Modular dissection of mediastinal lymphadenectomy in uniportal video-assisted thoracoscopic surgery for radical resection of lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HAO Zhipeng , CAI Yixin , FU Shengling , ZHANG Ni ,  FU Xiangning

Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P.R.China;

Corresponding author：

FU Xiangning, Email: fuxn2006@aliyun.com

Keywords：

Uniportal surgery; video-assisted thoracoscopic surgery; lung cancer; mediastinal lymph node dissection

DOI：

10.7507/1007-4848.201607002

Video：

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Objective To investigate the effect of modular disscection of mediastinal lymphadenectomy in uniportal video-assisted thoracoscopic surgery (uniportal-VATS) for lung cancer radical resection and assess its safety and feasibility. Methods Data of 311 patients (171 males and 140 females, a mean age of 59.4±5.1 years) with non-small cell lung cancer (NSCLC) who received modular dissection of mediastinal lymphadenectomy in uniportal-VATS or three portal VATS (3P-VATS group) during March to December 2015 were retrospectively analyzed. There were 208 patients (110 males and 98 females, a mean age of 59.2±5.3 years) in the uniportal-VATS group and 103 patients (61 males and 42 femals, a mean age of 59.7±5.1 years) in the 3P-VATS group. The effects of lymph nodes (LNs) dissection and postoperative clinical data were compared between the two groups, especially for N2 LNs dissection. Results There were no perioperative death in two groups. The overall number of dissected stations and LNs in the uniportal-VATS group (7.3±1.0, 17.5±3.0) were similar with those in the 3P-VATS group (7.2±1.0, 17.7±2.7, P=0.208, P=0.596). The dissected stations (uniportal-VATS: 4.3±0.7, 3P-VATS: 4.3±0.6) and number (uniportal-VATS: 8.6±1.1, 3P-VATS: 8.5±1.1) of N2 LNs were both similar between the two groups (P=0.850, P=0.587). The chest tube duration and postoperative hospital stay of uniportal-VATS group (4.4±1.3 d and 9.2±0.9 d) were much shorter than those of 3P-VATS group (5.0±1.3 d and 9.8±2.0 d, both P<0.001). No significant difference was found in morbidity rate between the two groups (P>0.05). Conclusion Modular dissection of mediastinal lymphadenectomy could meet the requirment of radical resection and it is a safe and valid method which could be used during uniportal-VATS for radical resection of lung cancer.

Citation： HAO Zhipeng, CAI Yixin, FU Shengling, ZHANG Ni, FU Xiangning. Modular dissection of mediastinal lymphadenectomy in uniportal video-assisted thoracoscopic surgery for radical resection of lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(7): 527-532. doi: 10.7507/1007-4848.201607002 Copy

1.	Vielva LR, Jaen MW, Alcacer JA, et al. State of the art in surgery for early stage NSCLC-does the number of resected lymph nodes matter? Transl Lung Cancer Res, 2014, 3(2): 95-99.
2.	Bria E, Milella M, Sperduti I, et al. A novel clinical prognostic score incorporating the number of resected lymph-nodes to predict recurrence and survival in non-small-cell lung cancer. Lung Cancer, 2009, 66(3): 365-371.
3.	D'Amico TA, Niland J, Mamet R, et al. Efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy. Ann Thorac Surg, 2011, 92(1): 226-231.
4.	Denlinger CE, Fernandez F, Meyers BF, et al. Lymph node evaluation in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy. Ann Thorac Surg, 2010, 89(6): 1730-1735.
5.	Ramos R, Girard P, Masuet C, et al. Mediastinal lymph node dissection in early-stage non-small cell lung cancer: totally thoracoscopic vs thoracotomy. Eur J Cardiothorac Surg, 2012, 41(6): 1342-1348.
6.	Watanabe A, Mishina T, Ohori S, et al. Is video-assisted thoracoscopic surgery a feasible approach for clinical N0 and postoperatively pathological N2 non-small cell lung cancer? Eur J Cardiothorac Surg, 2008, 33(5): 812-818.
7.	Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
8.	Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg, 2011, 12(3): 514-515.
9.	Chung JH, Choi YS, Cho JH, et al. Uniportal video-assisted thoracoscopic lobectomy: an alternative to conventional thoracoscopic lobectomy in lung cancer surgery? Interact Cardiovasc Thorac Surg, 2015, 20(6): 813-819.
10.	Shen Y, Wang H, Feng M, et al. Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study. Eur J Cardiothorac Surg, 2016, 49 Suppl 1: i48-i53.
11.	支修益, 石远凯, 于金明. 中国原发性肺癌诊疗规范(2015 年版). 中华肿瘤杂志, 2015, 37(1): 67-78.
12.	Rami-Porta R, Wittekind C, Goldstraw P, et al. Complete resection in lung cancer surgery: proposed definition. Lung Cancer, 2005, 49(1): 25-33.
13.	Mier JM, Chavarin A, Izquierdo-Vidal C, et al. A prospective study comparing three-port video-assisted thoracoscopy with the single-incision laparoscopic surgery (SILS) port and instruments for the video thoracoscopic approach: a pilot study. Surg Endosc, 2013, 27(7): 2557-2560.
14.	Chen CH, Lee SY, Chang H, et al. The adequacy of single-incisional thoracoscopic surgery as a first-line endoscopic approach for the management of recurrent primary spontaneous pneumothorax: a retrospective study. J Cardiothorac Surg, 2012, 7: 99.
15.	Tamura M, Shimizu Y, Hashizume Y. Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg, 2013, 8: 153.

1. Vielva LR, Jaen MW, Alcacer JA, et al. State of the art in surgery for early stage NSCLC-does the number of resected lymph nodes matter? Transl Lung Cancer Res, 2014, 3(2): 95-99.
2. Bria E, Milella M, Sperduti I, et al. A novel clinical prognostic score incorporating the number of resected lymph-nodes to predict recurrence and survival in non-small-cell lung cancer. Lung Cancer, 2009, 66(3): 365-371.
3. D'Amico TA, Niland J, Mamet R, et al. Efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy. Ann Thorac Surg, 2011, 92(1): 226-231.
4. Denlinger CE, Fernandez F, Meyers BF, et al. Lymph node evaluation in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy. Ann Thorac Surg, 2010, 89(6): 1730-1735.
5. Ramos R, Girard P, Masuet C, et al. Mediastinal lymph node dissection in early-stage non-small cell lung cancer: totally thoracoscopic vs thoracotomy. Eur J Cardiothorac Surg, 2012, 41(6): 1342-1348.
6. Watanabe A, Mishina T, Ohori S, et al. Is video-assisted thoracoscopic surgery a feasible approach for clinical N0 and postoperatively pathological N2 non-small cell lung cancer? Eur J Cardiothorac Surg, 2008, 33(5): 812-818.
7. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
8. Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg, 2011, 12(3): 514-515.
9. Chung JH, Choi YS, Cho JH, et al. Uniportal video-assisted thoracoscopic lobectomy: an alternative to conventional thoracoscopic lobectomy in lung cancer surgery? Interact Cardiovasc Thorac Surg, 2015, 20(6): 813-819.
10. Shen Y, Wang H, Feng M, et al. Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study. Eur J Cardiothorac Surg, 2016, 49 Suppl 1: i48-i53.
11. 支修益, 石远凯, 于金明. 中国原发性肺癌诊疗规范(2015 年版). 中华肿瘤杂志, 2015, 37(1): 67-78.
12. Rami-Porta R, Wittekind C, Goldstraw P, et al. Complete resection in lung cancer surgery: proposed definition. Lung Cancer, 2005, 49(1): 25-33.
13. Mier JM, Chavarin A, Izquierdo-Vidal C, et al. A prospective study comparing three-port video-assisted thoracoscopy with the single-incision laparoscopic surgery (SILS) port and instruments for the video thoracoscopic approach: a pilot study. Surg Endosc, 2013, 27(7): 2557-2560.
14. Chen CH, Lee SY, Chang H, et al. The adequacy of single-incisional thoracoscopic surgery as a first-line endoscopic approach for the management of recurrent primary spontaneous pneumothorax: a retrospective study. J Cardiothorac Surg, 2012, 7: 99.
15. Tamura M, Shimizu Y, Hashizume Y. Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg, 2013, 8: 153.

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Modular dissection of mediastinal lymphadenectomy in uniportal video-assisted thoracoscopic surgery for radical resection of lung cancer

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