Long-term results of video-assisted thoracic surgery lobectomy for stage I non-small cell lung cancer: a single-centre study of 104 cases

Abstract

The use of video-assisted thoracic surgery (VATS) for carrying out major pulmonary resections in the treatment of lung cancer is still controversial. In order to contribute to knowledge about the long term results obtained with this technique in the treatment of stage I NSCLC, we present data relating to research in our institute over the past 10 years. From January 1993 to December 2002, 138 patients with peripheral clinical stage I NSCLC were selected to undergo VATS lobectomy. The procedure was based on a mini-thoracotomy without rib spreading, with hilar dissection and separate sectioning of the arteries, veins and bronchi; this was associated with hilar and mediastinal lymph-node sampling. Follow-up consisted of clinical and radiological examination every 6 months in the first 2 years after surgery, then once a year; a CT scan was carried out 1, 3 and 5 years after surgery. The probability of survival was estimated with the Kaplan-Meier method. Surgery by VATS was successfully completed in 122 cases, with a thoracotomy conversion rate of 11.6%. Of these, stage I was confirmed by pathological examination in only 104 cases: there were 56 T1N0 and 48 T2N0. With a mean follow-up of 65 months, the 5-year survival rate was found to be 67+/-10%; in the T1N0 it was 68+/-15%, whereas in the T2N0 it was 67+/-16%. The rate of local or regional recurrence was 4.8% while the systemic recurrence rate was 15.4%. From an appraisal of the study results we consider VATS to be a valid approach for carrying out lobectomy for the treatment of stage I pulmonary carcinoma. The long-term results are comparable to those obtained in open surgery both in terms of survival and the rate of local recurrence. Therefore in selected cases, where there is no increase in surgical risk, VATS may be the preferred approach.

Video-assisted thoracic surgery (VATS) of the lung

“…As reported elsewhere [76] the incidence of local cancer recurrence seems to be similar to that reported after open surgery and is not correlated to the VATS approach. One complication linked to the anterior utility thoracotomy was registered: 6 months after surgery, a herniation of the lung through the thoracotomy site occurred, but it did not require surgical repair.…”

Non–Small Cell Lung Cancer

“…[90][91][92][93][94] In patients with stage I NSCLC who undergo VATS with lymph node dissection, the 5-year survival, long-term survival, and local recurrence rates were comparable to those achieved with routine open lung resection. [95][96][97] VATS has also been shown to improve discharge independence in older populations and high-risk patients. 98,99 Recent data show that VATS improves the ability of patients to complete postoperative chemotherapy regimens.…”

Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

“…Issues investigated deal with the impact of: (I) age (1-4); (II) safety of choice for a combined or staged surgical procedure (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19); (III) on-or off-pump technique on postoperative complications occurrence (12,16,(20)(21)(22)(23)(24)(25)(26)(27); (IV) an extended surgery, due to LC infiltration in the left atrium and/or great vessels, on postoperative outcome (24,(28)(29)(30); (V) videoassisted thoracoscopic surgery (VATS) method on primary LC patients (31)(32)(33)(34)(35)(36); (VI) neo-adjuvant or adjuvant treatment (37)(38)(39)(40); and (VII) factors, other than the aforementioned ones, influencing postoperatively patients operated for primary LC and HD. These factors were: myocardial ischemia (41), arrhythmias (41,42), type of grafts selected (20), high preoperative serum level of lactate dehydrogenase (LDH) (43), low preoperative forced expiratory volume in one second ...…”