Video-assisted thoracic surgery versus open lobectomy for cN0-pN2 lung cancer patients: single center case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Hanyue , HUANG Jia , LIN Hao ,  LUO Qingquan

Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, P.R.China;

Corresponding author：

LUO Qingquan, Email: luoqingquan@hotmail.com

Keywords：

Lung cancer; occult N2; video-assisted thoracic surgery

DOI：

10.7507/1007-4848.201702014

Video：

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Objective To investigate the efficacy, early and late outcomes of video-assisted thoracic surgery (VATS) for cN0-pN2 lung cancer patients compared to open lobectomy. Methods We retrospectively reviewed 262 out of 1 754 patients’ clinical records with cN0-pN2 lung cancer who underwent VATS or open lobectomy in our center between January 2009 and December 2014. There were 107 patients in a VATS group with 50 males and 57 females at the age of 61.5±10.7 years, and 155 patients in an open lobectomy group consisting of 104 males and 51 females at the age of 59.0±8.7 years. Results There was no statistical difference in patients’ age, pulmonary function, and underlying diseases between two groups. Operation time was shorter in the open lobectomy group than that in the VATS group (P=0.044). Postoperative in-hospital time was shorter in the VATS surgery group than that in the open lobectomy group (P=0.008). There was an obvious difference in tumor’s maximum diameter (P<0.05). As for mediatinal lymph node, there was no statistical difference in station dissected and positive rate. One year overall survival rate was 91.6% in the VATS group and 81.9% in the open group. Three-year overall survival rate was 58.3% in the VATS group and 47.3% in the open lobectomy group (P<0.05). Conclusion VATS can achieve both the thoroughness and feasibility as the same as open surgery and with better early outcomes. The overall survival rate may have more to do with tumor’s maximum diameter, not the operation method. Still, it needs prospective studies to demonstrate this relationship.

Citation： LI Hanyue, HUANG Jia, LIN Hao, LUO Qingquan. Video-assisted thoracic surgery versus open lobectomy for cN0-pN2 lung cancer patients: single center case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(6): 439-444. doi: 10.7507/1007-4848.201702014 Copy

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3.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115.
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5.	Roviaro G, Varoli F, Vergani C, et al. Long-term survival after videothoracoscopic lobectomy for stage I lung cancer. Chest, 2004, 126(3): 725-732.
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7.	Hanna WC, Valence MD, Atenafu EG, et al. Is video-assisted lobectomy for non-small-cell lung cancer oncologically equivalent to open lobectomy? Eur J Cardiothorac Surg, 2013, 43(6): 1121.
8.	Kim SH, Kim HK, Choi YS, et al. Pleural recurrence and long-term survival after thoracotomy and thoracoscopic lobectomy. Ann Thorac Surg, 2013, 96(5): 1769-1775.
9.	Higuchi M, Yaginuma H, Yonechi A, et al. Long-term outcomes after video-assisted thoracic surgery (VATS) lobectomy versus lobectomy via open thoracotomy for clinical stage ⅠA non-small cell lung cancer. J Cardiothorac Surg, 2014, 9(1): 88.
10.	Dziedzic D, Orlowski T. The role of vats in lung cancer surgery: current status and prospects for development. Minim Invasive Surg, 2015, 2015: 938430.
11.	Shiraishi T, Hiratsuka M, Yoshinaga Y, et al. Thoracoscopic lobectomy with systemic lymph node dissection for lymph node positive non-small cell lung cancer——is thoracoscopic lymph node dissection feasible? Thorac Cardiovasc Surg, 2008, 56(3): 162-166.
12.	Yu Y, Jian H, Shen L, et al. Lymph node involvement influenced by lung adenocarcinoma subtypes in tumor size ≤3 cm disease: A study of 2268 cases. Eur J Surg Oncol, 2016, 42(11): 1714-1719.
13.	黄佳, 赵晓菁, 林皓, 等. 单向四孔法全胸腔镜肺叶切除术治疗非小细胞肺癌的临床研究. 中国胸心血管外科临床杂志, 2012, 19(2): 125-129.
14.	李雪娇, 许庆珍, 肖洪玲, 等. 胸腔镜与开胸肺叶切除术后患者慢性疼痛的对比研究. 临床肺科杂志, 2016, 21(8): 1372-1374.
15.	Ichinose Y, Kato H, Koike T, et al. Overall survival and local recurrence of 406 completely resected stage Ⅲa-N2 non-small cell lung cancer patients: Questionnaire survey of the Japan Clinical Oncology Group to plan for clinical trials. Lung Cancer, 2001, 34(1): 29-36.
16.	Zhong W, Yang X, Bai J, et al. Complete mediastinal lymphadenectomy: the core component of the multidisciplinary therapy in resectable non-small cell lung, cancer. Eur J Cardiothorac Surg, 2008, 34(1): 187-195.
17.	Yano T, Fukuyama Y, Yokoyama H, et al. Long-term survivors with pN2 non-small cell lung cancer after a complete resection with a systematic mediastinal node dissection. Eur J Cardiothorac Surg, 1998, 14(2): 152-155.
18.	李凤卫, 姜冠潮, 李运, 等. 全胸腔镜与开胸肺叶切除治疗 cN0-pN2 非小细胞肺癌效果初步比较. 北京大学学报医学版, 2011, 43(6): 861-865.
19.	Wang S, Zhou W, Hui Z, et al. Feasibility and long-term efficacy of video-assisted thoracic surgery for unexpected pathologic N2 disease in non-small cell lung cancer. Ann Thorac Med, 2013, 8(3): 170-175.
20.	李标, 林伟民, 李富, 等. 胸腔镜下切除术与传统开胸术对肺叶切除术中发现微小淋巴结转移患者预后的影响比较. 医学临床研究, 2014, 31(2): 290-292.
21.	Lee HS, Jang HJ. Thoracoscopic mediastinal lymph node dissection for lung cancer. Semin Thorac Cardiovasc Surg, 2012, 24(1): 68-73.
22.	Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg, 2015, 15(1): 38.
23.	Rami-Porta R, Bolejack V, Crowley J, et al. The IASLC lung cancer staging project: proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(7): 990-1003.

1. Wu YL, Huang ZF, Wang SY, et al. A randomized trial of systemic nodal dissection in resectable non-small cell lung cancer. Lung Cancer, 2002, 36(1): 1-6.
2. Ferlay J, Shin H R, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Inter J Cancer, 2010, 127(12): 2893-917.
3. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115.
4. Baltayiannis N, Chandrinos M, Anagnostopoulos D, et al. Lung cancer surgery: an up to date. J Thorac Dis, 2013, 5(Suppl 4): S425-S439.
5. Roviaro G, Varoli F, Vergani C, et al. Long-term survival after videothoracoscopic lobectomy for stage I lung cancer. Chest, 2004, 126(3): 725-732.
6. Hansen HJ, Petersen RH. A video-atlas of video-assisted thoracoscopic lobectomy using a standardized three-port anterior approach. Ann Cardiothorac Surg, 2012, 1(1): 104.
7. Hanna WC, Valence MD, Atenafu EG, et al. Is video-assisted lobectomy for non-small-cell lung cancer oncologically equivalent to open lobectomy? Eur J Cardiothorac Surg, 2013, 43(6): 1121.
8. Kim SH, Kim HK, Choi YS, et al. Pleural recurrence and long-term survival after thoracotomy and thoracoscopic lobectomy. Ann Thorac Surg, 2013, 96(5): 1769-1775.
9. Higuchi M, Yaginuma H, Yonechi A, et al. Long-term outcomes after video-assisted thoracic surgery (VATS) lobectomy versus lobectomy via open thoracotomy for clinical stage ⅠA non-small cell lung cancer. J Cardiothorac Surg, 2014, 9(1): 88.
10. Dziedzic D, Orlowski T. The role of vats in lung cancer surgery: current status and prospects for development. Minim Invasive Surg, 2015, 2015: 938430.
11. Shiraishi T, Hiratsuka M, Yoshinaga Y, et al. Thoracoscopic lobectomy with systemic lymph node dissection for lymph node positive non-small cell lung cancer——is thoracoscopic lymph node dissection feasible? Thorac Cardiovasc Surg, 2008, 56(3): 162-166.
12. Yu Y, Jian H, Shen L, et al. Lymph node involvement influenced by lung adenocarcinoma subtypes in tumor size ≤3 cm disease: A study of 2268 cases. Eur J Surg Oncol, 2016, 42(11): 1714-1719.
13. 黄佳, 赵晓菁, 林皓, 等. 单向四孔法全胸腔镜肺叶切除术治疗非小细胞肺癌的临床研究. 中国胸心血管外科临床杂志, 2012, 19(2): 125-129.
14. 李雪娇, 许庆珍, 肖洪玲, 等. 胸腔镜与开胸肺叶切除术后患者慢性疼痛的对比研究. 临床肺科杂志, 2016, 21(8): 1372-1374.
15. Ichinose Y, Kato H, Koike T, et al. Overall survival and local recurrence of 406 completely resected stage Ⅲa-N2 non-small cell lung cancer patients: Questionnaire survey of the Japan Clinical Oncology Group to plan for clinical trials. Lung Cancer, 2001, 34(1): 29-36.
16. Zhong W, Yang X, Bai J, et al. Complete mediastinal lymphadenectomy: the core component of the multidisciplinary therapy in resectable non-small cell lung, cancer. Eur J Cardiothorac Surg, 2008, 34(1): 187-195.
17. Yano T, Fukuyama Y, Yokoyama H, et al. Long-term survivors with pN2 non-small cell lung cancer after a complete resection with a systematic mediastinal node dissection. Eur J Cardiothorac Surg, 1998, 14(2): 152-155.
18. 李凤卫, 姜冠潮, 李运, 等. 全胸腔镜与开胸肺叶切除治疗 cN0-pN2 非小细胞肺癌效果初步比较. 北京大学学报医学版, 2011, 43(6): 861-865.
19. Wang S, Zhou W, Hui Z, et al. Feasibility and long-term efficacy of video-assisted thoracic surgery for unexpected pathologic N2 disease in non-small cell lung cancer. Ann Thorac Med, 2013, 8(3): 170-175.
20. 李标, 林伟民, 李富, 等. 胸腔镜下切除术与传统开胸术对肺叶切除术中发现微小淋巴结转移患者预后的影响比较. 医学临床研究, 2014, 31(2): 290-292.
21. Lee HS, Jang HJ. Thoracoscopic mediastinal lymph node dissection for lung cancer. Semin Thorac Cardiovasc Surg, 2012, 24(1): 68-73.
22. Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg, 2015, 15(1): 38.
23. Rami-Porta R, Bolejack V, Crowley J, et al. The IASLC lung cancer staging project: proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(7): 990-1003.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Video-assisted thoracic surgery versus open lobectomy for cN0-pN2 lung cancer patients: single center case control study

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