|
1
|
Rodriguez GR, Kucera J, Antevil JL, Mullenix PS, Trachiotis GD. Contemporary Video-Assisted Thoracoscopic Lobectomy for Early-Stage Lung Cancer. J Laparoendosc Adv Surg Tech A 2024; 34:798-807. [PMID: 39288366 DOI: 10.1089/lap.2024.0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
The treatment of non-small cell lung cancer (NSCLC) has evolved tremendously in recent decades as innovations in medical therapies advanced concomitantly with minimally invasive surgical techniques. Despite early skepticism regarding its benefits, video-assisted thoracoscopic surgery (VATS) techniques for the surgical resection of early-stage NSCLC have now become the standard of care. After being the subject of many studies since its inception, VATS has been shown to cause less postoperative pain, have shorter recovery time, and have fewer overall complications when compared to conventional open approaches. Furthermore, some studies have shown it to have comparable oncological outcomes, though more higher evidence studies are needed. Newer technologies and improved surgical instruments, advancements in nodule localization techniques, and improved preoperative staging procedures have allowed for the development of newer, less invasive techniques such as uniportal VATS and parenchymal-sparing sublobar resections, which might further improve postoperative rates of complications in specific cases. These minimally invasive approaches have allowed surgeons to offer surgery to high-risk patients and those who would otherwise not tolerate conventional thoracotomy, though some relative contraindications still exist. This review aims to describe the evolution of VATS lobectomy, current techniques, its indications, contraindications, preoperative testing, benefits, and outcomes in patients with stage I and II NSCLC.
Collapse
Affiliation(s)
- Gustavo R Rodriguez
- Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA
| | - John Kucera
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jared L Antevil
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Philip S Mullenix
- Division of Cardiothoracic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Gregory D Trachiotis
- Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| |
Collapse
|
|
2
|
Liu S, Li S, Tang Y, Chen R, Qiao G. Minimally invasive surgery vs. open thoracotomy for non-small-cell lung cancer with N2 disease: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1152421. [PMID: 37324136 PMCID: PMC10265993 DOI: 10.3389/fmed.2023.1152421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023] Open
Abstract
Background This meta-analysis aimed to investigate the effectiveness and safety of minimally invasive surgery [MIS, including robotic-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS)] and open thoracotomy (OT) for non-small cell lung cancer (NSCLC) patients with N2 disease. Methods We searched online databases and studies from the creation of the database to August 2022, comparing the MIS group to the OT group for NSCLC with N2 disease. Study endpoints included intraoperative outcomes [e.g., conversion, estimated blood loss (EBL), surgery time (ST), total lymph nodes (TLN), and R0 resection], postoperative outcomes [e.g., length of stay (LOS) and complication], and survival outcomes [e.g., 30-day mortality, overall survival (OS), and disease-free survival (DFS)]. We estimated outcomes using random effects meta-analysis to account for studies with high heterogeneity (I2 > 50 or p < 0.05). Otherwise, we used a fixed-effect model. We calculated odds ratios (ORs) for binary outcomes and standard mean differences (SMDs) for continuous outcomes. Treatment effects on OS and DFS were described by hazard ratio (HR). Results This systematic review and meta-analysis of 15 studies on MIS vs. OT for NSCLC with N2 disease included 8,374 patients. Compared to OT, patients that underwent MIS had less estimated blood loss (EBL) (SMD = - 64.82, p < 0.01), shorter length of stay (LOS) (SMD = -0.15, p < 0.01), higher R0 resection rate (OR = 1.22, p = 0.049), lower 30-day mortality (OR = 0.67, p = 0.03), and longer overall survival (OS) (HR = 0.61, P < 0.01). The results showed no statistically significant differences in surgical time (ST), total lymph nodes (TLN), complications, and disease-free survival (DFS) between the two groups. Conclusion Current data suggest that minimally invasive surgery may provide satisfying outcomes, a higher R0 resection rate, and better short-term and long-term survival than open thoracotomy. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022355712.
Collapse
Affiliation(s)
- Songlin Liu
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shaopeng Li
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Thoracic Surgery, The Ninth People's Hospital of Shenzhen, Shenzhen, China
| | - Yong Tang
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Rixin Chen
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| |
Collapse
|
|
3
|
VATS versus Open Lobectomy following Induction Therapy for Stage III NSCLC: A Propensity Score-Matched Analysis. Cancers (Basel) 2023; 15:cancers15020414. [PMID: 36672363 PMCID: PMC9857329 DOI: 10.3390/cancers15020414] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Objectives: This study aims to evaluate the perioperative and oncologic outcomes of thoracoscopic lobectomy for advanced stage III NSCLC. Methods: We retrospectively reviewed 205 consecutive patients who underwent VATS or open lobectomy for clinical stage III lung cancer between January 2013 and December 2020. The perioperative and oncologic outcomes of the two approaches were compared. Long-term survival was assessed using the Kaplan−Meier estimator. Propensity score-matched (PSM) comparisons were used to obtain a well-balanced cohort of patients undergoing VATS and open lobectomy. Results: VATS lobectomy was performed in 77 (37.6%) patients and open lobectomy in 128 (62.4%) patients. Twelve patients (15.6%) converted from VATS to the open approach. PSM resulted in 64 cases in each group, which were well matched according to twelve potential prognostic factors, including tumor size, histology, and pTNM stage. Between the VATS and the open group, there were no significant differences in unmatched and matched analyses, respectively, of the overall postoperative complications (p = 0.138 vs. p = 0.109), chest tube duration (p = 0.311 vs. p = 0.106), or 30-day mortality (p = 1 vs. p = 1). However, VATS was associated with shorter hospital stays (p < 0.0001). The five-year overall survival (OS) and five-year Recurrence-free survival (RFS) were comparable between the VATS and the open groups. There was no significant difference in the recurrence pattern between the two groups in both the unmatched and matched analyses. Conclusion: For the advanced stage III NSCLC, VATS lobectomy achieved equivalent postoperative and oncologic outcomes when compared with open lobectomy without increasing the risk of procedure-related locoregional recurrence.
Collapse
|
|
4
|
Li X, Huang K, Deng H, Zheng Q, Xiao T, Yu J, Zhou Q. Feasibility and oncological outcomes of video-assisted thoracic surgery versus thoracotomy for pathologic N2 disease in non-small cell lung cancer: A comprehensive systematic review and meta-analysis. Thorac Cancer 2022; 13:2917-2928. [PMID: 36102196 PMCID: PMC9626309 DOI: 10.1111/1759-7714.14614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023] Open
Abstract
This meta-analysis aimed to evaluate the feasibility and oncological outcomes between video-assisted thoracic surgery (VATS) and thoracotomy for non-small cell lung cancer (NSCLC) patients with pathologic N2 (pN2) disease. Data for analysis included short-term outcomes and long-term outcomes. We calculated the weighted mean differences (WMDs) for continuous data and the results of overall survival (OS) and disease free survival (DFS) were pooled using the hazard ratios (HRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the Q-test and I2 -test. Sensitivity analysis was performed to further examine the stability of pooled HRs and WMDs. In the pooled analyses of 10 eligible studies, results showed that VATS for NSCLC patients with pN2 disease yielded significantly less blood loss (WMD = -61.43; 95% confidence intervals [CI], [-87.69, -35.18]; p < 0.001), less post-operation hospital stay (WMD, -1.62; 95% CI, [-2.96, -0.28]; p = 0.02), and comparable operation time (WMD, -8.32; 95% CI, [-23.88, 7.23]; p = 0.29), post-operation complication rate (risk ratio [RR], 0.95; 95% CI, [0.78, 1.15]; p = 0.59), chest tube duration to thoracotomy (WMD, -0.64; 95% CI, [-1.45, 0.17]; p = 0.12), extent of lymph node dissection (WMD, -1.46; 95% CI, [-3.87, 0.95]; p = 0.23) and 1-year OS (HR, 1.30; 95% CI, [0.96, 1.76]; p = 0.09) than thoracotomy. However, VATS may improve 3-year OS (HR, 1.26; 95% CI, [1.12, 1.42]; p = 0.0002) and yield comparable 1-year DFS (HR, 1.14; 95% CI, [0.89, 1.46]; p = 0.32) and 3-year DFS (HR, 1.03; 95% CI, [0.88, 1.22]; p = 0.70) for NSCLC patients with pN2 disease than thoracotomy. VATS could yield less surgical trauma and improve post-operative recovery than thoracotomy. Moreover, VATS may improve the oncological outcomes of those patients.
Collapse
Affiliation(s)
- Xiaogang Li
- Lung Cancer CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Kaili Huang
- Lung Cancer CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Hanyu Deng
- Lung Cancer CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Qiangqiang Zheng
- Lung Cancer CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Tao Xiao
- Lung Cancer CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Jinming Yu
- Lung Cancer CenterWest China Hospital of Sichuan UniversityChengduChina,Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation OncologyShandong First Medical University and Shandong Academy of Medical SciencesJinanChina,Research Unit of Radiation OncologyChinese Academy of Medical SciencesJinanChina
| | - Qinghua Zhou
- Lung Cancer CenterWest China Hospital of Sichuan UniversityChengduChina
| |
Collapse
|
|
5
|
Hireche K, Canaud L, Lounes Y, Aouinti S, Molinari N, Alric P. Thoracoscopic Versus Open Lobectomy After Induction Therapy for Nonsmall Cell Lung Cancer: New Study Results and Meta-analysis. J Surg Res 2022; 276:416-432. [PMID: 35465975 DOI: 10.1016/j.jss.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/23/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The use of video-assisted thoracoscopic surgery (VATS) lobectomy has become a mainstay of modern thoracic surgery practice and the technique of choice for resection of early-stage lung cancers. However, the benefits of VATS following induction therapy are yet to be clarified. This study aims to assess whether VATS lobectomy achieves similar perioperative and oncologic outcomes compared to thoracotomy for nonsmall cell lung cancer after induction therapy. METHODS We retrospectively reviewed the outcomes of 72 patients who underwent lung lobectomy after induction therapy in our institution from January 2017 to January 2020. Subsequently, we carried out a comprehensive literature search and pooled our results with available data from previously published studies to perform a meta-analysis. RESULTS VATS was associated with reduced intraoperative blood loss (P = 0.05) and less perioperative complications (P = 0.04) in our local institution. The meta-analysis comprised nine studies. A total of 943 patients underwent VATS and 2827 patients underwent open lobectomy. VATS was associated with significant shorter surgery duration (P < 0.0001), shorter chest-tube drainage duration (P < 0.0001), and shorter hospital stays (P < 0.0001). Furthermore, there was significantly less perioperative complications (P = 0.006) and less intraoperative blood loss (P = 0.036) in the VATS group. However, there were no significant differences in 3-y overall survival and 3-y disease-free survival rates. CONCLUSIONS In some selected patients undergoing induction therapy, VATS lobectomy could achieve equivalent perioperative outcomes to thoracotomy but evidence is lacking on oncologic outcomes. Further trials with a focus on oncologic outcomes and longer follow-up are required.
Collapse
Affiliation(s)
- Kheira Hireche
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Youcef Lounes
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Safa Aouinti
- IDESP, INSERM, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- IDESP, INSERM, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| |
Collapse
|
|
6
|
Yun J, Lee J, Shin S, Kim HK, Choi YS, Kim J, Zo JI, Shim YM, Cho JH. Video-assisted thoracoscopic lobectomy versus open lobectomy in the treatment of large lung cancer: propensity-score matched analysis. J Cardiothorac Surg 2022; 17:2. [PMID: 34996488 PMCID: PMC8742315 DOI: 10.1186/s13019-021-01749-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background There are several concerns on thoracoscopic surgery for large tumors because of the increased risk of tumor cell spillage. This study aimed to compare perioperative outcomes and oncological validity between video-assisted thoracoscopic surgery (VATS) and open lobectomy for non-small cell lung cancer (NSCLC) with tumor size > 5 cm. Methods We retrospectively reviewed 355 patients who underwent lobectomy with clinical N0 NSCLC with solid tumor component diameter > 5 cm between January 2009 and December 2016. Patients with tumor invading adjacent structures were excluded. The patients were divided into the VATS group (n = 132) and thoracotomy group (n = 223). Propensity score matching (1:1) was applied. Results After propensity score matching, 204 patients were matched, and clinical characteristics of the two groups were well balanced. The VATS group was associated with a shorter length of hospital stay (6 days vs. 7 days; P < 0.001) than the thoracotomy group. There were no significant differences in the 5-year overall survival (71.5% in VATS vs. 64.4% in thoracotomy, P = 0.390) and 5-year recurrence-free survival (60.1% in VATS vs. 51.5% in thoracotomy, P = 0.210) between the two groups. The cumulative incidence of ipsilateral pleural recurrence was not significantly different between the two groups (12.0% in VATS vs. 7.9% in thoracotomy; P = 0.582). Conclusions In clinical N0 NSCLC larger than 5 cm, VATS lobectomy resulted in shorter hospital stay and similar survival outcome compared to open lobectomy. Based on these results, VATS lobectomy is a valuable option in this subset of patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01749-8.
Collapse
Affiliation(s)
- Jeonghee Yun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Junghee Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Jae Il Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06531, South Korea.
| |
Collapse
|
|
7
|
Thoracoscopic Surgery Shows Non-Inferiority to Open Surgery for Clinical N0-N2 and Pathologic N2 Non-Small Cell Lung Cancer. Int Surg 2021. [DOI: 10.9738/intsurg-d-16-00164.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives
Controversy has remained over the primary surgical management for stage IIIA-N2 non–small cell lung cancer. Minimal or non-bulky N2 disease defined as single-station nodal involvement may still be a candidate of radical surgery. The aim of this study was thus to assess the outcome of thoracoscopic surgery in clinical N0-N2 and pathologic N2 disease.
Methods
Seventy-nine cases of pathologic N2 diseases without induction therapy (clinical N0, 27; N1, 13; N2, 39) were operated on between September 2003 and December 2010 in our institute. Forty-seven patients underwent thoracoscopic surgery (group T) and 32 patients underwent standard thoracotomy (group S). Perioperative and oncologic outcomes were compared between the 2 groups.
Results
There were no significant differences between the 2 groups regarding dissected number of lymph nodes, operative time, morbidity, and mortality. However, blood loss in group T was less than in group S (Mean: T, 229 versus S, 534 mL, respectively; P = 0.0004). Although disease-free survival in group T did not differ from that in group S, overall survival in group T was better than in group S after propensity score matching to adjust confounding factors including tumor size and T factor (P = 0.03). Multivariate analysis showed that multinodal stations was significantly worse prognostic factor [hazard ratio (HR) = 4.79; 95% confidence interval (CI) = (1.6–14.3); P = 0.005) in disease-free and overall survivals [HR = 8.21; 95% CI = (1.9–35.4); P = 0.005]. Thoracoscopic surgery was favorable prognostic factor in overall survivals [HR = 0.13; 95% CI = (0.03–0.6); P = 0.009].
Conclusions
Our study demonstrated that thoracoscopic surgery for non-bulky N2 disease was feasible and not inferior to standard thoracotomy in terms of oncologic outcome.
Collapse
|
|
8
|
Shen H, Wang X, Nie Y, Zhang K, Wei Z, Yang F, Wang J, Chen K. Minimally invasive surgery versus thoracotomy for resectable stage II and III non-small-cell lung cancers: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 59:940-950. [PMID: 33370437 DOI: 10.1093/ejcts/ezaa437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/23/2020] [Accepted: 11/04/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The study aimed to compare the long-term oncological efficacy and perioperative outcomes of patients with locally advanced non-small-cell lung cancers who underwent minimally invasive surgery (MIS) or thoracotomy. METHODS Cochrane Library, PubMed and EMBASE databases, ClinicalTrials.gov and reference lists were searched for relevant studies. Two reviewers independently assessed the quality of the studies. Recurrence-free survival (RFS) and overall survival (OS) and perioperative outcomes were synthesized. Random-effects models were used to summarize hazard ratios (HRs), relative risks and standardized mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS Twenty-three retrospective cohort studies were reviewed with a total of 3281 patients, of whom 1376 (41.9%) received MIS and 1905 (58.1%) received thoracotomy. Meta-analysis showed no significant differences in both RFS (HR, 1.02; 95% CI, 0.89-1.17; P = 0.78) and OS (HR, 0.91; 95% CI, 0.80-1.03; P = 0.15) between MIS versus thoracotomy approaches. Similar results were observed in propensity score matched studies (RFS, HR, 0.94; 95% CI, 0.73-1.20; P = 0.62; OS, HR, 0.96; 95% CI, 0.72-1.30; P = 0.81). No significant difference was found in lymph node clearance and margin positivity. As for perioperative outcomes, MIS was associated with a significant reduction in postoperative complications (relative risk, 0.83; P = 0.01), intraoperative blood loss (standardized mean difference, -0.68; P = 0.007), chest tube drainage (standardized mean difference, -0.38; P = 0.03) and length of hospital stay (standardized mean difference, -0.79; P = 0.002) when compared with thoracotomy. CONCLUSIONS The use of MIS for resectable stage II and III non-small-cell lung cancers is an eligible alternative to conventional thoracotomy without compromising the long-term survival and short-term outcomes.
Collapse
Affiliation(s)
- Haifeng Shen
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Xin Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Yuntao Nie
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Kai Zhang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Zihan Wei
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Kezhong Chen
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| |
Collapse
|
|
9
|
IJsseldijk MA, Ten Broek RPG, Wiering B, Hekma E, de Roos MAJ. Oncological outcomes of unsuspected pN2 in patients with non-small-cell lung cancer: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2021; 32:727-736. [PMID: 33517373 DOI: 10.1093/icvts/ivaa334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/20/2020] [Accepted: 12/06/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Optimal treatment of stage IIIA (N2) non-small-cell lung cancer (NSCLC) is controversial. Guidelines advise induction therapy before surgical resection. A proportion of patients with cN0 NSCLC are postoperatively upstaged due to unsuspected N2 disease. Survival of unsuspected N2 NSCLC treated with surgery varies and technical feasibility of video-assisted thoracic surgery (VATS) is unknown. The purpose of this study was to assess prevalence and survival of unsuspected N2 NSCLC treated with thoracotomy or VATS. METHODS A systematic review and meta-analysis was performed of all available literatures through Pubmed, Cochrane, EMBASE, Web of Science, Trials registries and System for Information on Grey Literature (SIGLE) from 2000 to 2019. Outcomes of interest were prevalence, overall survival (OS) and disease-free survival of unsuspected N2 NSCLC. Secondary outcomes were number of harvested lymph nodes, postoperative complications and survival of unsuspected N2 NSCLC treated with VATS. RESULTS Seventeen studies with patients with clinical stage N0-1 and unsuspected pN2 NSCLC were included. Prevalence of unsuspected pN2 was 8.6%. Three- and 5-year OS was 58% [95% confidence interval (CI) 37-78%) (N = 4337] and 35% (95% CI 28-43%) (N = 4337). Three- and 5-y ear disease-free survival was 48% (95% CI 30-66%) (N = 109) and 35% (95% CI 24-46%) (N = 517). VATS resulted in a low complication rate with similar 5-year OS as thoracotomy. CONCLUSIONS In patients with cN0-1 NSCLC, a minority has unsuspected pN2 NSCLC. Even for these patients, 5-year OS and disease-free survival are reasonable. VATS with adequate lymph node dissection is the treatment of choice when in experienced hands. Adjuvant therapy should be provided in absence of relevant comorbidity.
Collapse
Affiliation(s)
- Michiel A IJsseldijk
- Division of Surgery, Radboud University Medical Center, Nijmegen, Netherlands.,Division of Surgery, Slingeland Ziekenhuis, Doetinchem, Netherlands
| | - Richard P G Ten Broek
- Division of Surgery, Radboud University Medical Center, Nijmegen, Netherlands.,Division of Surgery, Slingeland Ziekenhuis, Doetinchem, Netherlands
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, Netherlands
| | - Edo Hekma
- Division of Surgery, Rijnstate Hospital, Arnhem, Netherlands
| | | |
Collapse
|
|
10
|
Zhao J, Li W, Wang M, Liu L, Fu X, Li Y, Xu L, Liu Y, Zhao H, Hu J, Liu D, Shen J, Yang H, Li X. Video-assisted thoracoscopic surgery lobectomy might be a feasible alternative for surgically resectable pathological N2 non-small cell lung cancer patients. Thorac Cancer 2020; 12:21-29. [PMID: 33205914 PMCID: PMC7779187 DOI: 10.1111/1759-7714.13680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 02/05/2023] Open
Abstract
Background The majority of previous studies of the clinical outcome of video‐assisted thoracoscopic surgery (VATS) versus open lobectomy for pathological N2 non‐small cell lung cancer (pN2 NSCLC) have been single‐center experiences with small patient numbers. The aim of this study was therefore to investigate these procedures but in a large cohort of Chinese patients with pathological N2 NSCLC in real‐world conditions. Methods Patients who underwent lobectomy for pN2 NSCLC by either VATS or thoracotomy were retrospectively reviewed from 10 tertiary hospitals between January 2014 and September 2017. Perioperative outcomes and overall survival of the patients were analyzed. Cox regression analysis was performed to identify potential prognostic factors. Propensity‐score analysis was performed to reduce cofounding biases and compare the clinical outcomes between both groups. Results Among 2144 pN2 NSCLC, 1244 patients were managed by VATS and 900 by open procedure. A total of 305 (24.5%) and 344 patients died during VATS and the thoracotomy group during a median follow‐up of 16.7 and 15.6 months, respectively. VATS lobectomy patients had better overall survival when compared with those undergoing the open procedure (P < 0.0001). Multivariate COX regression analysis showed VATS lobectomy independently favored overall survival (HR = 0.75, 95% CI: 0.621–0.896, P = 0.0017). Better perioperative outcomes, including less blood loss, shorter drainage time and hospital stay, were also observed in patients undergoing VATS lobectomy (P < 0.05). After propensity‐score matching, 169 patients in each group were analyzed, and no survival difference were found between the two groups. Less blood loss was observed in the VATS group, but there was a longer operation time. Conclusions VATS lobectomy might be a feasible alternative to conventional open surgery for resectable pN2 NSCLC. Key points
Significant findings of the study: VATS lobectomy has comparative OS in pN2 NSCLC versus open procedure in resectable patients. What this study adds: VATS lobectomy might be feasible for pN2 NSCLC.
Collapse
Affiliation(s)
- Jinbo Zhao
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Weimiao Li
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Meng Wang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Cancer Institute of Jiangsu Province, Nanjing, China.,Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Jian Hu
- Department of Thoracic Surgery, First Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jianfei Shen
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Haiying Yang
- Medical Affairs, Linkdoc Technology Co, Ltd, Beijing, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| |
Collapse
|
|
11
|
Batihan G, Ceylan KC, Usluer O, Kaya ŞÖ. Video-Assisted Thoracoscopic Surgery vs Thoracotomy for Non-Small Cell Lung Cancer Greater Than 5 cm: Is VATS a feasible approach for large tumors? J Cardiothorac Surg 2020; 15:261. [PMID: 32948217 PMCID: PMC7501690 DOI: 10.1186/s13019-020-01305-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022] Open
Abstract
Background VATS lobectomy is a recommended surgical approach for patients with early-stage lung cancer. However, it is still controversial in locally advance disease. This study was conducted to compare intraoperative and postoperative results of VATS and thoracotomy in patients with tumors greater than 5 cm. Methods From January 2014 to December 2018, 849 patients underwent lobectomy or pneumonectomy for the treatment of non-small-cell lung cancer at our center. The inclusion criterion of this study was patients who underwent anatomic lung resection for lung cancer with tumors larger than 5 cm((≥ T3). The patients were divided into two groups: those who underwent video-assisted thoracoscopic surgery (n = 24) and those who underwent thoracotomy (n = 36). Patient characteristics, intraoperative and postoperative results were evaluated by review of the hospital records. Results In the VATS group, mean drainage time and postoperative length of hospital stay were significantly shorter than the thoracotomy group. Kaplan–Meier survival curves showed that overall and recurrence-free survival was longer in the VATS group and this result was statistically significant. Conclusions According to the results of this study, we emphasize that VATS is a feasible surgical procedure for tumors larger than 5 cm.
Collapse
Affiliation(s)
- Güntuğ Batihan
- Dr Suat Seren Chest Diseases and Surgery, Medical Practice and Research Center, Department of Thoracic Surgery, University of Health Sciences, Yenişehir, Gaziler Street 331, 35110, Izmir, Turkey.
| | - Kenan Can Ceylan
- Dr Suat Seren Chest Diseases and Surgery, Medical Practice and Research Center, Department of Thoracic Surgery, University of Health Sciences, Yenişehir, Gaziler Street 331, 35110, Izmir, Turkey
| | - Ozan Usluer
- Dr Suat Seren Chest Diseases and Surgery, Medical Practice and Research Center, Department of Thoracic Surgery, University of Health Sciences, Yenişehir, Gaziler Street 331, 35110, Izmir, Turkey
| | - Şeyda Örs Kaya
- Dr Suat Seren Chest Diseases and Surgery, Medical Practice and Research Center, Department of Thoracic Surgery, University of Health Sciences, Yenişehir, Gaziler Street 331, 35110, Izmir, Turkey
| |
Collapse
|
|
12
|
Results of video-assisted thoracic surgery versus thoracotomy in surgical resection of pN2 non-small cell lung cancer in a Chinese high-volume Center. Surg Endosc 2020; 35:2186-2197. [PMID: 32394172 DOI: 10.1007/s00464-020-07624-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/02/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the short-term outcomes and long-term oncological efficacy of video-assisted thoracic surgery (VATS) for surgical treatment of pN2 non-small cell lung cancer (NSCLC) compared with open thoracotomy (OT). PATIENTS AND METHODS We retrospectively collected data from 1034 patients who underwent pulmonary resection and systemic lymph node dissection for pathological N2 NSCLC from September 2005 to December 2017 (536 patients in VATS group and 498 patients in OT group). Propensity score matching was applied to reduce the confounding effects. Factors affecting survival were assessed by Kaplan-Meier estimates and Cox regression analysis. RESULTS The VATS procedure was associated with shorter operative time compared with the OT procedure (147.96 ± 58.91 min vs. 165.34 ± 58.91 min, P < 0.001). No significant difference was identified between the two groups in the number of dissected mediastinal lymph nodes (MLNs) and number of dissected MLNs stations. More patients after VATS procedure received postoperative adjuvant therapy (83.4% vs. 75.5%, P = 0.002). At a median follow-up of 36 (range 4-150) months, comparing VATS procedure and OT procedure, no significant differences were noted in 5-year DFS (20.7% vs. 22.5%, P = 0.89) and 5-year OS (30.7% vs. 34.5%, P = 0.821). The VATS procedure was not found to be an independent predictor of DFS (hazard ratio, 0.986; 95% CI, 0.809 to 1.202) or OS (hazard ratio, 0.977; 95% CI 0.802 to 1.191). CONCLUSION In this large propensity-matched comparison, the VATS procedure offered comparable short-term outcomes and long-term oncological efficacy for patients with pN2 NSCLC when compared with OT procedure.
Collapse
|
|
13
|
Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
Collapse
Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
| |
Collapse
|
|
14
|
Huang J, Li C, Li H, Lv F, Jiang L, Lin H, Lu P, Luo Q, Xu W. Robot-assisted thoracoscopic surgery versus thoracotomy for c-N2 stage NSCLC: short-term outcomes of a randomized trial. Transl Lung Cancer Res 2019; 8:951-958. [PMID: 32010573 DOI: 10.21037/tlcr.2019.11.31] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Safety and short-term efficacy of robot-assisted thoracoscopic surgery (RATS) for early-stage non-small cell lung cancer (NSCLC) have been previously proven; however, RATS for N2 stage NSCLC was barely evaluated. The aim of this randomized controlled trial (RCT) was to explore the short-term outcome of RATS for cN2 stage NSCLC. Methods Total of 113 patients who were diagnosed with clinically single cN2 stage NSCLC were enrolled and randomly assigned to RATS and thoracotomy groups. The patients in RATS group were treated by lobectomy and mediastinal lymph node dissection using the da Vinci Surgical System, while the patients in thoracotomy group underwent lobectomy and mediastinal lymph node dissection from. And, short-term outcomes were analyzed statistically. Results The data from 108 subjects (58 in RATS and 55 in thoracotomy groups) were eligible for analyses. Five patients who received robot-assisted lobectomy initially was converted intraoperatively to open operation due to extensive pleural adhesion and equipment issues. And, one subject underwent robot-assisted surgery was died preoperatively due to pulmonary embolism. Compared with thoracotomy, RATS was associated with less intraoperative blood loss (86.3±41.1 vs. 165.7±46.4 mL, P<0.001), median chest duration (4 vs. 5, P<0.01), visual analog scores at postoperative day one to five (P<0.001), and slightly fewer incidence of postoperative complications. Also, both surgical approaches revealed comparable drainages and nodal harvest. The cancer residual margins occurred in one subject in RATS group and three patients in thoracotomy group (P=0.56). However, overall cost of subjects underwent RATS was higher than those received thoracotomy (100,367±19,251 vs. 82,002±20,434, P<0.001). Conclusions Present study proves that the feasibility and safety of RATS lobectomy to treat patients with cN2 stage NSCLC, and it should be superior to thoracotomy due to lesser intraoperative blood loss.
Collapse
Affiliation(s)
- Jia Huang
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang xxxx, China
| | - Chongwu Li
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai xxxx, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai xxxx, China
| | - Fanzhen Lv
- Department of Thoracic Surgery, The Affiliated Huadong Hospital of Fudan University, Shanghai xxxx, China
| | - Long Jiang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai xxxx, China
| | - Hao Lin
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai xxxx, China
| | - Peiji Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai xxxx, China
| | - Qingquan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai xxxx, China
| | - Wenrong Xu
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang xxxx, China
| |
Collapse
|
|
15
|
Abah U, Casali G, Batchelor TJP, Internullo E, Krishnadas R, Joshi N, Egbulonu S, Warden F, Bruno VD, West DG. Pathological lymph node involvement is not a predictor of adverse outcomes in patients undergoing thoracoscopic lobectomy for lung cancer†. Eur J Cardiothorac Surg 2019; 53:342-347. [PMID: 28958031 DOI: 10.1093/ejcts/ezx297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/21/2017] [Accepted: 07/24/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES As the practice of video-assisted thoracoscopic surgery (VATS) lobectomy gains widespread acceptance, the complexity of procedures attempted increases and the stage of tumour that may be safely approached remains controversial. We examined the impact of nodal involvement with respect to perioperative outcomes after VATS lobectomy. METHODS All patients listed for VATS lobectomy for non-small-cell lung cancer at our institution from 2012 to 2016 were analysed. Bronchoplastic or chest wall resections and tumours over 7 cm were considered a contraindication to a thoracoscopic approach. RESULTS Of the 489 patients identified, 97 (19.8%) patients had pathological nodal involvement. The overall conversion rate was 6.1%, reoperation rate was 5.3% and readmission rate was 5.9%. Median hospital stay was 5 days, 30-day mortality was 0.6% and 90-day mortality was 1.6%. No significant difference was identified between the nodal-negative or -positive groups in terms of preoperative demographics, hospital stay, postoperative complications, conversion rate, reoperation rate or readmission rate. Univariate logistic regression identified gender, Thoracoscore, dyspnoea score, performance status, chronic obstructive pulmonary disease, previous stroke, preoperative lung function and non-adenocarcinoma as predictors of postoperative complications. A multivariate model including nodal status identified Thoracoscore (odds ratio 1.57, 95% confidence interval 1.16-2.18; P < 0.001) and preoperative transfer factor (odds ratio 0.97, 95% confidence interval 0.96-0.98; P < 0.001) as the only predictors of complications. CONCLUSIONS In non-small-cell lung cancer patients with pathological hilar or mediastinal lymph node involvement, VATS lobectomy can be safely performed, as there does not appear to be an adverse effect on the incidence of perioperative complications, length of stay or readmissions.
Collapse
Affiliation(s)
- Udo Abah
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Gianluca Casali
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Eveline Internullo
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rakesh Krishnadas
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Natasha Joshi
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Samson Egbulonu
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Frances Warden
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Douglas George West
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| |
Collapse
|
|
16
|
Gao HJ, Jiang ZH, Gong L, Ma K, Ren P, Yu ZT, Wei YC. Video-Assisted Vs Thoracotomy Sleeve Lobectomy for Lung Cancer: A Propensity Matched Analysis. Ann Thorac Surg 2019; 108:1072-1079. [DOI: 10.1016/j.athoracsur.2019.04.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/14/2019] [Accepted: 04/12/2019] [Indexed: 12/20/2022]
|
|
17
|
Mori S, Noda Y, Tsukamoto Y, Shibazaki T, Asano H, Matsudaira H, Yamashita M, Odaka M, Morikawa T. Perioperative outcomes of thoracoscopic lung resection requiring a long operative time. Interact Cardiovasc Thorac Surg 2019; 28:380-386. [PMID: 30212874 DOI: 10.1093/icvts/ivy275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/31/2018] [Accepted: 08/15/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Difficult thoracoscopic surgery sometimes requires a long operative time. It is unclear whether patients benefit from such thoracoscopic surgeries. We investigated whether thoracoscopic surgery for difficult cases contributed to improvements in perioperative outcomes. METHODS We retrospectively reviewed cases of anatomical lung resection with thoracoscopic surgery, including conversion to thoracotomy, between January 2006 and December 2016 and compared patient demographics and perioperative outcomes of the long (≥360 min) and the normal operative time groups (<360 min). RESULTS One hundred and seventy-six patients were in the long operative time group and 655 patients were in the normal operative time group. The long operative time group had more male patients, more progressive clinical stages, bilobectomy or pneumonectomy, conversion to thoracotomy and more blood loss than the normal operative time group. The long operative time group had higher rates of postoperative complications and longer hospital stay (30% vs 16%, P < 0.001 and 9 ± 9 days vs 7 ± 8 days, P < 0.001; respectively). Multivariate analysis showed that in the first half of the operative period, chronic obstructive pulmonary disease and bilobectomy or pneumonectomy were independent predictive factors for postoperative complications. The long operative time as a factor was close to statistical significance (odds ratio 1.689, P = 0.079) unlike the elective conversion to thoracotomy (odds ratio 0.784, P = 0.667) and emergency conversion to thoracotomy (odds ratio 0.938, P = 0.924). CONCLUSIONS In conclusion, when difficult cases are encountered, conversion to thoracotomy should be considered by surgeons if continuation of thoracoscopic surgery increases the operative time.
Collapse
Affiliation(s)
- Shohei Mori
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Yuki Noda
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Yo Tsukamoto
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Takamasa Shibazaki
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Hisatoshi Asano
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Hideki Matsudaira
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Makoto Yamashita
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Makoto Odaka
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Toshiaki Morikawa
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| |
Collapse
|
|
18
|
Tian Z, Sui X, Yang F, Wang J. Is video-assisted thoracoscopy a sufficient approach for mediastinal lymph node dissection to treat lung cancer after neoadjuvant therapy? Thorac Cancer 2019; 10:782-790. [PMID: 30756507 PMCID: PMC6449226 DOI: 10.1111/1759-7714.12999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 12/01/2022] Open
Abstract
Background The role of video‐assisted thoracoscopic surgery (VATS) in mediastinal lymph node dissection (MLND) for non‐small cell lung cancer (NSCLC) following neoadjuvant therapy remains controversial. The aim of this study was to demonstrate the sufficiency of VATS by evaluating perioperative and long‐term outcomes. Methods Patients with locally advanced NSCLC and treated with radical surgery after neoadjuvant therapy were identified in our database. The thoroughness of MLND was compared by approach. Multivariable logistic regression analysis was used to evaluate predictors of sufficient MLND. Propensity score matching was performed. Kaplan–Meier and Cox proportional hazard analyses were used to assess long‐term survival. Results Of the 127 enrolled patients, 56 underwent attempted VATS and 71 underwent thoracotomy. Multivariable logistic regression analysis revealed that approach was not a predictor of sufficient MLND (odds ratio 0.81, 95% confidence interval [CI] 0.364–1.803; P = 0.606). After matching, 28 pairs of patients were selected from the two groups. There was no significant difference between the numbers of dissected lymph nodes (15 vs. 20; P = 0.191) and nodal stations (7 vs. 7; P = 0.315). Recurrence‐free (log‐rank P = 0.613) and overall survival (log‐rank P = 0.379) was similar in both groups. Multivariable Cox proportional hazards model analysis indicated that VATS was not an independent predictor of recurrence‐free (hazard ratio 0.955, 95% CI 0.415–2.198; P = 0.913) or overall survival (hazard ratio 0.841, 95% CI 0.338–2.093; P = 0.709). Conclusion Compared to thoracotomy, VATS is a sufficient approach for MLND to treat locally advanced NSCLC following neoadjuvant therapy without compromising long‐term survival.
Collapse
Affiliation(s)
- Zhoujunyi Tian
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Xizhao Sui
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| |
Collapse
|
|
19
|
Curcio C, Amore D. Lymphadenectomy during thoracoscopy: techniques and efficacy. J Vis Surg 2018; 3:167. [PMID: 29302443 DOI: 10.21037/jovs.2017.10.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/12/2017] [Indexed: 11/06/2022]
Abstract
Nowadays several studies have shown that, in the management of patients with early-stage lung cancer, video-assisted thoracoscopic surgery (VATS) lobectomy compared to open surgery is associated with many clinical short-term benefits, such as less post-operative pain and shorter hospital stay. Despite the advantages described earlier, some authors have expressed concern about the effectiveness of the procedure arguing that the lymph node harvest performed during VATS lobectomy is inferior to that performed through thoracotomy access. Experience from a multicentre database, with a more balanced number of VATS versus open patients, actually has shown that there is no difference in the efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy. In expert hands the technique of VATS lymphadenectomy is the same as that performed by thoracotomy: instrumentation and tricks can change but not the oncologic principles. We believe that is necessary to follow a learning curve not only for VATS lobectomy but also for thoracoscopic lymph node dissection. However even experienced VATS surgeons should keep in mind that the metastatic lymphadenopathy with extracapsular lymph node spread requires great caution during dissection and that a preoperative plan for conversion to thoracotomy can be useful in this case.
Collapse
Affiliation(s)
- Carlo Curcio
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | - Dario Amore
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| |
Collapse
|
|
20
|
Bille A, Woo KM, Ahmad U, Rizk NP, Jones DR. Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage I lung cancer patients. Eur J Cardiothorac Surg 2017; 51:674-679. [PMID: 28200091 DOI: 10.1093/ejcts/ezw400] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 10/10/2016] [Indexed: 12/22/2022] Open
Abstract
Objectives Early clinical stage (T1 and T2) non-small cell lung cancer (NSCLC) is commonly treated with anatomic lung resection and lymph node sampling or dissection. The aims of this study were to evaluate the incidence and the distribution of occult N2 disease according to tumour location and the short- and long-term outcomes. Methods We performed a retrospective review of patients with clinical stage I NSCLC who underwent anatomic lung resection and lymphadenectomy. Mediastinal lymphadenectomy (ML) was defined as resection of at least 2 mediastinal stations, always including station 7 lymph nodes. Patients who had a lobe-specific lymphadenectomy were excluded. Results One thousand six hundred and sixty-seven consecutive patients met inclusion criteria and were included. Overall, 9% (146/1667) of the patients had occult pN2 disease. At multivariable analysis, adenocarcinoma histology and vascular invasion were independently associated with greater risk of occult pN2 disease. In left and right upper lobe tumours, station 7 nodes were involved in 5 and 13% of pN2 positive cases, respectively. Station 5 and station 2/4 nodes were involved in 29 and 18% of left and right lower lobe pN2 tumours, respectively. There was no postoperative mortality, and postoperative morbidity was 28%. The median overall survival was 77.4 months. N0 patients had a median overall survival of 83.7 months vs 48.0 months and 37.9 months in N1 and N2 populations, respectively ( P < 0.001). Conclusions Sixteen percent of pN2 patients had mediastinal lymph node metastasis beyond the lobe-specific lymphatic drainage. We recommend a complete lymphadenectomy be performed, even in clinical stage I NSCLC.
Collapse
Affiliation(s)
- Andrea Bille
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaitlin M Woo
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Usman Ahmad
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nabil P Rizk
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
|
21
|
Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, Sacro Cuore-Don Calabria Research Hospital and Cancer Care Centre Negrar-Verona, Verona, Italy
| | - Stéphane Renaud
- Department of Thoracic Surgery, Nancy University Hospital, Nancy, France
| | - Francesco Guerrera
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Surgical Sciences, University of Torino, Torino, Italy
| |
Collapse
|
|
22
|
Magee MJ, Herbert MA, Tumey L, Prince SL. Establishing a Dedicated General Thoracic Surgery Subspecialty Program Improves Lung Cancer Outcomes. Ann Thorac Surg 2017; 103:1063-1069. [PMID: 27938908 DOI: 10.1016/j.athoracsur.2016.09.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 11/24/2022]
|
|
23
|
Watanabe A, Miyajima M, Mishina T, Tsuruta K, Takahashi Y, Maki R, Tada M. Video-assisted thoracoscopic surgery node dissection for lung cancer treatment. Surg Today 2017; 47:1419-1428. [PMID: 28285463 DOI: 10.1007/s00595-017-1494-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/01/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Mediastinal node dissection (MND) is an integral component of the surgical treatment for non-small cell lung cancer (NSCLC). Although video-assisted thoracoscopic surgery (VATS) has been used increasingly for lung cancer treatment, the accuracy of by VATS MND still remains controversial. We reviewed the surgical results of VATS MND for NSCLC. METHODS A systematic review of literature was performed, and articles that fully described the surgical procedure, devices, and results of VATS MND were selected to compare the efficacy of MND by VATS and thoracotomy. RESULTS Various techniques and equipments have been shown to perform adequate MND, but there is an argument as to the method of estimation of the accuracy of MND. Most of the recent studies showed that the nodal upstaging and number of dissected nodes are significantly lower by VATS than after thoracotomy. Oppositely, some studies showed VATS noninferiority in these issues. Complications such as chylothorax, pleural effusion, bleeding, and nerve damage were similar in both groups. CONCLUSIONS Although ND by VATS remains controversial, VATS MND is becoming easier and more feasible owing to the development of more advanced endoscopic cameras and equipments. We should learn further to become more adept at performing adequate ND by VATS.
Collapse
Affiliation(s)
- Atsushi Watanabe
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Masahiro Miyajima
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Taijiro Mishina
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Kodai Tsuruta
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Yuki Takahashi
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ryunosuke Maki
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Makoto Tada
- Department of Thoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan
| |
Collapse
|
|
24
|
Zhang W, Wei Y, Jiang H, Xu J, Yu D. Thoracotomy is better than thoracoscopic lobectomy in the lymph node dissection of lung cancer: a systematic review and meta-analysis. World J Surg Oncol 2016; 14:290. [PMID: 27855709 PMCID: PMC5114806 DOI: 10.1186/s12957-016-1038-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/04/2016] [Indexed: 01/20/2023] Open
Abstract
Background The aim of this study was to investigate which surgical method is better in lymph node (LN) dissection of lung cancer. Methods A comprehensive search of PubMed, Ovid MEDLINE, EMBASE, Web of Science, ScienceDirect, the Cochrane Library, Scopus, and Google Scholar was performed to identify studies comparing thoracoscopic lobectomy (video-assisted thoracic surgery (VATS) group) and thoracotomy (open group) in LN dissection. Results Twenty-nine articles met the inclusion criteria and involved 2763 patients in the VATS group and 3484 patients in the open group. The meta-analysis showed that fewer total LNs (95% confidence interval [CI] −1.52 to −0.73, p < 0.0001) and N2 LNs (95% CI −1.25 to −0.10, p = 0.02) were dissected in the VATS group. A similar number of total LN stations, N2 LN stations, and N1 LNs were harvested in both groups. Only one study reported that fewer N1 LN stations were dissected in the VATS group (1.4 ± 0.5 vs. 1.6 ± 0.6, p = 0.04). Conclusions Open lobectomy could achieve better LN dissection efficacy than thoracoscopic lobectomy in the treatment of lung cancer, especially in the N2 LNs dissection. These findings require validation by high-quality, large-scale randomized controlled trials.
Collapse
Affiliation(s)
- Wenxiong Zhang
- Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China
| | - Yiping Wei
- Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China
| | - Han Jiang
- Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China
| | - Jianjun Xu
- Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China
| | - Dongliang Yu
- Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China.
| |
Collapse
|
|
25
|
Numan RC, Berge MT, Burgers JA, Klomp HM, van Sandick JW, Baas P, Wouters MW. Peri- and postoperative management of stage I-III Non Small Cell Lung Cancer: Which quality of care indicators are evidence-based? Lung Cancer 2016; 101:129-136. [PMID: 27794401 DOI: 10.1016/j.lungcan.2016.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 05/30/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
Abstract
Quality of care (QoC) has a central role in our health care system. The aim of this review is to present a set of evidence-based quality indicators for the surgical treatment and postoperative management of lung cancer. A search was performed through PubMed, Embase and the Cochrane library database, including English literature, published between 1980 and 2012. Search terms regarding 'lung neoplasms', 'surgical treatment' and 'quality of care' were used. Potential QoC indicators were divided into structure, process or outcome measures and a final selection was made based upon the level of evidence. High hospital volume and surgery performed by a thoracic surgeon, were identified as important structure indicators. Sleeve resection instead of pneumonectomy and the importance of treatment within a clinical care path setting were identified as evidence-based process indicators. A symptom-based follow-up regime was identified as a new QoC indicator. These indicators can be used for registration, benchmarking and ultimately quality improvement in lung cancer surgery.
Collapse
Affiliation(s)
- Rachel C Numan
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands.
| | - Martijn Ten Berge
- Department of Surgical Oncology, Leids Universitair Medisch Centrum, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jacobus A Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Houke M Klomp
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Johanna W van Sandick
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Michel W Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| |
Collapse
|
|
26
|
Video-Assisted Thoracoscopic Surgery Versus Thoracotomy Lymph Node Dissection in Clinical Stage I Lung Cancer: A Meta-Analysis and System Review. Ann Thorac Surg 2016; 101:2417-24. [DOI: 10.1016/j.athoracsur.2015.11.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 11/23/2022]
|
|
27
|
Zhou S, Pei G, Han Y, Yu D, Song X, Li Y, Xiao N, Liu S, Liu Z, Xu S. Sleeve lobectomy by video-assisted thoracic surgery versus thoracotomy for non-small cell lung cancer. J Cardiothorac Surg 2015; 10:116. [PMID: 26357875 PMCID: PMC4564953 DOI: 10.1186/s13019-015-0318-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both video-assisted thoracic surgery (VATS) and thoracotomy are used for sleeve lobectomy for patients with non-small cell lung cancer (NSCLC). This retrospective study aimed to assess the safety and efficacy of VATS sleeve lobectomy for NSCLC patients. METHODS Between May 2009 and May 2013, 51 sleeve lobectomies (10 by VATS and 41 by thoracotomy) were performed for patients with NSCLC. Operative characteristics and postoperative course were compared between two groups. RESULTS Patient demographics were similar between the two groups. Thoracotomy patients had larger tumors compared with VATS patients (p = 0.02). VATS patients had a longer operating time (p < 0.001) but a shorter length of postoperative hospital stay (p = 0.009). The two groups did not differ in pathologic stage, histologic results, blood loss, ICU stay, amount of chest drainage, duration of chest drainage, numbers and distributions of dissected lymph nodes and the occurrence of complications. There were no perioperative deaths in the VATS group, whereas there was one death (2.4 %) in the thoracotomy group. There were no conversions to thoracotomy in the VATS group. The overall median survival between the two groups was similar (3.2 years VATS versus 3.2 years thoracotomy, log-rank p = 0.58). CONCLUSIONS VATS sleeve lobectomy for the treatment of NSCLC is technically feasible and safe and is associated with comparable complication rates and survival compared with thoracotomy approach, but it deserves further investigation in large series.
Collapse
Affiliation(s)
- Shijie Zhou
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Guotian Pei
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Yi Han
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Daping Yu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Xiaoyun Song
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Yunsong Li
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Ning Xiao
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Shuku Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China
| | - Zhidong Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China.
| | - Shaofa Xu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Machang 97, Tongzhou District, Beijing, 101149, China.
| |
Collapse
|
|
28
|
Li F, Jiang G, Chen Y, Wang J. Curative Effects of Different Sequences of Vessel Interruption During the Completely Thoracoscopic Lobectomy on Early Stage Non-Small Cell Lung Cancer. Ann Thorac Cardiovasc Surg 2015; 21:536-43. [PMID: 26289504 DOI: 10.5761/atcs.oa.15-00044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To study the correlation between prognosis and different sequences of pulmonary artery and vein interruption during completely thoracoscopic lobectomy for early stage non-small cell lung cancer. METHODS Retrospective analysis of 334 cases underwent completely thoracoscopic lobectomy, which were identified as stage I~II non-small cell lung cancer by pathology. They were divided into three groups according to the order of vessel interruption: pulmonary vein first (Group V, n = 174), pulmonary artery first (Group A, n = 93), and artery-vein-artery group (Group M, n = 67). Their preoperative and operative conditions, and the postoperative survival, recurrence were compared. RESULTS Group A had less cases with history of smoking but more with history of pulmonary infection. The average bleeding amount during the operation in Group A is significantly less Group V, and Group M fell in between them. The duration of operation and postoperative complications were similar among the three groups. The types of tumor recurrence were also similar, which were mostly distant metastasis. There was no statistically significant difference in tumor-free survival and overall survival among the three groups. CONCLUSIONS For the treatment of stage I~II non-small cell lung cancer using completely thoracoscopic lobectomy, pulmonary artery interruption first can reduce the bleeding amount without affecting the operative difficulty and postoperative complications. The sequence of vessel interruption during lobectomy by thoracoscopic surgery would not affect tumor recurrence, metastasis and survival.
Collapse
Affiliation(s)
- Fengwei Li
- Department of Thoracic Surgery, People's hospital of Peking University, Beijing, China
| | | | | | | |
Collapse
|
|
29
|
Reichert M, Steiner D, Kerber S, Bender J, Pösentrup B, Hecker A, Bodner J. A standardized technique of systematic mediastinal lymph node dissection by video-assisted thoracoscopic surgery (VATS) leads to a high rate of nodal upstaging in early-stage non-small cell lung cancer. Surg Endosc 2015; 30:1119-25. [PMID: 26169635 DOI: 10.1007/s00464-015-4312-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/24/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND A substantial part of the oncologic surgical procedure in non-small cell lung cancer (NSCLC) is systematic lymph node dissection (sLND). However, controversies still exist regarding the quality of minimally invasive (video-assisted thoracoscopic surgery, VATS) sLND in oncologic resections. The rate of stage migration from clinical to pathological N-status has been discussed as one parameter for the quality of sLND. METHODS Between March 2011 and May 2014, seventy-seven patients (62 male, 15 female) were scheduled for anatomical lung resection and sLND by VATS for clinical stage I (UICC 7th edition) NSCLC. Preoperative staging was performed by [18F]-fluorodesoxyglucose positron emission tomography with computed tomography (FDG-PET/CT). Patient data were retrospectively analyzed with regard to divergence in clinical and pathological N-factor. FDG-PET/CTs of patients with lymph node (LN) upstaging after VATS resections were blindly re-evaluated by an experienced radiologist. RESULTS In FDG-PET/CT, preoperative tumor stage was cT1N0M0 in 41 (53.2%) and cT2aN0M0 in 28 (36.4%) patients. In six (7.8%) patients the primary tumor was not suspicious for malignancy, and in two (2.6%) patients the tumor was not evaluable due to prior wedge resection before FDG-PET/CT. Thirty-one (40.3%) left-sided and 46 (59.7%) right-sided pulmonary resections with sLND were performed; 19.57 ± 0.99 LNs were dissected. In 13 (16.9%) patients a nodal stage migration from preoperative clinical to postoperative pathological N-stage was observed [cN0 to pN1 in 9 (11.7%) and cN0 to pN2 in 4 (5.2%) cases]. In correlation to the clinical T-factor, the rate of N-factor upstaging for cT1 was 12.2% and for cT2a was 28.6%, respectively. In 50% of the patients with postoperative nodal staging shift, no changes were observed on re-evaluation of the preoperative FDG-PET/CT. CONCLUSION In this series of clinical stage I NSCLC patients, the rate of nodal stage migration after sLND by VATS is higher than previously reported. Prospective randomized controlled trials are needed to prove the oncologic quality of a sLND by VATS versus standard open approach.
Collapse
Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Street 7, 35392, Giessen, Germany.
| | - Dagmar Steiner
- Department of Nuclear Medicine, University Hospital of Giessen, Klinik Street 32, 35392, Giessen, Germany
| | - Stefanie Kerber
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Street 7, 35392, Giessen, Germany
| | - Julia Bender
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Street 7, 35392, Giessen, Germany
| | - Bernd Pösentrup
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Street 7, 35392, Giessen, Germany
| | - Andreas Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Street 7, 35392, Giessen, Germany
| | - Johannes Bodner
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Street 7, 35392, Giessen, Germany.,Department of Thoracic Surgery, Klinikum Bogenhausen, Englschalkinger Street 77, 81925, Munich, Germany.,Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| |
Collapse
|
|
30
|
Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg 2015; 15:38. [PMID: 25884998 PMCID: PMC4392751 DOI: 10.1186/s12893-015-0025-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 03/20/2015] [Indexed: 02/05/2023] Open
Abstract
Background This study aims to introduce an optimized method named “non-grasping en bloc mediastinal lymph node dissection (MLND)” through video-assisted thoracoscopic surgery (VATS). Methods Between February 2009 and July 2013, 402 patients with clinical stage I non-small cell lung cancer (NSCLC) underwent “non-grasping en bloc MLND” conducted by one surgical team. Target lymph nodes (LNs) were exposed following non-grasping strategy with simple combination of a metal endoscopic suction and an electrocoagulation hook or an ultrasound scalpel. In addition, dissection was performed following a stylized three-dimensional process according to the anatomic features of each station. Clinical and pathological data were prospectively collected and retrospectively reviewed. Results The postoperative morbidity and mortality were 17.4% (70/402) and 0.5% (2/402), respectively. The total number of LNs (N1 + N2) was 16.0 ± 5.9 (range of 5–52), while the number of N2 LNs was 9.5 ± 4.0 (range of 3–23). The incidences of postoperative upstaging from N0 to N1 and N2 disease were 7.7% and 12.2%, respectively. Conclusions Non-grasping en bloc MLND enables en bloc dissection of mediastinal LNs with comparable morbidity and oncological efficacy while saving troubles of excessive interference of instruments and potential damage to the target LN.
Collapse
|
|
31
|
Li Y, Wang J. Analysis of lymph node impact on conversion of complete thoracoscopic lobectomy to open thoracotomy. Thorac Cancer 2015; 6:704-8. [PMID: 26557907 PMCID: PMC4632921 DOI: 10.1111/1759-7714.12241] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/07/2015] [Indexed: 11/28/2022] Open
Abstract
Background The aim of the study was to analyze the influence of lymph nodes in conversion thoracotomy and its measurements. Method Between September 2006 to April 2013, 1006 patients (545 men, 461 women, median age 60 years, range: 13 to 86 years) received a complete thoracoscopic lobectomy. The main procedure was complete video-assisted anatomical lobectomy with mediastinal lymphadenectomy. Results All procedures were carried out smoothly without serious complication. Eighty-three cases were converted to thoracotomy (8.2%), including 70 cases of initiative conversion and 13 of passive conversion, in which 59 cases had interference by doornail lymph nodes. The average operative time was significantly longer (272.7 ± 67.2 vs. 186.9 ± 58.1 minutes, P = 0.001); the average blood loss was significantly increased (564.2 ± 507.7 ml vs. 158.0 ± 121.0 ml, P = 0.001); and the drainage time and postoperative hospital stay were significantly longer (8.9 ± 5.0 vs. 6.6 ± 3.5 days, P = 0.001; 12.5 ± 7.7 vs. 9.2 ± 5.8 days, P = 0.001, respectively) in the conversion thoracotomy compared with the complete endoscopic surgery group. Conclusion Interference of the lymph nodes was the main reason for conversion to thoracotomy on video-assisted thoracoscopic lobectomy, which prolonged operative time, increased the blood loss during surgery, and delayed postoperative recovery. Selecting the proper indication of conversion thoracotomy may reduce the negative effects.
Collapse
Affiliation(s)
- Yun Li
- Department of Thoracic Surgery, People's Hospital of Peking University Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, People's Hospital of Peking University Beijing, China
| |
Collapse
|
|
32
|
Zhang Z, Feng H, Wang X, Liang C, Liu D. Can lymph node evaluation be performed well by video-assisted thoracic surgery? J Cancer Res Clin Oncol 2015; 141:143-51. [PMID: 25085011 DOI: 10.1007/s00432-014-1785-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/18/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND A systemic review was performed to investigate whether video-assisted thoracic surgery (VATS) could achieve equivalent lymph node (LN) evaluation efficacy to thoracotomy. METHODS A comprehensive search of PubMed, EMBASE, and Cochrane was performed to identify studies comparing VATS and thoracotomy in LNs and node stations. Mean difference was calculated by Review Manager 5.0 software and Stata 12. RESULTS Twenty-four studies met the inclusion criteria of LN evaluation. 2,015 patients were involved in VATS group in contrast to 3,250 patients in thoracotomy group. The same number of total nodes stations (mean difference, 0.09; 95% CI -0.25 to 0.42; P = 0.61) and mediastinal node stations (mean difference, -0.11; 95% CI -0.24 to 0.01; P = 0.08) could be assessed by thoracotomy and VATS. The same number of N1 LNs (mean difference, -0.33; 95% CI -0.70 to 0.05; P = 0.09) could be assessed by both groups. While more total (mean difference, -1.41; 95% CI -1.99 to -0.83; P < 0.00001) and mediastinal LNs (mean difference, -1.03; 95% CI -1.81 to -0.24; P = 0.01) could be harvested by thoracotomy. CONCLUSION Outcome showed that the same number of total and mediastinal LN stations could be harvested by VATS and OT. The same number of N1 LNs could be harvested by VATS and OT, while less total and mediastinal LNs could be harvested by VATS.
Collapse
Affiliation(s)
- Zhenrong Zhang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China,
| | | | | | | | | |
Collapse
|
|
33
|
Exérèse chirurgicale des métastases pulmonaires de cancer colorectal : quelle stratégie en 2014 ? ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
|
34
|
Delgado Roel M, Fieira Costa EM, González-Rivas D, Fernández LM, Fernández Prado R, de la Torre M. Uniportal video-assisted thoracoscopic lymph node dissection. J Thorac Dis 2014; 6:S665-8. [PMID: 25379208 DOI: 10.3978/j.issn.2072-1439.2014.10.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/04/2014] [Indexed: 11/14/2022]
Abstract
Lymphadenectomy is an important part of lung cancer surgery. At the moment, video-assisted thoracoscopic (VATS) is the most common approach to remove these tumors, when it is technically possible. With our current experience in VATS in major resections we have obtained a radical videothoracoscopic mediastinal lymphadenectomy, and single-port provides us with the best anatomic instrumentation and a direct view.
Collapse
Affiliation(s)
- María Delgado Roel
- Department of Thoracic Surgery Coruña's University Hospital, La Coruña, Spain
| | | | | | | | | | | |
Collapse
|
|
35
|
Al-Shahrabani F, Vallböhmer D, Angenendt S, Knoefel WT. Surgical strategies in the therapy of non-small cell lung cancer. World J Clin Oncol 2014; 5:595-603. [PMID: 25302164 PMCID: PMC4129525 DOI: 10.5306/wjco.v5.i4.595] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/06/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023] Open
Abstract
Lung cancer represents the leading cause of cancer mortality worldwide. Despite improvements in preoperative staging, surgical techniques, neoadjuvant/adjuvant options and postoperative care, there are still major difficulties in significantly improving survival, especially in locally advanced non-small cell lung cancer (NSCLC). To date, surgical resection is the primary mode of treatment for stage I and II NSCLC and has become an important component of the multimodality therapy of even more advanced disease with a curative intention. In fact, in NSCLC patients with solitary distant metastases, surgical interventions have been discussed in the last years. Accordingly, this review displays the recent surgical strategies implemented in the therapy of NSCLC patients.
Collapse
|
|
36
|
Shao W, Liu J, Liang W, Chen H, Li S, Yin W, Zhang X, He J. Safety and feasibility of video-assisted thoracoscopic surgery for stage IIIA lung cancer. Chin J Cancer Res 2014; 26:418-22. [PMID: 25232214 DOI: 10.3978/j.issn.1000-9604.2014.08.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 08/06/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery (VATS) radical treatment for patients with stage IIIA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery. METHODS A total of 51 patients with radiologically or mediastinoscopically confirmed stage IIIA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher. RESULTS A total of 51 patients with non-small cell lung cancer (NSCLC) were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 (80.4%) had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 (98%) received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage (>1,000 mL), and the postoperative recovery was satisfactory. Up to 45 patients (88.2%) did not suffer from any perioperative complication, and 6 (11.8%) experienced one or more complications. CONCLUSIONS VATS radical treatment is a safe and feasible treatment for stage IIIA lung cancer.
Collapse
Affiliation(s)
- Wenlong Shao
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Jun Liu
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Wehua Liang
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Hanzhang Chen
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Shuben Li
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Weiqiang Yin
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Xin Zhang
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Jianxing He
- 1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| |
Collapse
|
|
37
|
Shao W, Xiong X, Chen H, Liu J, Yin W, Li S, Xu X, Zhang X, He J. Long-term survival outcomes of video-assisted thoracic surgery for patients with non-small cell lung cancer. Chin J Cancer Res 2014; 26:391-8. [PMID: 25232210 DOI: 10.3978/j.issn.1000-9604.2014.08.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/25/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer (NSCLC). However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. METHODS Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. RESULTS Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients (69%). The median 5-year overall survival for Stage I, II, III and IV disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. CONCLUSIONS VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectable NSCLC.
Collapse
Affiliation(s)
- Wenlong Shao
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Xinguo Xiong
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Hanzhang Chen
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Jun Liu
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Weiqiang Yin
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Shuben Li
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Xin Xu
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Xin Zhang
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| | - Jianxing He
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China
| |
Collapse
|
|
38
|
Hanna JM, Berry MF, D'Amico TA. Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open. J Thorac Dis 2014; 5 Suppl 3:S182-9. [PMID: 24040521 DOI: 10.3978/j.issn.2072-1439.2013.07.08] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/15/2013] [Indexed: 11/14/2022]
Abstract
Since the introduction of anatomic lung resection by video-assisted thoracoscopic surgery (VATS) was introduced 20 years ago, VATS has experienced major advances in both equipment and technique, introducing a technical challenge in the surgical treatment of both benign and malignant lung disease. The demonstrated safety, decreased morbidity, and equivalent efficacy of this minimally invasive technique has led to the acceptance of VATS as a standard surgical modality for early-stage lung cancer and increasing application to more advanced disease. However, only a minority of lobectomies are performed using the VATS technique, likely owing to concern for intraoperative complications. Optimal operative planning, including obtaining baseline pulmonary function tests with diffusion measurements, positron emission tomography and/or computed tomography scans, bronchoscopy, and endobronchial ultrasound or mediastinoscopy, can be used to anticipate and potentially prevent the occurrence of complications. With increasing focus on operative planning, as well as comfort and experience with the VATS technique, the indications for which this technique is used has grown. As such, the absolute contraindications have narrowed to inability to tolerate single lung ventilation, inability to achieve complete resection with lobectomy, T3 or T4 tumors, and N2 or N3 disease. However, as VATS lobectomy has been applied to more advanced stage disease, the rate of conversion to open thoracotomy has increased, particularly early in the surgeon's learning curve. Causes of conversion are generally classified into four categories: intraoperative complications, technical problems, anatomical problems, and oncological conditions. Though it is difficult to anticipate which patients may require conversion, it appears that these patients do not suffer from increased morbidity or mortality as a result of conversion to open thoracotomy. Therefore, with a focus on a safe and complete resection, conversion should be regarded as a means of completing resections in a traditional manner rather than as a surgical failure.
Collapse
Affiliation(s)
- Jennifer M Hanna
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | | | | |
Collapse
|
|
39
|
Begum S, Hansen HJ, Papagiannopoulos K. VATS anatomic lung resections-the European experience. J Thorac Dis 2014; 6 Suppl 2:S203-10. [PMID: 24868437 DOI: 10.3978/j.issn.2072-1439.2014.05.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 05/13/2014] [Indexed: 11/14/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) has undergone significant evolution over several decades. Although endoscopic instruments continued to improve, it was not until 1992 that the first VATS lobectomy for lung cancer was performed. Despite significant seeding of such procedure in several thoracic units globally, the uptake was slow and frustrating. Many surgeons considered it complex and unsafe being skeptic about its oncological validity. The last decade has witnessed significant change of practice in many thoracic units with a new generation of VATS thoracic surgeons. Additionally the technique has been refined, standardized and proved its validity and superiority in lung cancer treatment.
Collapse
Affiliation(s)
- Sofina Begum
- 1 St. James's University Hospital, Leeds, UK ; 2 Rigshospitalet, University of Copenhagen, Denmark
| | - Henrik Jessen Hansen
- 1 St. James's University Hospital, Leeds, UK ; 2 Rigshospitalet, University of Copenhagen, Denmark
| | - Kostas Papagiannopoulos
- 1 St. James's University Hospital, Leeds, UK ; 2 Rigshospitalet, University of Copenhagen, Denmark
| |
Collapse
|
|
40
|
Wang W, Yin W, Shao W, Jiang G, Wang Q, Liu L, Liu D, Wang Z, Zhu Z, Chen H, He J. Comparative study of systematic thoracoscopic lymphadenectomy and conventional thoracotomy in resectable non-small cell lung cancer. J Thorac Dis 2014; 6:45-51. [PMID: 24455175 DOI: 10.3978/j.issn.2072-1439.2014.01.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 01/06/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the feasibility and safety of the video-assisted thoracoscopy surgery (VATS) systematic lymph node dissection in resectable non-small cell lung cancer (NSCLC). METHODS The clinical data of patients with NSCLC who underwent VATS or thoracotomy combined with lobectomy and systematic lymphadenectomy from January 2001 to January 2008 were retrospectively analyzed to identify their demographic parameters, number of dissected lymph nodes and postoperative complications. RESULTS A total of 5,620 patients were enrolled in this study, with 2,703 in the VATS group, including 1,742 men (64.4%), and 961 women (35.6%), aged 59.5±10.9 years; and 2,917 in the thoracotomy group, including 2,163 men (74.2%), and 754 women (25.8%), aged 58.5±10.4 years. Comparing the VATS with the thoracotomy groups, the mean operative time was 146 vs. 157 min, with a significant difference (P<0.001); and the average blood loss was 162 vs. 267 mL, with a significant difference (P<0.001). Comparing the two groups of patients data, the number of lymph node dissection: 18.03 in the VATS group and 15.07 in the thoracotomy group on average, with a significant difference (P<0.001); postoperative drainage time: 4.5 days in the VATS group and 6.37 days in the thoracotomy group on average, with a significant difference (P<0.001); postoperative hospital stay: 6.5 days in the VATS group and 8.37 days in the thoracotomy group on average, with a significant difference (P<0.001); proportion of postoperative chylothorax: 0.2% (4/2,579) in the VATS group and 0.4% (10/2,799) in the thoracotomy group, without significant difference (P>0.05). CONCLUSIONS For patients with resectable NSCLC, VATS systematic lymph node dissection is safe and effective with fewer postoperative complications, and significantly faster postoperative recovery compared with traditional open chest surgery.
Collapse
Affiliation(s)
- Wei Wang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Weiqiang Yin
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Wenlong Shao
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai 200433, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China
| | - Zheng Wang
- Department of Thoracic Surgery, Shenzhen People's Hospital, Shenzhen 518020, China
| | - Zhihua Zhu
- Department of Thoracic Oncology, Cancer Center of Sun Yat-Sen University, Guangzhou 510060, China
| | - Hanzhang Chen
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China
| |
Collapse
|
|
41
|
Wang H, D'Amico TA. Efficacy of mediastinal lymph node dissection during thoracoscopic lobectomy. Ann Cardiothorac Surg 2013; 1:27-32. [PMID: 23977461 DOI: 10.3978/j.issn.2225-319x.2012.04.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 04/23/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Hanghang Wang
- Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27705, USA
| | | |
Collapse
|
|
42
|
Zhou W, Chen X, Zhang H, Zhang H, Zhao M. Video-assisted thoracic surgery lobectomy for unexpected pathologic N2 non-small cell lung cancer. Thorac Cancer 2013; 4:287-294. [PMID: 28920251 DOI: 10.1111/1759-7714.12015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 11/27/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
- Wenyong Zhou
- Department of Cardiovascular and Thoracic Surgery; East Hospital; Tongji University; Shanghai; China
| | - Xiaofeng Chen
- Department of Thoracic Surgery; Shanghai Pulmonary Hospital; Tongji University; Shanghai; China
| | - Huijun Zhang
- Department of Anesthesia; Shanghai Pulmonary Hospital; Tongji University; Shanghai; China
| | - Hui Zhang
- Department of Thoracic Surgery; Shanghai Pulmonary Hospital; Tongji University; Shanghai; China
| | - Mingchuan Zhao
- Department of Thoracic Surgery; Shanghai Pulmonary Hospital; Tongji University; Shanghai; China
| |
Collapse
|
|
43
|
Cho S, Song IH, Yang HC, Kim K, Jheon S. Predictive Factors for Node Metastasis in Patients With Clinical Stage I Non-Small Cell Lung Cancer. Ann Thorac Surg 2013; 96:239-45. [DOI: 10.1016/j.athoracsur.2013.03.050] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/15/2013] [Accepted: 03/22/2013] [Indexed: 10/26/2022]
|
|
44
|
Video-assisted thoracoscopic surgery for stage I non-small cell lung cancer: long-term survival and prognostic factors. Tumour Biol 2013; 34:3389-96. [DOI: 10.1007/s13277-013-0911-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022] Open
|
|
45
|
Robotic-assisted minimally invasive vs. thoracoscopic lung lobectomy: comparison of perioperative results in a learning curve setting. Langenbecks Arch Surg 2013; 398:895-901. [DOI: 10.1007/s00423-013-1090-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/27/2013] [Indexed: 10/26/2022]
|
|
46
|
Minimally invasive pulmonary surgery for lung cancer, up to date. Gen Thorac Cardiovasc Surg 2013; 61:449-54. [PMID: 23666809 DOI: 10.1007/s11748-013-0260-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Indexed: 10/26/2022]
Abstract
Recently, the minimally invasive surgical approach is an important issue in the pulmonary surgery. In this review, we present the current fashion of video-assisted thoracic surgery (VATS) and new approach including robotic lobectomy. There is no clear definition or standard for this surgical procedure regarding VATS lobectomy. Therefore, no randomized controlled trial of VATS and conventional lobectomy can be set up. Although the definition of VATS lobectomy is not straightforward, VATS lobectomy showed the technical feasibility of conventional lobectomy in mortality and postoperative complication as well as lymph node dissection. VATS procedure for advanced lung cancer is unclear whether such observations can be developed into a standardized approach. There are no reports to evaluate the advantages of robotic lobectomy in terms of treatment outcomes for lung cancer compared with VATS lobectomy. However, we believe that robotic lobectomy has clear potential to improve the quality of minimally invasive surgery.
Collapse
|
|
47
|
Oparka JD, Yan TD, Walker WS. Twenty years of video-assisted thoracoscopic surgery: The past, present, and future. Thorac Cancer 2013; 4:91-94. [PMID: 28920195 DOI: 10.1111/1759-7714.12017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jonathan D Oparka
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William S Walker
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
|
48
|
Zhong C, Yao F, Zhao H. Clinical Outcomes of Thoracoscopic Lobectomy for Patients With Clinical N0 and Pathologic N2 Non-Small Cell Lung Cancer. Ann Thorac Surg 2013; 95:987-92. [DOI: 10.1016/j.athoracsur.2012.10.083] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 10/24/2012] [Accepted: 10/31/2012] [Indexed: 11/29/2022]
|
|
49
|
Gonzalez-Rivas D. VATS lobectomy: surgical evolution from conventional VATS to uniportal approach. ScientificWorldJournal 2012; 2012:780842. [PMID: 23346022 PMCID: PMC3544256 DOI: 10.1100/2012/780842] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 11/29/2012] [Indexed: 11/17/2022] Open
Abstract
There is no standardized technique for the VATS lobectomy, though most centres use 2 ports and add a utility incision. However, the procedure can be performed by eliminating the two small ports and using only the utility incision with similar outcomes. Since 2010, when the uniportal approach was introduced for major pulmonary resection, the technique has been spreading worldwide. The single-port technique provides a direct view to the target tissue. The conventional triple port triangulation creates a new optical plane with genesis of dihedral or torsional angle that is not favorable with standard two-dimension monitors. The parallel instrumentation achieved during single-port approach mimics inside the maneuvers performed during open surgery. Furthermore, it represents the less invasive approach possible, and avoiding the use of trocar, we minimize the compression of the intercostal nerve. Further development of new technologies like sealing devices for all vessels and fissure, robotic arms that open inside the thorax, and wireless cameras will facilitate the uniportal approach to become the standard surgical procedure for pulmonary resection in most thoracic departments.
Collapse
Affiliation(s)
- Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Coruna University Hospital and Minimally Invasive Thoracic Surgery Unit, 15006 Coruna, Spain.
| |
Collapse
|
|
50
|
Jheon S, Yang HC, Cho S. Video-assisted thoracic surgery for lung cancer. Gen Thorac Cardiovasc Surg 2012; 60:255-60. [PMID: 22453533 DOI: 10.1007/s11748-011-0898-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Indexed: 02/08/2023]
Abstract
Video-assisted thoracic surgery (VATS) lobectomy is currently accepted as an appropriate procedure for selected patients with early-stage non-small-cell lung cancer (NSCLC). Evidence has demonstrated that VATS lobectomy is not only a safe and feasible technique, it provides better functional recovery and oncological efficacy similar to that achieved with conventional thoracotomy. However, there are still ongoing issues concerning VATS in terms of terminology, oncological efficacy, functional recovery, benefit of screening detected lung cancer, and its role in limited resection. As the number of VATS procedures are increasing and VATS is becoming a dominant procedural choice, it would be wise to collect evidence and come to a consensus to justify the expansion of surgical indications for VATS.
Collapse
Affiliation(s)
- Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, 166 Gumiro, Bundang, Seungnam, Gyeonggi, 463-707, Korea.
| | | | | |
Collapse
|