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

This retrospective single-center study from Nara Medical University evaluated en bloc stapling of the pulmonary artery branches, bronchus, and adherent lymph nodes using an auto-stapler as a bailout technique during lobectomy for non-small cell lung cancer, reserved for cases where separate hilar dissection was deemed technically difficult or hazardous. Among 808 consecutive lobectomy patients (2019–2024), 18 (2.2 percent) underwent en bloc stapling. Of these, 13 achieved R0 resection, while five had incomplete (R1/R2) resections due to invasive metastatic nodes that precluded pneumonectomy in patients unfit for that procedure. There were no grade ≥3 intraoperative complications and no bronchovascular fistulas. The rate of grade ≥3 postoperative complications was 11 percent. The five-year overall survival was 44.7 percent overall, and notably similar between R0 (44.0 percent) and R1/R2 (50.0 percent) resection groups, with two patients on EGFR-targeted therapy remaining disease-free beyond two and six years. The authors conclude that en bloc stapling is a feasible, safe bailout option in carefully selected patients with hazardous hilar anatomy. They suggest that incomplete resections may achieve acceptable outcomes when followed by genetic-profiling-guided multimodal therapy, though they caution that the technique should not be viewed as a routine strategy and that the favorable R1/R2 survival findings are exploratory given the small sample and likely selection bias.