sex, comorbidities, tumour side or size, tumour stage, tumour histopathology, number of dissected lymph node stations, N status, CABG type, number of grafts used, operative time, hospitalization and complication rates.

Conclusion: The feasibility of upper lobectomies via median sternotomy is clear; however, performing lower lobectomies is challenging. In our study, we concluded that the operative feasibility of concurrent lower lobectomy by VATS assistance showed no essential difference to that of concurrent upper lobectomy by presenting that there was no statistically significant difference between the groups in terms of any studied parameters. We can speculate that median sternotomy with VATS assistance should be especially considered instead of anterolateral thoracotomy for lower lobectomies at centres where VATS lobectomies are performed.