Clinical Outcome of Complete Video-assisted Thoracoscopic Surgery Lobectomy for Patients with Early-stage Non-small Cell Lung Cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Wei , XI Junjie , WANG Hao

Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;

Corresponding author：

Keywords：

Video-assisted thoracoscopic surgery; Non-small cell lung cancer; Lobectomy

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Abstract： Objective To evaluate the safety, feasibility, and clinical outcome of complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage non-small cell lung cancer （NSCLC）. Methods We retrospectively analyzed the clinical data of 160 consecutive patients（the VATS group, 83 males and 77 females with average age at 60.8 years）with early-stage NSCLC who underwent complete VATS lobectomy between January 2005 andDecember 2008 in Zhongshan Hospital of Fudan University，and compared them with 357 patients（the thoracotomy group, 222 males and 135 females with average age at 59.5 years）who underwent open thoracotomy in the same period. Results The conversion rate of the VATS group was 5.0%（8/160）. The operation time of the VATS group was significantly shorter than that of the thoracotomy group（113.0 min vs.125.0 min, P=0.039）. Length of postoperative hospital stay was not statistically different between the two groups（10.3±4.3 d vs.9.1±4.6 d，P=0.425）. The postoperative morbidity of the VATS lobectomy group and the thoracotomy group was 9.4%（15/160）and 10.1% （36/357） respectively，and the postoperative mortality of the two groups was 0.6%（1/160）and 2.0%（7/357）respectively. There was no statistical difference in the mean group of lymph node dissection （2.4±1.5 groups vs.2.4±1.7 groups，P=0.743） and the mean number of lymph node dissection （9.8±6.3 vs.10.1±6.4，P=0.626） between the two groups. The overall 5-year survival rate of the VATS group was significantly higher than that of the thoracotomy group （81.5% vs.67.8%, P=0.001）. Subgroup analysis showed that the 5-year survival rate of pⅠa stage, pⅠb stage, and pⅢa stage was 86.0%, 84.5%, and 58.8% respectively in the VATS group, and 92.9%, 76.4%, and 25.3% respectively in the thoracotomy group. Conclusion Complete VATS lobectomy is technically safe and feasible for patients with early-stage NSCLC. The lymph node dissection extension of complete VATS lobectomy is similar to that of open thoracotomy, and long-term outcome of complete VATS lobectomy is superior to that of open thoracotomy. Randomized controlled trials of large sample size are further needed to demonstrate superiority.

Citation： JIANG Wei,XI Junjie,WANG Hao,et al .. Clinical Outcome of Complete Video-assisted Thoracoscopic Surgery Lobectomy for Patients with Early-stage Non-small Cell Lung Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(2): 120-124. doi: Copy

1.	?2 何健行, 刘会平, 杨运有. 电视胸腔镜肺癌根治术5年临床疗效. 中国胸心血管外科临床杂志, 2002, 9（1）：29-31.
2.	?3 王述民, 曲家骐, 侯维平, 等. 电视胸腔镜肺叶切除术454例临床分析. 临床军医杂志, 2010, 38（4）：641-642.
3.	?4 刘伦旭, 周清华, 车国卫, 等. 电视胸腔镜在肺癌手术治疗中的应用. 中国肺癌杂志, 2004, 7（5）：431-433.
4.	?5 张轶, 姜格宁, 朱余明, 等. 电视胸腔镜肺叶切除术临床疗效分析. 第二军医大学学报, 2010, 31（7）：770-774.
5.	?6 张真榕, 刘德若, 郭永庆, 等. 248例胸腔镜肺叶切除术手术心得. 中国肺癌杂志, 2011, 14（6）：523-528.
6.	?7 谭黎杰, 王群, 徐正浪, 等. 肺叶切除几种微创术式比较. 中华胸心血管外科杂志, 2005, 21（2）：78-79.
7.	?8 Flores RM. Video-assisted thoracic surgery （VATS） lobectomy：.
8.	focus on technique. World J Surg, 2010, 34（4）：616-620.
9.	?9 Onaitis MW, Petersen RP, Balderson SS, et al. Thoracoscopic lobectomy is a safe and versatile procedure： experience with 500 consecutive patients. Ann Surg, 2006, 244（3）：420-425.
10.	can VATS lobectomy be taught? Eur J Cardiothorac Surg, 2006, 29（5）：806-809.
11.	杨帆, 李晓, 王俊, 等. 连续300例全胸腔镜肺叶切除术及中期随访分析. 中国胸心血管外科临床杂志, 2011, 18（2）：95-98.
12.	McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy： experience with 1,100 cases. Ann Thorac Surg, 2006, 81（2）：421-426.
13.	Kim K, Kim HK, Park JS, et al. Video-assisted thoracic surgery lobectomy： single institutional experience with 704 cases. Ann Thorac Surg, 2010, 89（6）：S2118-2122.
14.	Ichinose J, Kohno T, Fujimori S, et al. Locoregional control of thoracoscopic lobectomy with selective lymphadenectomy for lung cancer. Ann Thorac Surg, 2010, 90（1）：235-239.
15.	Swanson SJ, Herndon JE 2nd, D’Amico TA, et al. Video-assisted thoracic surgery lobectomy ： report of CALGB 39802— a prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25（31）：4993-4997.
16.	Rueth NM, Andrade RS. Is VATS lobectomy better： perioperatively, biologically and oncologically? Ann Thorac Surg, 2010, 89（6）：S2107-2111.
17.	Park BJ. Is surgical morbidity decreased with minimally invasive lobectomy? Cancer J, 2011, 17（1）：18-22.
18.	Whitson BA, Groth SS, Duval SJ, et al. Surgery for early-stage non-small cell lung cancer： a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg, 2008, 86（6）：2008-2018.
19.	Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27（15）：2553-2562.
20.	Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy： a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139（2）：366-378.
21.	Ferquson J, Walker W. Developing a VATS lobectomy programme——.
22.	李运, 杨帆, 刘彦国, 等. 全胸腔镜肺叶切除术中转开胸手术指征的探讨. 中国胸心血管外科临床杂志, 2010, 17（1）：32-35.
23.	Ludwig MS, Goodman M, Miller DL, et al. Postoperative survival and the number of lymph nodes sampled during resection of node-negative non-small cell lung cancer. Chest, 2005, 128（3）：1545-1550.
24.	Defranchi SA, Cassivi SD, Nichols FC, et al. N2 Disease in T1 non-small cell lung cancer. Ann Thorac Surg, 2009, 88（3）： 924-928.
25.	Inoue M, Minami M, Sawabata N, et al. Clinical outcome of resected solid-type small-sized c-stage IA non-small cell lung cancer. Eur J Cardiothorac Surg, 2010, 37（6）： 1445-1449.
26.	Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 （less than hilar） non–small cell carcinoma： Results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg, 2011, 141（3）：662-670.
27.	杨学宁, 林欢, 吴一龙. 临床I期非小细胞肺癌的选择性淋巴结清扫术. 癌症进展, 2010, 8（6）： 549-553.
28.	Whitson BA, D’Cunha J, Andrade RS, et al. Thoracoscopic versus thoracotomy approaches to lobectomy： differential impairment of cellular immunity. Ann Thorac Surg, 2008, 86（6）：1735-1744.

1. ?2 何健行, 刘会平, 杨运有. 电视胸腔镜肺癌根治术5年临床疗效. 中国胸心血管外科临床杂志, 2002, 9（1）：29-31.
2. ?3 王述民, 曲家骐, 侯维平, 等. 电视胸腔镜肺叶切除术454例临床分析. 临床军医杂志, 2010, 38（4）：641-642.
3. ?4 刘伦旭, 周清华, 车国卫, 等. 电视胸腔镜在肺癌手术治疗中的应用. 中国肺癌杂志, 2004, 7（5）：431-433.
4. ?5 张轶, 姜格宁, 朱余明, 等. 电视胸腔镜肺叶切除术临床疗效分析. 第二军医大学学报, 2010, 31（7）：770-774.
5. ?6 张真榕, 刘德若, 郭永庆, 等. 248例胸腔镜肺叶切除术手术心得. 中国肺癌杂志, 2011, 14（6）：523-528.
6. ?7 谭黎杰, 王群, 徐正浪, 等. 肺叶切除几种微创术式比较. 中华胸心血管外科杂志, 2005, 21（2）：78-79.
7. ?8 Flores RM. Video-assisted thoracic surgery （VATS） lobectomy：.
8. focus on technique. World J Surg, 2010, 34（4）：616-620.
9. ?9 Onaitis MW, Petersen RP, Balderson SS, et al. Thoracoscopic lobectomy is a safe and versatile procedure： experience with 500 consecutive patients. Ann Surg, 2006, 244（3）：420-425.
10. can VATS lobectomy be taught? Eur J Cardiothorac Surg, 2006, 29（5）：806-809.
11. 杨帆, 李晓, 王俊, 等. 连续300例全胸腔镜肺叶切除术及中期随访分析. 中国胸心血管外科临床杂志, 2011, 18（2）：95-98.
12. McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy： experience with 1,100 cases. Ann Thorac Surg, 2006, 81（2）：421-426.
13. Kim K, Kim HK, Park JS, et al. Video-assisted thoracic surgery lobectomy： single institutional experience with 704 cases. Ann Thorac Surg, 2010, 89（6）：S2118-2122.
14. Ichinose J, Kohno T, Fujimori S, et al. Locoregional control of thoracoscopic lobectomy with selective lymphadenectomy for lung cancer. Ann Thorac Surg, 2010, 90（1）：235-239.
15. Swanson SJ, Herndon JE 2nd, D’Amico TA, et al. Video-assisted thoracic surgery lobectomy ： report of CALGB 39802— a prospective, multi-institution feasibility study. J Clin Oncol, 2007, 25（31）：4993-4997.
16. Rueth NM, Andrade RS. Is VATS lobectomy better： perioperatively, biologically and oncologically? Ann Thorac Surg, 2010, 89（6）：S2107-2111.
17. Park BJ. Is surgical morbidity decreased with minimally invasive lobectomy? Cancer J, 2011, 17（1）：18-22.
18. Whitson BA, Groth SS, Duval SJ, et al. Surgery for early-stage non-small cell lung cancer： a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg, 2008, 86（6）：2008-2018.
19. Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27（15）：2553-2562.
20. Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy： a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg, 2010, 139（2）：366-378.
21. Ferquson J, Walker W. Developing a VATS lobectomy programme——.
22. 李运, 杨帆, 刘彦国, 等. 全胸腔镜肺叶切除术中转开胸手术指征的探讨. 中国胸心血管外科临床杂志, 2010, 17（1）：32-35.
23. Ludwig MS, Goodman M, Miller DL, et al. Postoperative survival and the number of lymph nodes sampled during resection of node-negative non-small cell lung cancer. Chest, 2005, 128（3）：1545-1550.
24. Defranchi SA, Cassivi SD, Nichols FC, et al. N2 Disease in T1 non-small cell lung cancer. Ann Thorac Surg, 2009, 88（3）： 924-928.
25. Inoue M, Minami M, Sawabata N, et al. Clinical outcome of resected solid-type small-sized c-stage IA non-small cell lung cancer. Eur J Cardiothorac Surg, 2010, 37（6）： 1445-1449.
26. Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 （less than hilar） non–small cell carcinoma： Results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg, 2011, 141（3）：662-670.
27. 杨学宁, 林欢, 吴一龙. 临床I期非小细胞肺癌的选择性淋巴结清扫术. 癌症进展, 2010, 8（6）： 549-553.
28. Whitson BA, D’Cunha J, Andrade RS, et al. Thoracoscopic versus thoracotomy approaches to lobectomy： differential impairment of cellular immunity. Ann Thorac Surg, 2008, 86（6）：1735-1744.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Outcome of Complete Video-assisted Thoracoscopic Surgery Lobectomy for Patients with Early-stage Non-small Cell Lung Cancer

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