Treatment of Non-small Cell Lung Cancer by Single-direction Four-hole Complete Video-assisted Thoracoscopic Lobectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANG Jia , ZHAO Xiaojing , LIN Hao

Shanghai Lung Tumor Clinical Medical Center, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, P. R. China;

Corresponding author：

Keywords：

Video-assisted thoracoscopic surgery; Lobectomy; Single-direction; Four-hole; Non-small cell lung cancer

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Treatment of Non-small Cell Lung Cancer by Single-direction Four-hole Complete Video-assisted Thoracoscopic Lobectomy HUANG Jia, ZHAO Xiao-jing, LIN Hao, TAN Qiang, DING Zheng-ping, LUO Qing-quan. (Shanghai Lung Tumor Clinical Medical Center, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, P. R. China) Corresponding author：LUO Qing-quan, Email：luoqingquan@hotmail. com Abstract： Objective To explore the feasibility and safety of single-direction four-hole video-assisted thoracoscopic lobectomy in the treatment of non-small cell lung cancer (NSCLC). Methods Between January 2007 and December 2010, 428 patients with NSCLC were surgically treated by single-direction complete video-assisted thoracoscopic lobectomy in Shanghai Chest Hospital. There were 186 males and 242 females; aged 33 to 78 years. All the patients were diagnosed as primary NSCLC at early clinical stage. Among the 428 patients, 134 patients underwent right upper lobectomy, 48 patients underwent right middle lobectomy, 98 patients underwent right lower lobectomy, 4 patients underwent right middle and lower lobectomy, 72 patients underwent left upper lobectomy, and 72 patients underwent left lower lobectomy. All the 428 patients were divided into two groups according to their surgical approach：a three-hole group (300 patients) and a four-hole group (128 patients).The clinical results of the two groups were analyzed. Results A total of 412 patients underwent complete video-assisted thoracoscopic lobectomy, and 16 patients (3.7%) underwent conversion to open surgery. The average operation time was 132.1 (120-180) min, average length of incision was 3.7 (3-5) cm, and average blood loss was 150.0 (50-800) ml. There was no statistical difference in extubation time, intraoperative blood loss, and postoperative hospital stay between the two groups. But the operation time of the four-hole group is significantly shorter than that of the three-hole group （P＜0.05）. The 16 patients who underwent conversion to open surgery received intraoperative blood transfusion. Five patients died of severe pulmonary infection, pulmonary embolism, and acute cerebral infarction. Fifty two patients had squamous cancer, 340 patients had adenocarcinoma, 20 patients had adenosquamous carcinoma, 8 patients had poorly differentiated carcinoma, 6 patients had big cell lung cancer, and 2 patients had carcinoid. Postoperative persistent lung air leak occurred in 4 patients, thoracic empyema in 2 patients, pulmonary infection in 4 patients, arrhythmia in 26 patients, pulmonary embolism in 2 patients, chylothorax in 2 patients, and acute cerebral infarction in 2 patients. The overall 3-year survival rate was 83.6%（358/428）. Conclusion Single-direction four-hole complete video-assisted thoracoscopic lobectomy is feasible, safe and consistent with the operation standard in the surgical treatment for NSCLC patient. It is also helpful to reduce the operation time and facilitate lymph node dissection. Key words： Video-assisted thoracoscopic surgery； Lobectomy； Single-direction； Four-hole； Non-small cell lung cancer

Citation： HUANG Jia,ZHAO Xiaojing,LIN Hao,et al .. Treatment of Non-small Cell Lung Cancer by Single-direction Four-hole Complete Video-assisted Thoracoscopic Lobectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(2): 125-129. doi: Copy

1.	?2 Jemal A， Center MM， DeSantis C， et al. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol.
2.	Biomarkers Prev， 2010， 19（8）： 1893-1907.
3.	?3 Garzon JC， Ng CS， Sihoe AD， et al. Video assisted thoracic surgery pulmonary resection for lung cancer in patients with poor lung function. Ann Thorac Surg， 2006， 81 （6）：1996- 2003.
4.	?4 Lewis RJ， Caccavale RJ， Sisler GE， et al. Video-assisted thoracic surgical resection of malignant lung tumors. J Thorac Cardiovasc Surg， 1992， 104（6）：1679-1687.
5.	?5 Lewis RJ， Caccavale RJ， Bocage JP， et al. Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy： a more patient-friendly oncologic resection. Chest， 1999， 116（4）：1119-1124.
6.	?6 Kirby TJ， Mack MJ， Landreneau RJ， et al. Lobectomy--video-assisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial. J Thorac Cardiovasc Surg， 1995， 109（5）：997-1002.
7.	?7 Sugi K， Kaneda Y， Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg， 2000， 24（1）：27-31.
8.	?8 Yim AP， Wan S， Lee TW， et al. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg, 2000， 70（1）：243-247.
9.	?9 Nomori H， Horio H， Naruke T， et al. What is the advantage of a thoracoscopic lobectomy over a limited thoracotomy procedure for lung cancer surgery? Ann Thorac Surg， 2001， 72（3）：879-884.
10.	Jemal A， Bray F， Center MM， et al. Global cancer statistics. CA Cancer J Clin， 2011， 61（2）： 69-90.
11.	Nagahiro I， Andou A， Aoe M， et al. Pulmonary function， postoperative pain， and serum cytokine level after lobectomy： a comparison of VATS and conventional procedure. Ann Thorac Surg， 2001， 72（2）：362-365.
12.	Shigemura N， Akashi A， Funaki S， et al. Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stage IA lung cancer： a multi-institutional study. J Thorac Cardiovasc Surg， 2006， 132（2）：507-512.
13.	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.
14.	李运，王俊，刘军，等．胸腔镜下肺叶切除术40例临床分析．中华外科杂志， 2008， 46 （ 6）：405-407．.
15.	李运，王俊，隋锡朝，等．全胸腔镜肺叶切除手术操作流程及技巧的优化：北京大学人民医院经验．中华胸心血管外科杂志， 2010， 26（ 5）：300-306．.
16.	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．.
17.	刘伦旭，车国卫，蒲强，等．单向式全胸腔镜肺叶切除术．中华胸心血管外科杂志， 2008， 24（3）： 156-158．.
18.	Liu L， Che G， Pu Q， et al. A new concept of endoscopic lung cancer resection ： single-direction thoracoscopic lobectomy. Surg Oncol， 2009， 19（2）：e71- e77.
19.	West D， Rashid S， Dunning J. Does video-assisted thoracoscopic lobectomy produce equal cancer clearance compared to open lobectomy for non-small cell carcinoma of the lung? Interact Cardiovasc Thorac Surg， 2007， 6（1）：110-116.
20.	Yan TD， Black D， Bannon PG， et al . Systematic review and meta-analysis of randomized and non-randomized 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.
21.	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）： 2008-2016.

1. ?2 Jemal A， Center MM， DeSantis C， et al. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol.
2. Biomarkers Prev， 2010， 19（8）： 1893-1907.
3. ?3 Garzon JC， Ng CS， Sihoe AD， et al. Video assisted thoracic surgery pulmonary resection for lung cancer in patients with poor lung function. Ann Thorac Surg， 2006， 81 （6）：1996- 2003.
4. ?4 Lewis RJ， Caccavale RJ， Sisler GE， et al. Video-assisted thoracic surgical resection of malignant lung tumors. J Thorac Cardiovasc Surg， 1992， 104（6）：1679-1687.
5. ?5 Lewis RJ， Caccavale RJ， Bocage JP， et al. Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy： a more patient-friendly oncologic resection. Chest， 1999， 116（4）：1119-1124.
6. ?6 Kirby TJ， Mack MJ， Landreneau RJ， et al. Lobectomy--video-assisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial. J Thorac Cardiovasc Surg， 1995， 109（5）：997-1002.
7. ?7 Sugi K， Kaneda Y， Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg， 2000， 24（1）：27-31.
8. ?8 Yim AP， Wan S， Lee TW， et al. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg, 2000， 70（1）：243-247.
9. ?9 Nomori H， Horio H， Naruke T， et al. What is the advantage of a thoracoscopic lobectomy over a limited thoracotomy procedure for lung cancer surgery? Ann Thorac Surg， 2001， 72（3）：879-884.
10. Jemal A， Bray F， Center MM， et al. Global cancer statistics. CA Cancer J Clin， 2011， 61（2）： 69-90.
11. Nagahiro I， Andou A， Aoe M， et al. Pulmonary function， postoperative pain， and serum cytokine level after lobectomy： a comparison of VATS and conventional procedure. Ann Thorac Surg， 2001， 72（2）：362-365.
12. Shigemura N， Akashi A， Funaki S， et al. Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stage IA lung cancer： a multi-institutional study. J Thorac Cardiovasc Surg， 2006， 132（2）：507-512.
13. 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.
14. 李运，王俊，刘军，等．胸腔镜下肺叶切除术40例临床分析．中华外科杂志， 2008， 46 （ 6）：405-407．.
15. 李运，王俊，隋锡朝，等．全胸腔镜肺叶切除手术操作流程及技巧的优化：北京大学人民医院经验．中华胸心血管外科杂志， 2010， 26（ 5）：300-306．.
16. 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．.
17. 刘伦旭，车国卫，蒲强，等．单向式全胸腔镜肺叶切除术．中华胸心血管外科杂志， 2008， 24（3）： 156-158．.
18. Liu L， Che G， Pu Q， et al. A new concept of endoscopic lung cancer resection ： single-direction thoracoscopic lobectomy. Surg Oncol， 2009， 19（2）：e71- e77.
19. West D， Rashid S， Dunning J. Does video-assisted thoracoscopic lobectomy produce equal cancer clearance compared to open lobectomy for non-small cell carcinoma of the lung? Interact Cardiovasc Thorac Surg， 2007， 6（1）：110-116.
20. Yan TD， Black D， Bannon PG， et al . Systematic review and meta-analysis of randomized and non-randomized 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.
21. 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）： 2008-2016.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Treatment of Non-small Cell Lung Cancer by Single-direction Four-hole Complete Video-assisted Thoracoscopic Lobectomy

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