Total Videothoracoscopic Lobectomy Versus Open Thoracotomy for Early-Stage Non–Small-Cell Lung Cancer (original) (raw)
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SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2020
M any centers worldwide perform lobectomy by video-assisted thoracoscopic surgery (VATS) as an alternative to open thoracotomy in suitable cases, especially in early stage non-small cell lung cancer (NSCLC) cases. [1] According to many studies, the advantages of VATS lobectomy compared to conventional open thoracotomy include shorter length of hospitalization, less postoperative complications, shorter duration of the chest tube, a more cosmetic incision, less postoperative pain, therefore better postoperative life quality and importantly similar overall survival rates compared to open thoracotomy. [2-4] VATS resections have become increasingly popular worldwide following the improvements in training programmes, drawing young surgeons' interest in VATS lobectomy, leading to increased experience. [5] In our Thoracic Surgery Clinic, VATS lobectomy is being performed since the beginning of the 2010s. VATS experience of Objectives: This study aims to compare the outcomes of video-assisted thoracoscopic surgery (VATS) lobectomy with open thoracotomy lobectomy in patients with non-small cell lung cancer (NSCLC). Methods: There were 269 cases with NSCLC who underwent lobectomy between 2017-2019; these cases were retrospectively studied. VATS lobectomy (VATS Group) and open thoracotomy lobectomy (Thoracotomy Group) patients' results were compared according to the length of hospitalizations, early postoperative complications and tumor size and stages. Results: VATS lobectomy was performed in 89 (33%) of these patients, whereas 180 (67%) patients underwent lobectomy using open thoracotomy for NSCLC. The findings showed that the average length of hospitalization was shorter in the VATS Group compared to the Thoracotomy Group (4 vs. 5.5 days) (p<0.05). It was found that the mean size of the tumour was smaller in the VATS Group when compared to the Thoracotomy Group (2.66 cm vs 3.97 cm) (p<0.001). Early postoperative complications were lower in the VATS Group (n=15, 16.8% vs n=58, 32.2%; p<0.021). Conclusion: In VATS lobectomy cases, postoperative complications are less, and the length of hospitalization is shorter. VATS lobectomy is mostly preferred smaller than 3 cm tumor size.
Journal of cardiothoracic surgery, 2014
Video-assisted thoracic surgery (VATS) lobectomy is a standard treatment for lung cancer. This study retrospectively compared long-term outcomes after VATS lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer (NSCLC). From July 2002 to June 2012, 160 patients were diagnosed with clinical stage IA NSCLC and underwent lobectomy. Of these, 114 underwent VATS lobectomy and 46 underwent lobectomy via open thoracotomy. The 5-year disease-free survival (DFS) rate was 88.0% in the VATS group and 77.1% in the thoracotomy group for clinical stage IA NSCLC (p = 0.1504), and 91.5% in the VATS group and 93.8% in the thoracotomy group for pathological stage IA NSCLC (p = 0.2662). The 5-year overall survival (OS) rate was 94.1% in the VATS group and 81.8% in the thoracotomy group for clinical stage IA NSCLC (p = 0.0268), and 94.8% in the VATS group and 96.2% in the thoracotomy group for pathological stage IA NSCLC (p = 0.5545). The rate of accurate preop...
Thoracoscopic versus open lobectomy: short-term outcomes
Shanghai Chest
Video-assisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage nonsmall cell lung cancer (NSCLC) has spread worldwide and it has become a safe and viable alternative to thoracotomy. The aim of this review was to analyse the evidence presents in the current literature in order to assess the safety and efficacy of VATS versus open lobectomy, in terms of short-term outcomes. To identify relevant articles for inclusion in our analysis, we performed a search of PubMed/Medline database. We looked for randomized controlled trials, case series and comparative studies that reported outcomes following VATS or open lobectomy for NSCLC. Morbidity rates are reduced to 7.7-24.1% and mortality to 0.8-2.5% by the VATS approach. The reported lower morbidity rates included less intraoperative bleeding; shorter duration of air leak; lower incidence of post-operative pneumonia, atelectasis requiring bronchoscopy and atrial fibrillation. Furthermore, VATS lobectomy showed shorter chest tube duration; shorter length of hospital stays; reduced post-operative pain and inflammation; a better pulmonary function in the early post-operative phase, when compared with thoracotomy. Summarizing, thoracoscopic approach represents a valid alternative technique to treat NSCLC compared with standard thoracotomy; it offers patients a faster recovery and a better quality of life and allows high-risk patients to benefit from curative surgical treatment. VATS lobectomy might become the choice surgical approach for early-stage NSCLC.
Thoracoscopic lobectomy for the management of non-small cell lung cancer
Current Oncology Reports, 2008
Surgical resection is the primary treatment for earlystage non-small cell lung cancer (NSCLC). While open thoracotomy is the most frequently performed approach for lobectomy, minimally invasive surgical resection is a safe and viable alternative. Thoracoscopic lobectomy, also termed video-assisted thoracoscopic surgery lobectomy , is defi ned as the anatomic resection of an entire lobe of the lung-including mediastinal lymph node dissection-using a thoracoscope and an access incision without using a mechanical retractor and spreading of the ribs. As the procedure has evolved and been studied, thoracoscopic lobectomy has been demonstrated to be a safe and oncologically effective strategy in the surgical management of patients with stage I or II NSCLC, as well as selected patients with stage III NSCLC after induction therapy. Advantages of this approach include less postoperative pain, shorter chest tube duration and subsequent length of stay, fewer overall complications, better compliance with adjuvant chemotherapy, faster return to full activity, and greater preservation of pulmonary function.
The Journal of Thoracic and Cardiovascular Surgery, 2006
Background: Although video-assisted thoracic surgery (VATS) has been in use for more than a decade, its application to major lung resection for lung cancer is still not widely practiced. The success of a cancer operation is judged by the long-term survival of the treated patients. Therefore, the goal of the present study was to evaluate long-term outcomes associated with various video-assisted lobectomy techniques and conventional surgery in patients with peripheral non-small cell lung cancer less than or equal to 2 cm in diameter (stage IA).
Thoracoscopic lobectomy for stage I non-small cell lung cancer
Seminars in thoracic and cardiovascular surgery, 2010
Lobectomy via video-assisted thoracoscopic surgery (VATS) has a lower rate of morbidity and is less immunosuppressive than open lobectomy. Compared with open lobectomy, VATS lobectomy appears to have equivalent oncological results. We review the literature on perioperative outcomes, biological impact, and oncological results. Most published reports to date--although retrospective--suggest significant perioperative advantages to VATS lobectomy over open lobectomy. Data on acute phase reactants and cellular immunity show that VATS lobectomy causes less of an inflammatory response and is less immunosuppressive than open lobectomy. Mid- to long-term oncological results of patients with early-stage non-small cell lung cancer (NSCLC) appear to be equivalent for VATS and open lobectomy. Clinical evidence indicates that VATS lobectomy for early-stage NSCLC is associated with fewer postoperative complications and less negative biological impact than open lobectomy. Furthermore, all data to d...
The Annals of Thoracic Surgery, 2013
Background. Video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC) is increasingly popular. However, the oncologic soundness of VATS for patients with NSCLC as measured by longterm survival has not been proven. The objective here is to determine the overall survival (OS) and disease-free survival (DFS) in two well-matched groups of patients with NSCLC resected by VATS or thoracotomy. Methods. We conducted a retrospective review of a prospective database to identify patients who had a lobectomy for NSCLC. A propensity score-matched analysis was done with variables of age, sex, smoking history, Charlson comorbidity index, forced expiratory volume in 1 second, lung diffusing capacity for carbon monoxide, histology, and clinical T and N status. Medical records were reviewed and survival was analyzed. Results. After matching, there were 208 patients in each group. Patient and tumor characteristics were similar. The VATS group had a shorter length of stay.
Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer
The Journal of Thoracic and Cardiovascular Surgery, 2009
Background: The optimal surgical technique for lobectomy in lung cancer is not well defined. Proponents of video-assisted thoracic surgery (VATS) hypothesize that less trauma leads to quicker recovery, whereas those who advocate thoracotomy claim it as an oncologically superior procedure. However, a well-balanced comparison of the two procedures is lacking in the literature.
Interactive Cardiovascular and Thoracic Surgery, 2004
The use of video-assisted thoracic surgery (VATS) for carrying out major pulmonary resections in the treatment of lung cancer is still controversial. In order to contribute to knowledge about the long term results obtained with this technique in the treatment of stage I NSCLC, we present data relating to research in our institute over the past 10 years. From January 1993 to December 2002, 138 patients with peripheral clinical stage I NSCLC were selected to undergo VATS lobectomy. The procedure was based on a mini-thoracotomy without rib spreading, with hilar dissection and separate sectioning of the arteries, veins and bronchi; this was associated with hilar and mediastinal lymph-node sampling. Follow-up consisted of clinical and radiological examination every 6 months in the first 2 years after surgery, then once a year; a CT scan was carried out 1, 3 and 5 years after surgery. The probability of survival was estimated with the Kaplan-Meier method. Surgery by VATS was successfully completed in 122 cases, with a thoracotomy conversion rate of 11.6%. Of these, stage I was confirmed by pathological examination in only 104 cases: there were 56 T1N0 and 48 T2N0. With a mean follow-up of 65 months, the 5-year survival rate was found to be 67^10%; in the T1N0 it was 68^15 %, whereas in the T2N0 it was 67^16%. The rate of local or regional recurrence was 4.8% while the systemic recurrence rate was 15.4%. From an appraisal of the study results we consider VATS to be a valid approach for carrying out lobectomy for the treatment of stage I pulmonary carcinoma. The long-term results are comparable to those obtained in open surgery both in terms of survival and the rate of local recurrence. Therefore in selected cases, where there is no increase in surgical risk, VATS may be the preferred approach.
Thoracoscopic lobectomy for lung cancer in challenging cases: technical aspects
Current Challenges in Thoracic Surgery
Over the last years, in the management of patients with early stage non-small cell lung cancer (NSCLC), video-assisted thoracoscopic surgery (VATS) lobectomy has been considered an optimal alternative to conventional thoracotomy and several studies have demonstrated his superiority over open lobectomy in terms of peri-operative outcomes. Nowadays, increased experience and technological advancements in minimally invasive thoracic surgery are leading surgeons to deal with more complex cases and some conditions as chest wall involvement or previous cardio-thoracic surgery are no longer considered an absolute contraindication to VATS lobectomy. Advanced thoracoscopic skills are required to perform N1 nodal dissection that can be challenging in presence of bulky lymphadenopathy or extracapsular invasion by metastatic lymph nodes.