Video-assisted lobectomy in elderly lung cancer patients

OBJECTIVES: We evaluated the pre-, intra- and postoperative outcome of video-assisted thoracic surgery lobectomy in elderly lung cancer patients to determine what factors may be disadvantageous. METHODS: From June 1982 to May 2000, 707 patients underwent pulmonary resection for primary lung cancer. Of these, 87 patients with t1-2 peripheral lung cancer underwent lobectomy and postoperative pulmonary function tests and postoperative conditions at an average of 2.3 months postoperatively. Of these, 52 underwent video-assisted thoracic surgery lobectomy since 1994 and 35 lobectomy by standard thoracotomy. RESULTS: Video-assisted thoracic surgery lobectomy offered advantages in blood loss, chest wall damage, and minimal performance deterioration status. The percent vital capacity, percent forced expiratory in 1 second, and percent maximum ventilatory volume were well preserved in patients who underwent video-assisted thoracic surgery lobectomy. Multivariate logistic regression analysis identified operation duration as an independent risk factor in morbidity and operative procedure as an independent risk factor in performance deterioration. In stage IA and IB patients, 3-year-survival was 92.9% and 5-year survival 53.8% in those undergoing lobectomy by standard thoracotomy and 84.2% at 3 years and 60.1% at 5-years in those undergoing video-assisted thoracic surgery lobectomy. CONCLUSION: We thus consider video-assisted thoracic surgery lobectomy in this age group to be an effective procedure, but the long surgical duration is a risk factor in a poor clinical outcome.     

Video-assisted thoracoscopic lobectomy vs. conventional lobectomy via open thoracotomy in patients with clinical stage IA non-small cell lung carcinoma

The aim of this study was to evaluate our personal experience with video-assisted thoracoscopic lobectomy and compare survival between this procedure and conventional lobectomy via open thoracotomy in patients with clinical stage IA non-small cell lung carcinoma. Between May 1997 and December 2004, 140 patients with clinical stage IA non-small cell lung carcinoma had either VATS lobectomy (VATS group, 84 patients) or standard lobectomy via open thoracotomy (open group, 56 patients) performed in our hospital. We compared overall survival, disease-free survival and recurrence between the two groups. The overall survival rate five years after surgery was 72% in the open group and 82% in the VATS group. There were no significant differences in the overall survival rate between the two groups. The disease-free survival rate five years after surgery was 68% in the open group and 80% in the VATS group. There were no significant differences in the disease-free survival rate between the two groups. Five patients in the open group developed distant recurrence, whereas one patient developed regional recurrence. In the VATS group six patients developed distant recurrence, whereas one patient developed regional recurrence. We consider VATS lobectomy to be one of the therapeutic options in patients with clinical stage IA non-small cell lung carcinoma.     

Video-assisted lobectomy for a lung cancer patient with chronic obstructive pulmonary disease

Objectives: This retrospective study was conducted to see whether a video-assisted lobectomy is beneficial in lung cancer patients with chronic obstructive pulmonary disease regarding preservation of pulmonary function compared to lobectomy by standard thoracotomy.Subjects and Methods: Between 1982 and 2002, 67 patients who underwent lobectomy for primary lung cancer showed 55% or less of preoperative forced expiratory, volume in one second/vital capacity. Among them, 25 patients were enrolled in this retrospective study. The remaining 42 patients were excluded because of no presence of a postoperative pulmonary function test. Nine of 25 patients underwent a video-assisted lobectomy between 1994 and 2002 and the remaining 16 patients who underwent a lobectomy by standard thoractomy between 1982 and 1994 were employed as a historical control. Perioperative conditions and changes in pulmonary function were compared between two groups.Results: A parameter of chest wall damage was minor in video-assisted lobectomy compared to that in lobectomy by standard thoracotomy. Changes between pre- and postoperative percent of vital capacity, forced expiratory volume in one second and maximal ventilatory volume showed significantly minor deterioration or even improvement in video-assisted lobectomy patients. Predicted postoperative pulmonary function tended to be underestimated for postoperative values in video-assisted lobectomy patientsConclusions: Video-assisted lobectomy seemed to be profitable in preservation of pulmonary function in lung cancer patients with chronic obstructive pulmonary disease. Prediction of postoperative pulmonary function should be revised due to the underestimation for postoperative values in video-assisted lobectomy, which could offer profitable surgical treatment for lung cancer patients with chronic obstructive pulmonary disease.     

Very long-term outcomes of video-assisted thoracoscopic surgery for lung cancer

Background  The most critical parameter in the evaluation of the feasibility of video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer is long-term outcome. In this study, patients in whom more than 5 years had elapsed since they had undergone VATS lobectomy for lung cancer were identified, and the 5-year survival rate and frequency of recurrence were evaluated as the long-term outcomes; in addition, the frequency of perioperative complications were also evaluated as the short-term outcomes. Methods  The stage, histology, perioperative complications, recurrence, and survival data were carefully reviewed in 198 patients who underwent VATS lobectomy for lung cancer between 1998 and 2002. Results  Median postoperative follow-up period was 72.1 months. Of the 198 patients, 138 and 30 were diagnosed as having p-stage IA and IB disease, respectively, while the remaining 30 patients had more advanced disease. Perioperative complications were observed in 20 patients (10.1%), however, there were no perioperative mortalities. Recurrence was observed in 26 patients (13.1%): of these, 11 patients showed local recurrence, including malignant pleural effusion and mediastinal lymph node recurrence, and 16 patients showed distant metastasis, the lung being the commonest site of metastasis; six patients had both local recurrence and distant metastasis. During the study period, there were 26 deaths (13.1%), of which 17 were due to lung cancer and 9 were due to other causes. The 5-year overall survival rates of the patients with p-stage IA and IB disease were 93.5% and 81.6%, respectively. Conclusion  VATS lobectomy for the treatment of lung cancer is as feasible and safe as open lobectomy in terms of both very long- and short-term outcomes.     

微小N2非小细胞肺癌胸腔镜肺叶切除与同期开胸手术对照研究

目的 研究分析临床分期Ⅰ期接受胸腔镜肺叶切除,术中意外发现微小纵隔淋巴结转移(N2)的非小细胞肺癌患者的近、远期预后.方法 回顾性分析2004年1月至2007年12月术前诊断为早期非小细胞肺癌(cT1-2N0M0,Ⅰ期),而术中或术后意外发现微小纵隔淋巴结转移(pT1-2N2M0,Ⅲa期)患者263例的临床资料.全部患者接受肺叶切除术+系统淋巴结清扫根治性治疗.其中接受胸腔镜肺叶切除术63例(腔镜组),男性37例,女性26例,平均年龄(58±11)岁.同期接受开胸肺叶切除术治疗的为200例(开胸组),男性132例,女性68例,平均年龄(59±11)岁.对比上述两组患者的临床特征及近、远期预后.结果 全部263例患者平均生存时间(34.9±1.2)个月,中位生存时间31个月.腔镜组平均生存时间(40.3±2.2)个月,中位生存时间37个月;开胸组平均生存时间(33.1±1.3)个月,中位生存时间29个月.全部患者1、2、3年生存率为92.0%、57.4%、29.3%,腔镜组1、2、3年生存率为92.1%、82.5%、41.3%,开胸组1、2、3年生存率为92.0%、49.5%、25.5%,两组间差异有统计学意义(x2=5.58,P=0.018).结论 VATS肺叶切除治疗微小N2非小细胞肺癌是安全、有效的.患者经过术前严格的评估,手术中出现意料之外的纵隔淋巴结转移,通过系统的淋巴结清扫后没有必要中转开胸完成手术.

Abstract：

Objective To assess early and late outcomes of patients with minimal mediastinal lymph nodes metastasis N2 non-small cell lung cancer disease unexpectedly detected during the operation, who underwent video-assisted thoracic surgery lobectomy for clinical stage I. Methods This study retrospectively reviewed and analyzed the medical records of 263 patients underwent surgery between January 2004 and December 2007, who were diagnosed as having early-stage non-small cell lung cancer (clinical stage was cT1-2N0M0, stage Ⅰ) before the surgery, but were found to have mini mediastinal lymph nodes metastasis disease (clinical stage was pTI-2N2M0, stage Ⅲa) unexpectedly detected during the operation and after the operation. All patients underwent lobectomy and systematic lymph nodes dissection as radical treatments. Among them, 63 patients underwent video-assisted thoracic surgery (VATS) lobectomy,including 37 male patients (58. 7%) with a mean age of (58 ± 11) years old. Two hundred patients underwent open thoracotomy lobectomy, including 132 male patients (66%) with a mean age of (59 ± 11) years old. To compare and analyze clinical features, early and late outcomes of patients in these two groups.Results A total of 263 patients with an average survival time (34. 9 ± 1.2) months (median 31 months),63 cases in VATS lobectomy group with an average survival time (40. 3± 2. 2) months (median 37 months), 200 cases in open pulmonary lobectomy group with an average survival time (33.1 ±1.3)months (median 29 months). The 1 -, 2-, 3-year over survival rate of all the patients was 92.0%, 57.4%,29. 3%. The 1-, 2-, 3-year survival rate of patients in VATS lobectomy group was 92. 1%, 82. 5%,41.3%. The 1,2,3 year survival rate of patients in thoracotomy lobectomy group was 92. 0%, 49. 5%,25.5%. There was significant difference between the two groups in this factor (x2 =5.58, P =0.018).     

Video-assisted thoracoscopic lobectomy reduces cytokine production more than conventional open lobectomy.

OBJECTIVE: We studied cytokine changes after video-assisted thoracoscopic lobectomy and conventional lobectomy in patients with stage IA lung cancer. METHODS: From June, 1997, 20 consecutive patients with stage IA non small-cell lung carcinoma underwent either conventional lobectomy via an open thoracotomy (n = 10) or video-assisted thoracoscopic lobectomy (n = 10). The cytokine concentration in serum and pleural fluid were measured for 6 days postoperatively. RESULTS: Interleukin-6 and interleukin-8 leads peaked at 3 h or 1 day after surgery. Cytokine levels in pleural fluid were more than 100 times higher than corresponding systemic levels. The increase of interleukin-6 in pleural fluid 3 hours after surgery was significantly smaller in video-assisted thoracoscopic lobectomy (3971 +/- 2793 pg/mL for video-assisted thoracoscopic lobectomy vs. 23274 +/- 8426 pg/mL for open lobectomy). There were no significant differences in the serum interleukin-6 and interleukin-8 concentrations between the 2 groups. CONCLUSION: The thoracoscopic approach lessened the increase of cytokines in pleural fluid, but benefits of reduced cytokine production in video-assisted thoracoscopy remain to be clarified.     

Surgical results for second primary lung cancer

Of 897 patients who underwent operation for lung cancer between April 1996 and March 2010, 57 patients underwent pulmonary resection for 2nd primary lung cancer. There were 44 men and 13 women. The average age at the 2nd operation was 71. The initial pulmonary resection was lobectomy in 49 patients, segmentectomy in 4 and wedge resection in 4. The 2nd pulmonary resection was lobectomy in 10 patients, segmentectomy in 12 and wedge resection in 35. Preoperative stage of the 2nd primary lung cancer was IA in 43, IB in 13 and IIB in 1. Postoperative stage was IA in 38, IB in 10, IIA in 1, IIB in 3, IIIA in 2 and IIIB in 3. Surgical complications occurred in 4, but there were no perioperative deaths. The 5-year survival rate for 2nd primary lung cancers was 59.9%. The 5-year survival rate for patients treated with wedge resection was 71.1%. The 5-year survival rate of the patients with p-stage IA was 72.7%, and that for patients with p-stage IB or more advanced diseases was 32.9%. We conclude that an aggressive surgical approach for a 2nd primary lung cancer is effective and is linked with good outcome if the tumor is detected at stage IA, when the possible cure by performing wedge resection is promissing.     

The role of video-assisted thoracic surgery for the treatment of lung cancer: lung lobectomy by thoracoscopy versus the standard thoracotomy approach

Our objective was to evaluate the usefulness, safety, validity and benefits of video-assisted thoracoscopic surgery (VATS) for performing pulmonary lobectomy in 24 patients with clinical NO stage I primary non-small-cell lung cancer compared with 30 patients who underwent a conventional thoracotomy. There were no significant differences in the intra-operative blood loss, duration of operation, or duration of chest tube drainage between the VATS group and the standard lobectomy group, but in this VATS' experience, patients had less postoperative pain. Numbers and distributions of dissected lymph-nodes were similar in patients whether undergoing standard thoracotomy or VATS lobectomy. We can confirm that the safety and validity of VATS are virtually identical to those of the standard thoracotomy approach in the lobectomy. However, the former technique causes less discomfort to patients and requires a shorter recovery period of laboratory data and IL-6 concentrations in thoracic drainage fluid. We conclude that VATS major lung resection is technically feasible. Stringent patient selection is important and special training is needed.     

Video-assisted thoracic surgery lobectomy reduces the morbidity after surgery for stage I non-small cell lung cancer

Objective: We conducted this study to evaluate the surgical invasiveness and the safety of video-assisted thoracic surgery lobectomy for stage I lung cancer. Methods: Video-assisted thoracic surgery lobectomies were performed on 43 patients with clinical stage IA non-small cell lung cancer. We compared the surgical invasiveness parameters with 42 patients who underwent lobectomy by conventional thoracotomy. Results: Intraoperative blood loss was significantly less than that in the conventional thoracotomy group (151±149 vs. 362±321 g, p<0.01). Chest tube duration (3.0±2.1 vs. 3.9±1.9 days) was significantly shorter than those in the conventional thoracotomy group (p<0.05). The visual analog scale which was evaluated as postoperative pain level on postoperative day 7, maximum white blood count and C-reactive protein level were significantly lower than those in the conventional thoracotomy group (p<0.05). The morbidity rate was significantly lower than that in the conventional thoracotomy group (25.6% vs. 47.6%, p<0.05). Sputum retention and arrhythmia were significantly less frequent than in the conventional thoracotomy group (p<0.05). We experienced no operative deaths in both groups. Conclusion: We conclude that video-assisted thoracic surgery lobectomy for stage I non-small cell lung cancer patients is a less invasive and safer procedure with a lower morbidity rate compared with lobectomy by thoracotomy.     

Video-assisted thoracic surgery for metachronous lung cancer

Of 1,391 patients who underwent operation for primary lung cancer between 2000 and 2009, 50 patients (3.6%) had a past history of pulmonary resection for lung cancer. Three patients underwent completion pneumonectomy by thoracotomy and in the other 47 patients video-assisted thoracic surgery (VATS) was performed. We considered 42 cases (3 of completion pneumonectomy and 39 of VATS) to be metachronous lung cancer and 8 cases of VATS to be recurrence by detailed histologic assessment. We examined 39 cases of metachronous lung cancer resected by VATS. The patients were aged 68 +/- 8 years and 4 patients were aged 80-years or more. The surgical procedures performed were lobectomy in 4 patients, segmentectomy in 3, and wedge resection in 40. The operation time was 121 +/- 66 minutes and the blood loss was 67 +/- 140 ml. There were no major complications. We registered 6 deaths during follow-up; 3 were due to disease progression and 3 were due to other causes. The survival rate of the 42 patients including 3 patients who underwent completion pneumonectomy was 74.9% at 5 years. Early detection of metachronous lung cancer and surgical resection offers a favorable prognosis.     

Registration of resected lung cancer in Niigata Prefecture

Objectives: Our registration of surgically treated lung cancer patients in Niigata Prefecture began in 2001. The purpose of this study was to identify the characteristics of patients and surgical treatment of lung cancer. Methods: All patients who underwent resection for lung cancer in Niigata Prefecture from January 2001 to December 2002 were eligible for registration. A total of 31 medical data for each patient were registered. Results: During the 2-year period, 1,211 patients were registered. A total of 605 cases (50%) were detected by mass screening, and 874 cases (72%) were diagnosed preoperatively. There were 718 (59%) c-stage IA cases and 317 (26%) c-stage IB cases. The most common operative procedure was lobectomy; 850 patients underwent single lobectomy. Limited resection was performed in 301 patients (25%), and video-assisted thoracoscopic surgery in 193 (16%). The most common histological type was adenocarcinoma in 860 cases (71%), followed by squamous cell carcinoma in 273 (23%). Pathologic staging yielded stage IA in 635 cases (52%) and stage IB in 262 (22%). Conclusions: The results of our registration demonstrate a very high ratio of surgically treated stage IA cases in Niigata Prefecture and that limited resection was performed in many patients. Accumulation of these data will reveal the characteristics of lung cancer surgically treated in Niigata Prefecture and will provide a basis for determining the future course of surgical treatment for lung cancer. Registration is continuing, and it will provide new and useful information about lung cancer, eventually including 5-year survival data.     

Surgical treatment of pulmonary metastases from colon and rectal cancer

We retrospectively studied the surgical treatment for pulmonary metastases from colon and rectal cancer. A total of 24 patients (9 males and 15 females; mean age 61 years) underwent 29 thoracotomies for metastatic colon carcinoma, while 22 patients (16 males and 6 females; mean age 63 years) underwent 29 thoracotomies for metastatic rectal cancer. The median interval between the primary procedure and lung resection for metastases was 26 months in the patients with colon carcinoma and 32 months in the patients with rectal cancer. In the patients with colon carcinoma, 16 underwent wedge resection or segmentectomy (including 4 video-assisted procedures) and 13 (54%) underwent lobectomy or pneumonectomy. In the patients with rectal cancer, 15 underwent wedge or segmentectomy (including 1 video-assisted procedure), 13 (59%) underwent lobectomy or pneumonectomy, and 1 underwent exploratory thoracotomy. All procedures except exploratory thoracotomy were curative operations. There was no mortality. Overall 5-year survival was 56% (n=46). Five-year survival was 65% for patients with colon metastases (n=24) and 45% for patients with rectal metastases (n=22), and there was no significant difference. Recurrent sites were 4 lungs (36%), 4 livers (36%), 1 bone, 1 uterus, and 1 peritoneum in patients with colon carcimoma, and 10 lungs (43%), 5 brains (22%), 3 livers (13%), 1 bone, and 1 vagina in patients with rectal cancer. Pulmonary resection for metastases from colon carcinoma may have better prognosis than that from rectal cancer. However, further investigation may be required to obtain convincing conclusions.     

Changes in right ventricular performance in elderly patients who underwent lobectomy using video-assisted thoracic surgery for primary lung cancer.

OBJECTIVE: Even though lobectomy using video-assisted thoracic surgery for primary lung cancer has been reported to be beneficial in terms of the perioperative outcome, changes in the right ventricular performance have not yet been reported. The aim of this study was to determine whether lobectomy by video-assisted thoracic surgery is also advantageous with respect to the right ventricular performance in elderly patients who are 70 years old or older. SUBJECTS AND METHODS: Thirteen patients (mean age: 76 years) who underwent lobectomy using video-assisted thoracic surgery (Video-assisted Thoracic Surgery Group), and 10 patients (mean age: 76 years) who underwent lobectomy using a standard thoracotomy as a historical control group (Standard Thoracotomy Group) were studied. The hemodynamics and right ventricular ejection fraction were evaluated preoperatively, and at 6, 12, 24, and at 48 hours postoperatively. RESULTS: Postoperative values were expressed as a percentage of the preoperative values. The systemic vascular resistance index decreased to a greater extent in the Video-assisted Thoracic Surgery Group than in the Standard Thoracotomy Group. The pulmonary arteriolar resistance index at 24 hours postoperation tended to be higher in the Standard Thoracotomy Group than in the Video-assisted Thoracic Surgery Group. The stroke index, cardiac index, and right ventricular ejection fraction at 24 hours postoperation were each significantly higher in the Video-assisted Thoracic Surgery Group than in the Standard Thoracotomy Group. CONCLUSION: Lobectomy using video-assisted thoracic surgery for elderly patients offers not only beneficial effects in the right ventricular afterload but also acceleration in the expected compensatory hyperdynamics during the acute postoperative phase.     

Long-term benefits for the quality of life after video-assisted thoracoscopic lobectomy in patients with lung cancer

Quality of life (QOL) after video-assisted thoracic surgical (VATS) lobectomy remains to be defined. Forty-four consecutive patients with clinical stage I lung cancer underwent lobectomy by the VATS approach (n = 22 patients) or thoracotomy approach (n = 22 patients). Acute pain was quantitated by postoperative narcotic requirements and the need for epidural anesthesia. Long-term QOL was assessed by questioning patients about the presence of chronic chest pain, ongoing limitations in arm or shoulder function, time until return to preoperative activity, and satisfaction with the operation. Patients who underwent VATS lobectomy had significant decreases in both acute and chronic chest pain and time until return to preoperative activity. Patients also had more confidence regarding wound size and their overall impression of the operation. In this series, VATS lobectomy was associated with long-term benefits for the QOL in patients with lung cancer. However, the exact role of this approach should be defined by carefully-designed controlled trials studying long-term survival.     

Video-assisted Thoracoscopic Lobectomy Achieves a Satisfactory Long-term Prognosis in Patients with Clinical Stage IA Lung Cancer

We designed a prospective trial to determine the long-term prognosis of video-assisted thoracoscopic (VATS) lobectomy versus conventional lobectomy for patients with clinical stage IA (T1N0M0) lung cancer. Between January 1993 and June 1994, 100 consecutive patients with clinical stage IA non-small cell lung carcinoma underwent either conventional lobectomy through an open thoracotomy (open group; n= 52) or VATS lobectomy (VATS group; n= 48). Lymph node dissections were performed in a similar manner in both groups. No significant differences were observed in the number of dissected lymph nodes between the 2 groups. Pathologic N1 and N2 disease was found in 3 and 1 patients, respectively, from the open group, and in 2 and 1 patients, respectively, from the VATS group. During the follow-up period, distant metastases and local or regional recurrences developed in 7 and 3 of the open group patients, respectively, and in 2 and 3 of the VATS group patients, respectively. Two and one of the open and VATS group patients developed second primary cancers, respectively. The overall survival rates 5 years after surgery were 85% and 90% in the open and VATS groups, respectively (log-rank test, p= 0.74; generalized Wilcoxon test, p= 0.91). VATS lobectomy with lymph node dissection achieved an excellent 5-year survival, similar to that achieved by the conventional approach.     

Changes in right ventricular performance in elderly patients who underwent lobectomy using video-assisted thoracic surgery for primary lung cancer

Objective: Even though lobectomy using video-assisted thoracic surgery for primary lung cancer has been reported to be beneficial in terms of the perioperative outcome, changes in the right ventricular performance have not yet been reported. The aim of this study was to determine whether lobectomy by video-assisted thoracic surgery is also advantageous with respect to the right ventricular performance in elderly patients who are 70 years old or older.Subjects and Methods: Thirteen patients (mean age: 76 years) who underwent lobectomy using video-assisted thoracic surgery (Video-assisted Thoracic Surgery Group), and 10 patients (mean age: 76 years) who underwent lobectomy using a standard thoracotomy as a historical control group (Standard Thoracotomy Group) were studied. The hemodynamics and right ventricular ejection fraction were evaluated preoperatively, and at 6, 12, 24, and at 48 hours postoperatively.Results: Postoperative values were expressed as a percentage of the preoperative values. The systemic vascular resistance index decreased to a greater extent in the Video-assisted Thoracic Surgery Group than in the Standard Thoracotomy Group. The pulmonary arteriolar resistance index at 24 hours postoperation tended to be higher in the Standard Thoracotomy Group than in the Video-assisted Thoracic Surgery Group. The stroke index, cardiac index, and right ventricular ejection fraction at 24 hours postoperation were each significantly higher in the Video-assisted Thoracic Surgery Group than in the Standard Thoracotomy Group.Conclusion: Lobectomy using video-assisted thoracic surgery for elderly patients offers not only beneficial effects in the right ventricular afterload but also acceleration in the expected compensatory hyperdynamics during the acute postoperative phase.     

Lung cancer in octogenarians: factors affecting long-term survival following resection.

OBJECTIVE: To identify factors associated with long-term survival following pulmonary resection for lung cancer in patients 80 years of age or older. METHODS: The medical records of all patients >or=80 years, who underwent pulmonary resection for lung cancer from 1985 to 2002, were reviewed. RESULTS: There were 294 patients (192 men, 102 women). Median age was 82 years (range 80-94 years). Overall 1-, 2-, and 5-year survival was 80%, 62%, and 34%, respectively. Histologic subtype, diabetes, renal insufficiency, prior myocardial infarction, congestive heart failure or stroke were not significantly associated with differences in 5-year survival. Female gender was associated with increased survival (36.2% vs 32.7% at 5 years, p=0.04). Extent of preoperative forced expiratory volume in 1s (FEV1) limitation did not influence survival. However, there were no 5-year survivors amongst patients with dyspnea as their presenting chief complaint, whereas there was a 35% 5-year survival in patients presenting without dyspnea (p<0.001). Five-year survival by pathologic stage was IA, 48%; IB, 39%; IIA, 17%; IIB, 23%; IIIA, 9%; and IIIB, 0% (p<0.001). Five-year survival of patients undergoing a lobectomy was 42% versus 11% for pneumonectomy (p<0.001). CONCLUSIONS: Meaningful long-term survival is obtainable in elderly patients undergoing surgical resection for lung cancer. Careful patient evaluation and selection is necessary to identify patients who will benefit most from resection. Shorter survival was observed in male patients and those presenting with dyspnea. As could be expected, survival was also dependent on extent of resection and initial pathologic stage.     

Video-assisted thoracic surgery for lung cancer

Objective|The objective of this study was to confirm the safety and feasibility of video-assisted thoracic surgery (VATS) for primary lung cancer and to compare prognoses with that of conventional procedures, and then to examine whether VATS would supplant a conventional thoracotomy for stage I lung cancer. Methods: From September 1995 through March 2002, 144 patients with primary lung cancer, included 118 patients with postoperative state I, underwent VATS lobectomy. We reviewed the previous cases whether they could be candidates for VATS lobectomy according to present indications. 166 cases were supposed to be candidates for VATS, and 121 cases of postoperative stage I disease were recruited into the “conventional thoracotomy” group. Results: There was no mortality or major complication except one case, and mean follow-up was 31.8 months in VATS. The number of removed lymph nodes was not significantly less than the number by conventional thoractomy (p=0.061). Five-year survival for patients with pathological stage IA adenocarcinoma was 92.4% (n=66) in VATS and 86.9% (n=50) in conventional thoracotomy, and a statistical significance could not be recognized (p=0.980). The length of hospital stay was significantly short in VATS lobectomy (p<0.0001). Conclusions: VATS lobectomy for stage I lung cancer can be performed safely with minimal morbidity, satisfying survival comparable with that of lobectomy through conventional thoractomy. VATS approach is a feasible surgical technique for patients with stage I lung cancer.     

Video-assisted bronchial stump reinforcement with an intercostal muscle flap

For lobectomy patients at considerable risk of developing a postoperative bronchopleural fistula, the bronchial stump reinforcement with an intercostal muscle flap is sometimes performed. This procedure usually requires a standard thoracotomy, even if video-assisted thoracoscopic surgery (VATS) is better for the patient. Our patient was a 76-year-old male with lung cancer and severe diabetes mellitus. He underwent lobectomy and systematic nodal dissection combined with bronchial stump reinforcement using an intercostal muscle flap, performed as a VATS procedure. No postoperative complications were observed. This procedure is applicable to patients who are candidates for VATS lobectomy.     

全胸腔镜肺叶切除术治疗临床早期非小细胞肺癌的疗效评价

目的探讨全胸腔镜肺叶切除术治疗临床早期肺癌的安全性和可行性,评价其手术疗效。方法回顾性分析2005年1月至2008年12月复旦大学附属中山医院160例(全胸腔镜手术组,其中男83例,女77例;平均年龄60.8岁)接受全胸腔镜肺叶切除术治疗的临床早期非小细胞肺癌患者的围手术期资料及生存数据,并与同期357例(开放手术组,其中男222例,女135例;平均年龄59.5岁)接受常规开放手术的早期非小细胞肺癌患者数据进行比较。结果全胸腔镜手术组患者中转开胸率为5.0%(8/160)。全胸腔镜组手术时间明显短于开放手术组(113.0 min vs.125.0 min,P=0.039);两组患者术后住院时间差异无统计学意义[(10.3±4.3)d vs.(9.1±4.6)d,P=0.425]。全胸腔镜手术组和开放手术组患者并发症发生率分别为9.4%(15/160)和10.1%(36/357),围术期死亡率为0.6%(1/160)和2.0%(7/357)。两组患者平均淋巴结清扫组数[(2.4±1.5)组vs.(2.4±1.7)组,P=0.743]和平均淋巴结清扫数[(9.8±6.3)枚vs.(10.1±6.4)枚,P=0.626]差异无统计学意义。全胸腔镜手术组总体5年生存率高于开放手术组(81.5%vs.67.8%,P=0.001)。进一步按不同病理分期进行亚组分析显示全胸腔镜手术组5年生存率为pⅠa期86.0%,pⅠb期84.5%,pⅢa期58.8%;开放手术组5年生存率为pⅠa期92.9%,pⅠb期76.4%,pⅢa期25.3%。结论全胸腔镜肺叶切除术治疗临床早期肺癌在技术上安全可行,其淋巴结清扫可达到开放手术的范围,远期疗效优于开放手术,但亟待大样本量的随机对照研究进一步证实。