完全胸腔镜手术与传统开胸手术对早期非小细胞肺癌患者术后近期生活质量影响的对比研究

目的比较完全胸腔镜手术(VATS)与传统开胸手术对早期非小细胞肺癌(NSCLC)患者术后近期生活质量的影响。方法选取2012年6月—2014年8月濮阳市人民医院胸外科收治的早期NSCLC患者45例,根据患者自主意愿分为观察组22例和对照组23例,观察组患者行VATS,对照组患者行传统开胸手术。采用癌症治疗功能性量表(FACT-L)评估患者术后3个月生活质量。结果观察组患者术后3个月身体状况、情感状况、功能状况、附加状况评分及总分均高于对照组(P0.05),两组患者社会/家庭状况评分比较,差异无统计学意义(P0.05)。结论 VATS对早期NSCLC患者术后近期生活质量造成的影响较传统开胸手术小。     

老年肺癌患者胸腔镜不同术式术后肺功能、预后及LCQ评分对比

目的 对比分析胸腔镜下肺叶切除和楔形切除对老年Ⅰ期非小细胞肺癌患者肺功能和预后的影响。方法 选取行胸腔镜下手术治疗的非小细胞肺癌患者，分为胸腔镜下肺叶切除组(n=76)和胸腔镜下肺楔形切除组(n=78)。比较两组术后5 d和术后1年肺功能和斯特咳嗽问卷(LCQ)评分。比较两组术后2年死亡率、局部复发率和远处转移率。结果 术后第5天，肺楔形切除组肺总量显著高于肺叶切除组，残气量显著低于肺叶切除组，1 s用力呼气容积(FEV1)、肺活量、分钟最大通气量显著高于肺叶切除组(P<0.05,P<0.001);两组6 min步行距离(6 MWD)差异无统计学意义(P>0.05);肺楔形切除组LCQ量表生理维度、心理维度、社会维度评分显著高于肺叶切除组(P<0.05)。术后1年，两组肺总量、残气量、FEV1、肺活量、分钟最大通气量及6MWD上差异无统计学意义(P>0.05);两组LCQ量表生理维度评分、心理维度评分及社会维度评分差异无统计学意义(P>0.05)。术后2年，肺楔形切除组局部复发比例显著高于肺叶切除组(P<0.05);两组远处转移患者比例差异无统...     

不同手术方式治疗肺癌的疗效及生活质量对比

目的：比较不同手术方式治疗肺癌的疗效及生活质量。方法选择2008年7月—2010年6月在我院进行手术治疗的肺癌患者96例,按照治疗方法将患者分成胸腔镜组和传统手术组,各48例。传统手术组患者采用传统手术,胸腔镜组患者采用胸腔镜辅助小切口肺切除手术。观察并记录两组患者手术情况,采用VAS评分对两组患者手术前后疼痛程度进行评价,采用生存质量测定量表FACT－L中文版（ V4.0）对患者生活质量进行问卷调查。结果胸腔镜组患者手术时间、开胸时间、术后置管时间、术后下床时间、术后住院时间均短于传统手术组,术中出血量少于传统手术组（P＜0.05）。两组患者术前VAS评分比较,差异无统计学意义（P＞0.05）;胸腔镜组患者术后第1～8天VAS评分均低于传统手术组（ P＜0.05）。胸腔镜组患者术后临床症状、躯体功能、角色功能、情绪功能、认知功能及社会功能评分均高于传统手术组（ P＜0.05）。结论胸腔镜手术治疗肺癌较传统开胸手术能明显减少术中出血,缩短手术时间,减轻术后疼痛,明显提高患者生活质量。     

不同手术方式治疗肺癌的疗效及生活质量对比

目的：比较不同手术方式治疗肺癌的疗效及生活质量。方法选择2008年7月—2010年6月在我院进行手术治疗的肺癌患者96例,按照治疗方法将患者分成胸腔镜组和传统手术组,各48例。传统手术组患者采用传统手术,胸腔镜组患者采用胸腔镜辅助小切口肺切除手术。观察并记录两组患者手术情况,采用VAS评分对两组患者手术前后疼痛程度进行评价,采用生存质量测定量表FACT－L中文版（ V4.0）对患者生活质量进行问卷调查。结果胸腔镜组患者手术时间、开胸时间、术后置管时间、术后下床时间、术后住院时间均短于传统手术组,术中出血量少于传统手术组（P＜0.05）。两组患者术前VAS评分比较,差异无统计学意义（P＞0.05）;胸腔镜组患者术后第1～8天VAS评分均低于传统手术组（ P＜0.05）。胸腔镜组患者术后临床症状、躯体功能、角色功能、情绪功能、认知功能及社会功能评分均高于传统手术组（ P＜0.05）。结论胸腔镜手术治疗肺癌较传统开胸手术能明显减少术中出血,缩短手术时间,减轻术后疼痛,明显提高患者生活质量。     

基层医院开展胸腔镜肺叶切除的经验总结

目的总结在基层医院开展胸腔镜(video-assisted thoracic surgery,VATS)肺叶切除手术与传统开胸肺叶切除的临床经验。方法通过分析同时期VATS肺叶切除18例患者以及传统开胸肺叶切除10例患者的临床资料,对比两组患者的住院时间、手术时间、术中出血量、术后拔管天数以及术后并发症发生率。结果两组患者在手术时间、术中出血量、术后拔管天数均无统计学差异(P0.05)。住院时间,VATS组要明显少于传统开胸组(9.9±2.6d VS18.4±7.8d),统计学有明显差异(P0.05)。术后总的并发症发生率,VATS组也要小于传统组(11.1%vs 30%)。结论在基层医院开展早期胸腔镜肺叶手术过程中,VATS肺叶切除术具有传统开胸手术相似的临床效果,且创伤小、住院时间短、术后并发症少等优点。     

开胸手术与胸腔镜手术治疗非小细胞肺癌临床效果的比较研究

目的比较开胸手术与胸腔镜手术治疗非小细胞肺癌的临床效果。方法选取西安交通大学第一附属医院2005年1月—2010年2月收治的非小细胞癌患者180例,根据手术方式分为开胸手术组和胸腔镜手术组,每组90例。开胸手术组患者行传统开胸手术,胸腔镜手术组患者行胸腔镜手术。比较两组患者手术情况(术中出血量、淋巴结清扫数目、术后引流量、置管时间、住院时间)、复发及转移情况、5年生存率、FACF-L中文4.0版调查表评分、手术前后免疫功能指标(血清Ig G、Ig A、Ig M水平及CD+3、CD+4、CD+8细胞分数)及并发症发生情况。结果胸腔镜手术组患者术中出血量、术后引流量小于开胸手术组,置管时间及住院时间短于开胸手术组(P0.05);而两组患者淋巴结清扫数目比较,差异无统计学意义(P0.05)。胸腔镜手术组患者复发时间长于开胸手术组,远处转移率低于开胸手术组(P0.05);而两组患者复发率比较,差异无统计学意义(P0.05)。胸腔镜手术组患者5年生存率为44.4%,开胸手术组为41.1%,差异无统计学意义(P0.05)。胸腔镜手术组患者FACF-L中文4.0版调查表生理状况评分、功能状况评分、附加肺癌相关因素评分及总分高于开胸手术组(P0.05);而两组患者社会状况评分、情感状况评分比较,差异无统计学意义(P0.05)。两组患者术前血清Ig G、Ig A、Ig M水平及CD+3、CD+4、CD+8细胞分数比较,差异均无统计学意义(P0.05);胸腔镜手术组患者术后血清Ig G水平及CD+3、CD+4、CD+8细胞分数均高于开胸手术组(P0.05);而两组患者术后血清Ig A、Ig M水平比较,差异均无统计学意义(P0.05)。胸腔镜手术组患者并发症发生率为12.2%,低于开胸手术组的35.6%(P0.05)。结论与传统开胸手术相比,胸腔镜手术治疗非小细胞肺癌具有创伤小、住院时间短、康复速度快、并发症少、对免疫功能影响小等优点,在保证淋巴结清扫效果和生存期的前提下有利于提高患者术后生活质量,降低术后远处转移率及延长复发时间。     

胸腔镜下行肺癌根治术治疗肺癌80例分析

目的探讨胸腔镜下行肺癌根治术在治疗肺癌中的效果。方法分析入住我院的80例肺癌患者的临床资料,本组患者均经电视胸腔镜(VATS)辅助下的小切口行肿瘤切除并系统纵膈淋巴结清扫术,并对病理类型、病理分级、淋巴结转移频度以及随访6年之内的生存时间、手术前后患者的生存质量等方面进行观察、分析。结果本组80例肺癌患者,一共清理淋巴结688个区1054枚淋巴结,每位患者平均为(12.31±2.67)枚;胸腔镜下肺癌根治术与传统治疗方法的术后患者生存率不存在统计学差异(P>0.05);胸腔镜下肺癌患者在手术前后的生存质量存在显著的统计学差异(P<0.01)。结论胸腔镜下行肺癌根治术是一种安全、有效地治疗肺癌的方法。     

胸腔镜手术治疗重度COPD的疗效分析

目的前瞻性研究电视胸腔镜手术(VATS)与常规手术治疗慢性阻塞性肺气肿的疗效,总结更适合该类患者的手术方法。方法 30例慢性阻塞性肺气肿患者随机分组,分别采用VATS和常规单侧肺减容手术治疗,比较其近远期疗效,肺功能、血气分析及血IL-1和TNF-α变化。结果该组无死亡病例,VATS组胸管留置时间及镇痛剂使用时间短,术后2 d,IL-1和TNF-α显著低于开胸组(P0.05),术后3月FEV1、TLC、RV、PaO2及6MWD改善程度VATS组优于开胸手术组(P0.05),术后24月相关指标VATS组和开胸手术组无统计学差别(P0.05)。结论 VATS肺减容手术治疗重度慢性阻塞性肺气肿患者近期疗效优于开胸手术,远期疗效相似。     

电视胸腔镜手术对非小细胞肺癌患者疗效、心理及生活质量的影响

目的分析电视胸腔镜手术(VATS)对非小细胞肺癌(NSCLC)患者疗效、心理及生活质量的影响。方法选择老年NSCLC患者83例,随机分为VATS组43例、对照组40例,分别采取VATS肺叶切除术及传统开胸肺叶切除术治疗。比较两组手术相关情况、术后疼痛视觉模拟评分VAS变化、手术前后血清C反应蛋白(CRP)水平变化、治疗前后心理状态及术后3个月生活质量。结果 VATS组术中出血量、术后住院时间显著低于对照组(P0.05),两组手术时间、淋巴结清扫数量、术后引流液体积及术后并发症发生率无显著差异(P0.05)。VATS组术后1 d、术后3 d及术后7 d VAS均显著低于对照组(P0.05)。术后1 d、术后3 d、术后7 d两组血清CRP均较术前显著升高(P0.05),而术后各时间VATS组血清CRP水平显著低于对照组(P0.05)。术后7 d两组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均较术前显著降低(P0.05),且术后7 d VATS组SAS、SDS评分显著低于对照组(P0.05)。术后3个月,VATS组身体状况、情感状况、功能状况及生活质量总分均显著高于对照组(P0.05)。结论 VATS治疗老年NSCLC可有效减少术中出血量、减轻术后疼痛及应激水平,有助于患者术后康复、心理状态的改善及生活质量的提高。     

76例单肺叶切除术术后早期肺功能的变化研究

目的比较完全胸腔镜下单肺叶切除术和传统开放式单肺叶切除术对肺癌患者术后早期肺功能变化的影响。方法选取2014年1月至2014年6月在安徽医科大学第一附属医院普胸外科行单肺叶切除术肺癌患者共76例,按照手术方法分为传统开放手术组40例及胸腔镜手术(VATS)组36例,通过术后第7天和术后第30天肺功能检查指标及血气分析指标比较单肺叶切除术中传统开放术式和胸腔镜术式对患者术后早期肺功能变化的影响。结果单肺叶切除术后早期肺功能下降明显;术后第7天胸腔镜组反映肺功能指标(VCmax、MVV、Pa O2、Pa CO2、SO2%)优于开放组,差异有统计学意义(P0.05);术后第30天胸腔镜组反映肺功能指标(VCmax、MVV、Pa O2、Pa CO2、SO2%)优于开放组,差异有统计学意义(P0.05)。结论单肺叶切除行胸腔镜手术有利于患者术后早期肺功能更快速、更有效的恢复。     

Quality of life after lung cancer surgery: video-assisted thoracic surgery versus thoracotomy

OBJECTIVE: To assess the benefit of video-assisted thoracic surgery (VATS), we compared time-related quality of life (QOL) after lobectomy performed by VATS to that performed by thoracotomy. METHODS: Thirty-three patients underwent surgery for lung cancer during the period April 2001 through November 2002 completed a mailed questionnaire after surgery. RESULTS: Over time, improved QOL was reported in six dimensions by VATS patients but in only two dimensions by thoracotomy patients. There was significant improvement in bodily pain subscores in both groups during the 36 months after surgery. At 3 months after surgery, QOL scores for all eight dimensions were lower in the VATS group, but QOL scores for all eight dimensions did not differ significant between groups at 3 or 12 months after surgery. At 36 months after surgery, QOL scores for six dimensions were higher in the VATS group, and the difference was significant in scores for two dimensions. CONCLUSION: We found recovery was quicker in patients who underwent VATS than in those who underwent thoracotomy.     

Decreased invasiveness via two methods of thoracoscopic lobectomy for lung cancer, compared with open thoracotomy

BACKGROUND AND OBJECTIVE: Video-assisted thoracic surgery (VATS) lobectomy for primary lung cancer is considered minimally invasive. However, different procedures may be used for the VATS lobectomy, from complete videoscopic (CV) surgery to a technique similar to the muscle-sparing thoracotomy. We divided patients into two groups based on the surgical approach and analysed the outcomes. METHODS: Two hundred and thirty-one patients were treated using one of two VATS procedures: the video-supported method (VS, n = 63) and the CV method (n = 168). Patients treated by posterolateral thoracotomy (PL, n = 61) were also evaluated for certain postoperative parameters and pulmonary function. The CV method is the standard VATS lobectomy procedure in our institution, but the VS method is used when the CV method becomes difficult because of severe adhesion around the pulmonary artery, or for other reasons. RESULTS: Creatinine phosphokinase and CRP levels, and blood loss were lower in the VS and CV groups than in the PL group. Blood loss during CV was lower than that during VS. Postoperative VC after CV was higher than that after PL. Analgesic requirements in both VATS groups were lower than that in the PL group. The visual analogue scale pain score was lower in both VATS groups than in the PL group. CONCLUSIONS: Two methods of VATS cause less surgical damage than PL. CV, in particular, causes less damage to pulmonary function than PL, and achieves good postoperative quality of life.     

Quality of life following lung cancer resection: video-assisted thoracic surgery vs thoracotomy

STUDY OBJECTIVES: Quality of life (QOL) following video-assisted thoracic surgery (VATS) major lung resection has not been systematically studied. This study was designed to evaluate the intermediate to long-term QOL in patients with lung cancer following resection, comparing VATS with thoracotomy. DESIGN: Cross-sectional study, telephone survey. METHODS: Of 136 disease-free surviving patients with non-small cell lung cancer operated on between 1994 and 2000, 45 patients were excluded because of large tumors (> 5 cm) or locally advanced disease, and another 27 patients were excluded because of adjuvant therapy, coexisting cancer from another source, or psychiatric illness. At the time of the survey, 13 patients were found to be either unsuitable or unwilling to participate. This left a total of 51 patients, with 27 patients in the VATS group and 24 patients in the thoracotomy group (open group), for the final analysis. QOL was assessed using Chinese versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and the EORTC QLQ-LC13, supplemented with nine self-developed surgery-related questions. RESULTS: Mean follow-up time was 33.5 months in the VATS group (median, 20.8 months; range, 6.0 to 84.2 months) and 39.4 months in the open group (median, 37.7 months; range, 7.0 to 75.1 months). Both groups had good QOL and high levels of functioning despite a fairly high incidence of symptoms. There was a trend for VATS patients to score higher on the QOL and functioning scales and to report fewer symptoms. However, these differences did not lead to statistical significance. CONCLUSIONS: This study showed that lung cancer patients with resectable disease following surgical treatment without recurrence have good QOL and high levels of functioning on intermediate to long-term follow-up, with no significant differences between the VATS and open groups.     

全腔镜肺叶切除与开胸肺叶切除治疗早期肺癌1年随访

目的探讨全腔镜肺叶切除与开胸肺叶切除治疗对早期肺癌患者肺功能、并发症、生活质量等的影响。方法146例早期肺癌患者根据患者意愿,以手术方式不同,分成两组,其中67例实施传统开胸肺叶切除术(开胸组),另外79例实施全腔镜肺叶切除术(全腔镜组)。对两组术中和术后恢复情况、肺功能指标、生活质量、术后并发症、术后1年预后情况进行对比。结果全腔镜组手术时间明显长于开胸组(P<0.05),但术中失血量、术后引流量要明显少于开胸组(P<0.05),切口长度、术后住院时间均明显短于开胸组(P<0.05),术后伤口疼痛程度显著低于开胸组(P<0.05),淋巴结清除个数组间无统计学差异(P>0.05)。术后1 w,两组肺功能1秒用力呼气容积(FEV1)和每分钟最大通气量(MVV)明显下降,但全腔镜组显著优于开胸组(P<0.05);在术后1年,两组肺功能已基本达到术前水平,且组间水平无统计学差异(P>0.05)。术后3个月,两组肺癌症状量表(LCSS)得分和肺癌患者生存质量测定量表(FACT-L)均较术前显著降低(P<0.05),全腔镜组LCSS得分较开胸组明显降低(P<0.05),FACT-L得分较开胸组显著升高(P<0.05);术后1年,LCSS得分的组间差异无统计学意义(P>0.05),两组FACT-L得分均达到术前水平,组间差异无统计学意义(P>0.05)。全腔镜组并发症发生率明显低于开胸组(P<0.05)。术后1年,组间在复发、远处转移和生存率差异均无统计学意义(P>0.05)。结论全腔镜肺叶切除与开胸肺叶切除治疗早期肺癌均可达到满意效果,在远期预后上效果相当,且全腔镜方案术中创伤小、术后恢复快、并发症低。     

Effect of operative approach on quality of life following anatomic lung cancer resection

Patient-reported outcomes (PRO) after lung cancer surgery are of increasing interest to patients and clinicians. A variety of studies have investigated the impact of the surgical approach on quality of life (QOL) after surgery for early non-small-cell lung cancer (NSCLC). Our aim is to review the current evidence on how minimally-invasive approaches, including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), versus open thoracotomy for lung cancer affect QOL. We conducted a systematic review of the literature of studies comparing QOL after VATS/RATS versus thoracotomy approach using studies published before 2019 on PubMed and Google Scholar. Studies were assessed for differences in QOL by domains. Fifteen studies met our inclusion criteria including 14 observational studies and one randomized trial. Survey instruments and timing of QOL assessments differed between all studies. A thoracoscopic (VATS or RATS) approach was associated with better general health (3/10 studies), physical functioning (9/14 studies), social functioning (1/12 studies), mental health (3/13 studies), emotional role functioning (4/12 studies), physical role functioning (7/12 studies), and bodily pain (7/12 studies) as compared to open surgery. The open thoracotomy approach was associated with better general health and mental health in one study each. Although QOL assessment in current studies is highly variable, the existing evidence suggests that a thoracoscopic approach is associated with improved QOL, particularly in the areas of physical functioning and pain as compared to open lung cancer surgery.     

Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy

Background

Video-assisted thoracic surgery (VATS) and thoracotomy are standard treatment methods for early lung cancer. We compared their effects on the long-term recovery of pulmonary function in patients with stage I non-small cell lung cancer (NSCLC).

Methods

We retrospectively reviewed 203 patients with early NSCLC who underwent VATS or thoracotomy at Seoul University Hospital from January 2005 to December 2010. Two matched groups (VATS and thoracotomy) each consisting of 60 patients were created via propensity score matching according to TNM stage, age, sex, smoking history, lung disease history, and preoperative pulmonary function.

Results

There were no significant differences in the recovery of forced expiratory volume in 1 second, the forced vital capacity (FVC), or the peak flow rate (PFR), presented as the postoperative value/predicted value, between the VATS and thoracotomy groups during the 12-month follow-up period. The standardized functional loss ratio [(measured postoperative value – predicted postoperative value)/(predicted postoperative value × 100)] did not differ between the two groups at 6 and 12 months. In an intragroup analysis, the postoperative FVC in the thoracotomy group remained below predicted postoperative value during the follow-up period and did not reach the predicted postoperative FVC (6 months/12 months: –6.58%/–2.43%). The analgesic requirements and pain procedures were similar in the VATS and thoracotomy groups during the 12-month follow-up period.

Conclusions

There were no significant differences in pulmonary function recovery during the late postoperative period in NSCLC patients receiving VATS versus thoracotomy. We suggest that the volume of the resected lung and preoperative lung function are the main determinants of late recovery, rather than postoperative pain.     

磨玻璃变的早期肺癌的两种治疗方式研究

目的探讨对以GGO为临床表现的早期肺癌病人两种治疗方式的效果研究。方法遴选以发现GGO为首发表现的早期肺癌病人,共58例,随机分成两组。观察组病人选择CT引导术前定位胸腔镜切除术(VATS),对照组病人行Muscle-sparing(MS)剖胸切口肺癌切除术。对比两组病人手术情形、手术相关指标区别、术后并发症迥异。结果VATS切除术成功率100%,CT引导术前结节定位成功率为100%,术前定位平均时间(14.65±4.72)min。观察组病人的手术时间、术中出血数量、术后胸引管维持时间,全部小于对照组,(P<0.05)。结论应用CT引导下术前定位胸腔镜切除术,拥有创伤小、出血少、术后恢复快等益处,如今已成为处理早期肺癌的第一术式。     

电视胸腔镜手术在非小细胞肺癌治疗中的优势

目的探讨电视胸腔镜手术（VATS）相对于传统开胸手术在非小细胞肺癌（NSCLC）诊断和治疗中的优势。方法收集2008年11月至2010年11月行全胸腔镜肺叶切除术患者83例,并与同期97例行传统开胸肺叶切除术的患者进行比较,术前患者均行胸部CT等常规检查临床诊断为NSCLC,观察两组患者的术中出血量、手术时间、淋巴结清扫数目、术后胸腔闭式引流天数、术后住院时间,并将数据输入SPSS17．0统计软件包,计算两组均数±标准差（x±S）,统计方法采用两样本均数t检验,P≤0．05为差异有统计学意义。结果VATS组在平均术中出血量、淋巴结清扫数目、术后胸腔闭式引流天数方面与传统开胸组比较无统计学差异,而平均手术时间多于传统开胸组,术后平均住院时间少于传统开胸组,差异具有统计学意义。结论VATS在与传统开胸手术治疗NSCLC相比,其能达到相似的手术效果,并能明显减少术后并发症及术后住院时间,将手术创伤降至最低,提高患者术后生存质量。虽然有关VATS与传统手术术后生存效果的比较有待多中心、长期大宗完整病例的观察和分析。但有理由相信VATS应用前景将会更加广阔。     

肺癌切除术后乳糜胸的早期诊断和治疗

目的探讨肺癌切除术后乳糜胸的早期诊断和治疗。方法回顾性分析2009年1月至2013年12月我院胸外科肺癌切除术后并发乳糜胸患者的临床病理资料,并比较常规开胸与胸腔镜手术后乳糜胸的差别。结果 3 479例肺癌切除患者术后并发乳糜胸12例(0.34%,12/3 479),胸腔镜手术组的发生率为0.41%(7/1 719),开胸手术组为0.28%(5/1 760),两者之间未见统计学显著性差异(P0.05)。11例(91.7%)采用保守治疗,1例(8.3%)再次手术行胸导管结扎后,全部恢复顺利。胸腔镜手术组乳糜胸患者的手术时间(207±29.1)min、平均出血量(142.9±60.7)ml、清扫淋巴结数(20.1±5.7)枚、带胸管时间(13.9±4.9)d、住院时间(26.7±5.7)d,与开胸手术组乳糜胸患者的手术时间(192±72.2)min、平均出血量(220.0±109.5)ml、清扫淋巴结数(14.4±4.5)枚、带胸管时间(13.2±7.8)d、住院时间(27.0±8.7)d相比,未见统计学有显著性差异(P0.05)。结论乳靡胸是肺癌术后的一种少见并发症,与手术方式无关,多数可采用保守措施治愈。     

Clinical feasibility and efficacy of video-assisted thoracic surgery (VATS) anatomical resection in patients with central lung cancer: a comparison with thoracotomy

Background

The aim of this study is to evaluate the clinical feasibility and efficacy of video-assisted thoracoscopic surgery (VATS) anatomical pulmonary resection in patients with central lung cancer.

Methods

Between July 2004 and December 2011, 465 patients underwent anatomical pulmonary resection and systematic mediastinal lymph node sampling or dissection for central lung cancer. Because patients were not randomized to receive VATS, clinical outcomes were compared using a propensity score matching design, giving 88 patients in each group.

Results

A lobectomy was attempted in 69 patients of the thoracotomy group and 64 of the VATS group, bilobectomy in 19 patients of the thoracotomy group and 21 of the VATS group, and segmentectomy in 3 patients of the VATS group. There were no differences in the anatomical distribution of pulmonary resections between the two groups. There was no operation related in-hospital mortality. There were 34 postoperative complications in 30 patients, without significant differences between the two groups. The median hospital stay and chest tube indwelling period of the VATS group were shorter than those of the thoracotomy group by 2 days and 1 day, respectively (P<0.05). During a median follow-up of 32.5 months (range, 0.5-95.8 months), there was no difference between the two groups in 3-year recurrence-free or overall survivals (OS).

Conclusions

VATS anatomical pulmonary resection is safe and feasible for central lung cancer, providing a low operative mortality and favorable outcomes in selected patients. Further case studies with long-term outcome data are necessary to verify our conclusions.