Video-assisted thoracoscopic surgery lobectomy for non-small cell lung cancer

Since 1990s, video-assisted thoracoscopic surgery (VATS) lobectomy has become a standard procedure for early-stage non-small cell lung cancer. However, VATS lobectomies are less common, and no randomized controlled trial of VATS versus conventional open lobectomy for early-stage lung cancer has been performed in Japan. Furthermore, VATS lobectomy procedures are not standardized in Japan, and may vary by institution or by practitioner, which complicates their evaluation. Although VATS procedures (such as pneumonectomy, bronchoplasty, and chest wall resection) have been reportedly performed for patients with advanced disease, whether VATS could be a standard modality for advanced lung cancer is unclear from an oncological perspective. Until recently, VATS lobectomies commonly used three or four ports to conduct systemic lymph node dissection; however, VATS lobectomies with reduced port have been recently reported. This article reviews current trends in VATS lobectomy procedures.     

Minimally invasive pulmonary surgery for lung cancer, up to date

Recently, the minimally invasive surgical approach is an important issue in the pulmonary surgery. In this review, we present the current fashion of video-assisted thoracic surgery (VATS) and new approach including robotic lobectomy. There is no clear definition or standard for this surgical procedure regarding VATS lobectomy. Therefore, no randomized controlled trial of VATS and conventional lobectomy can be set up. Although the definition of VATS lobectomy is not straightforward, VATS lobectomy showed the technical feasibility of conventional lobectomy in mortality and postoperative complication as well as lymph node dissection. VATS procedure for advanced lung cancer is unclear whether such observations can be developed into a standardized approach. There are no reports to evaluate the advantages of robotic lobectomy in terms of treatment outcomes for lung cancer compared with VATS lobectomy. However, we believe that robotic lobectomy has clear potential to improve the quality of minimally invasive surgery.     

Thoracoscopic mediastinal lymph node dissection for lung cancer

Mediastinal lymph node staging is an important component of the assessment and management of patients with operable non-small cell lung cancer and is necessary to achieve complete resection. During minimally invasive surgery, performance of an equivalent oncologic resection, including adequate lymph node dissection similar in extent to open thoracotomy, is absolutely necessary. We describe our techniques for video-assisted thoracic surgery (VATS) and Robot-assisted VATS (R-VATS) mediastinal lymph node dissection when performing thoracoscopic lobectomy for lung cancer. Between 2008 and 2011, 200 consecutive patients who underwent VATS or R-VATS lobectomies for early stage lung cancer were analyzed. In our series, we removed about 25 lymph nodes per case in both complete VATS and R-VATS. A thorough lymph node dissection in lung cancer is possible with either VATS or R-VATS technique without oncological compromise.     

Video-assisted thoracic surgery for lung cancer

Video-assisted thoracic surgery (VATS) lobectomy is currently accepted as an appropriate procedure for selected patients with early-stage non-small-cell lung cancer (NSCLC). Evidence has demonstrated that VATS lobectomy is not only a safe and feasible technique, it provides better functional recovery and oncological efficacy similar to that achieved with conventional thoracotomy. However, there are still ongoing issues concerning VATS in terms of terminology, oncological efficacy, functional recovery, benefit of screening detected lung cancer, and its role in limited resection. As the number of VATS procedures are increasing and VATS is becoming a dominant procedural choice, it would be wise to collect evidence and come to a consensus to justify the expansion of surgical indications for VATS.     

Video-assisted thoracic surgery lobectomy for lung cancer: the point at issue

Among the four subjects addressed in this article, the definition of video-assisted thoracic surgery (VATS) lobectomy is fundamentally the point at issue, which leads to various obstacles for upcoming clinical trials. It is strongly expected that VATS lobectomy will be identified as a standard operation for primary lung cancer with confirmed clinical evidence. Standard surgical procedure with a certain oncological validity for lung cancer should be minimally invasive, safe, and technically simple for general thoracic surgeons. In conclusion, most patients with resectable lung cancer will be able to benefit from a validated painless VATS lobectomy in the near future.     

Video-assisted thoracic surgery lobectomy (VATS), open thoracotomy, and the robot for lung cancer

Video-assisted thoracic surgery (VATS) lobectomy provides a minimally invasive approach for the management of early-stage lung cancer. Questions about the safety of VATS lobectomy and its adequacy as a cancer operation compared with open thoracotomy have hindered its universal acceptance among thoracic surgeons. Evidence suggests that VATS lobectomy can be safely performed and is an adequate cancer operation for early-stage non-small cell lung cancer. However, adequately powered well-balanced studies comparing VATS with open thoracotomy for lobectomy are lacking in the literature.     

Lobectomy with extended lymph node dissection by video-assisted thoracic surgery for lung cancer

Background: Between September 1992 and September 1996, we performed 88 VATS (video-assisted thoracic surgery) lobectomies and two VATS pneumonectomies. Methods: The indications for surgery were 68 cases of lung cancer, nine cases of bronchiectasis, six cases of tuberculosis, and seven cases of benign lesions. Of the 68 cases of lung cancer, 36 were treated by VATS lobectomy with extended lymph node dissection for clinical stage I lung cancer, making full use of recently developed devices for thoracoscopic surgery, such as roticulating endoscissors, miniretractors, endoclips, and harmonic scalpels. Results: Twenty-four lymph nodes were resected on average (range, 10 to 51) by VATS. This number was comparable to lymph nodes resected in open thoracotomy during the same period. Among the 36 patients who underwent extended lymph node dissection, 20 showed no lymph node metastasis postoperatively (stage I), while 16 had N1 or N2 cancer. All patients with stage I cancer have survived 4 to 36 months (median: 17 months) with no signs of recurrence. Conclusions: This survival of stage I lung cancer after VATS is comparable to that of open thoracotomy. We thus believe that VATS lobectomy with extended lymph node dissection can be an alternative to standard posterolateral thoracotomy for stage I lung cancer. Received: 10 May 1996/Accepted: 19 November 1996     

Video-assisted thoracic lobectomy with bronchoplasty for lung cancer, with special reference to methodology

Few studies have described video-assisted thoracic surgery (VATS) to bronchoplasty with pulmonary resection. Here, we report the successful implementation of VATS bronchoplasty, as determined retrospectively. Between 2005 and 2010, 362 patients underwent elective lung resection for malignant or benign lung tumors. Of these patients, VATS lobectomy with bronchoplasty was performed in seven patients (four men, three women; median age, 72.9 years). The medical records were retrospectively reviewed. Of the seven patients, six had primary lung cancer (PLC), and one had metastatic cancer of the lung. The surgical procedures were lobectomy with wedge bronchoplasty. The patients with PLC also underwent mediastinal or hilar lymph node dissection. The median total operating time was 230 min, and the median blood loss was 152 ml. The median postoperative hospital stay was seven days, without major postoperative complications. The most important feature of the described method is that the surgeon mainly observes the operative field directly, through a working wound; the surgical team observes via a monitor. An advantage for the surgeon is the ability to use the same instruments in VATS as are used in conventional thoracotomy, as well as the same suturing techniques in vascular reconstruction, especially involving the pulmonary artery.     

Outcomes,safety, and feasibility of video-assisted thoracic surgery in lung cancer patients on hemodialysis: a case series

Objective

The rate of surgical resection of lung cancer in patients on hemodialysis is expected to increase due to the development of hemodialysis, improved diagnosis of lung cancer, and increases in the number and age of patients. However, studies assessing outcomes of lung resection in these patients are limited. In this retrospective case series, we investigated the safety and efficacy of video-assisted thoracic surgery (VATS) for lobectomy or segmentectomy for lung cancer in patients on hemodialysis.

Methods

Between January 2010 and January 2017, lobectomy or segmentectomy using VATS was performed for seven lung cancer cases in six patients receiving hemodialysis at our institution. There were two female and five male patients, with a median age of 61 years (range 53–76 years). Six patients underwent lobectomy, and segmentectomy and wedge resection were performed in each one case, respectively; systematic mediastinal lymph node dissection (ND2a-2) was performed in six patients.

Results

There were no perioperative deaths in this case series. Median recurrence-free and overall survival rates were 20 months (range 3–82 months) and 31 months (range 3–82 months), respectively.

Conclusions

Video-assisted thoracic surgery (VATS) is a safe and effective procedure for resection of lung cancer in hemodialysis patients and should be considered after accurate determination of surgical indications and careful perioperative management.

     

Limited thoracotomy as surgical therapy for lung cancer: lobectomy and lymph node dissection by means of 12 cm skin incision

In the domain of respiratory surgery minimally invasive approaches are currently being used and video-assisted thoracic surgery (VATS) is one of these methods. However VATS has some problems in its use for malignant lung diseases for example, with VATS adequate lymph node dissection and continuation of lobectomy in cases with severe adhesion are both difficult. In consideration of these points, limited thoracotomy has been practiced for treatment of lung cancer in our hospital. This study made comparisons between this new method (group A) and the conventional standard thoracotomy (group B). For the limited thoracotomy group (A) the skin incision and amount of bleeding were smaller than for the standard thoracotomy group (B) and the operation time was shorten. All limited thoracotomy group patients could lift up and move the hand of the affected side without pain immediately after the operation. The limited thoracotomy is an excellent approach as a curative operation for lung cancer, for preservation of post-operative pulmonary function, for movement capacity of the hand of the affected side and from the cosmetic viewpoint.     

A clinical evaluation of the practical reliability in video-assisted thoracic surgery for right primary lung cancer

Recently, lobectomy by video-assisted thoracic surgery (VATS lobectomy: VL) has been widely applied to peripheral lung cancer because of its less invasive approach compared to standard thoracotomy (ST). However, the appropriate approach in VL still remains to be solved. The aim of this study was to evaluate the practical reliability of our technical devices in VL for right primary lung cancer. For the VATS procedures, a mini-thoracotomy measuring about 6-7 cm was made in the fourth or fifth intercostal space (ICS) under the auscultatory triangle without rib resection. Two access holes 12 mm in size were also made in the fourth ICS at the anterior axillary line and in the seventh ICS at the posterior axillary line, respectively. These access holes were used for insertion of thoracoscope, endoscopic stapler or retracting instrument according to operative procedure. After stapling of the vessels and bronchus, the resected pulmonary lobe was removed from the thorax using a plastic retrieval bag. The present study showed the technical feasibility of this unique thoracoscopic approach in the standard lobectomy with systematic nodal dissection for right lung cancer.     

Diagnosis and surgical treatment for small-sized peripheral lung cancer

Small-sized peripheral lung cancers have been detected more frequently as a result of recent developments in diagnostic imaging including high-resolution computed tomography (HRCT). Although the diagnosis of small-sized peripheral lung cancers is difficult, it makes an adequate diagnosis possible using transbronchial fine needle aspiration cytology or a new thin-type bronchoscope. Surgical treatment using mini-thoracotomy or video-assisted thoracic surgery is effective for early stage small-sized peripheral lung cancers. Lesser resection of lung cancer may provide many benefits to patients, such as preserving vital lung tissue and providing the chance for further resection if a second primary lung cancer develops, however, lobectomy with systematic hilar and mediastinal lymph node dissection should remain the standard surgical treatment, and an intentional limited resection should be adopted for very limited patients with a definitive early stage because of recurrence rates.     

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 surgical lobectomy in conjunction with lymphadenectomy for lung cancer

Video-assisted thoracic surgery (VATS) has been in widespread use since the beginning of the 1990s. The initial indications for VATS were benign lesions of the lung, pneumothorax, benign tumors, etc. However, its application was extended to resection of lung cancer. We first gained experience with VATS lobectomy in September 1992, and also started performing lymphadenectomy using VATS in November 1993 after developing instruments for this meticulous operation. The 8-year survival rate of final stage IA lung cancers following VATS is 97.2%; this survival rate is significantly better than that with open thoracotomy. Here we report on our 10-year experience with VATS lobectomy, focusing on stage I lung cancer.     

原发性支气管肺癌电视胸腔镜下肺叶切除术后的早期疗效分析

目的探讨电视胸腔镜肺叶切除术治疗原发性支气管肺癌的早期疗效。方法1997年6月到2004年12月间治疗121例Ⅰ、Ⅱ期肺癌患者,其中Ⅰ期101例,右上叶切除术为34例,右中叶为13例,右下叶为17例;左上叶切除术为21例,左下叶为16例。病理分型：鳞癌24例,腺癌59例,细支气管肺泡癌10例,腺鳞混合癌7例,梭形细胞癌1例。全部使用胸腔镜器械切除的有38例。结果无术中死亡,并发症发生率15％。Ⅰ期患者的术后生存率：1年为99％（76／77）,2年为96％（49／51）,3年为79％（15／19）,腺癌相对于其他类型肺癌在术后生存率方面差异有统计学意义（P〈0．01）,38例全部使用电视胸腔镜手术器械切除与63例胸腔镜辅助下小切口手术者在术后生存率方面差异无统计学意义（P〉0.05）,与同期传统开胸手术相比亦如此。结论电视胸腔镜肺叶切除手术治疗早期肺癌的疗效优于传统开胸手术。     

Small size lung adenocarcinoma with rocal recurrence and port site recurrence 56 months after partial resection

A lobectomy with systemic lymphadenectomy is a standard surgical procedure for a resectable lung cancer. However there is not a consensus on the limited surgery. A 60-year-old man underwent left upper lobe partial resection for small size lung adenocarcinoma under video assisted thoracic surgery (VATS). Fifty-six months after the operation, a computed tomography (CT) scan showed a local recurrence on the staple-line. A positron emission tomography (PET) scan showed an additional port site recurrence, which wasn't showed by a CT scan. He underwent left upper lobectomy and port site resection.     

Video-assisted thoracic surgery lobectomy for lung cancer in a patient with complete situs inversus

Complete situs inversus is a rare abnormality of autosomal recessive inheritance; it requires particular care during surgery, because the viscus anatomy is a mirror image of the normal anatomy. Reports of surgery for lung cancer in cases of complete situs inversus are very rare. Here, we report a case of lobectomy for lung cancer of the right lower lobe performed using video-assisted thoracic surgery (VATS) in a patient with complete situs inversus. We emphasize the importance of careful examination of the relationship between the bronchus, pulmonary artery, and pulmonary vein in the hilum of the lung in cases of complete situs inversus requiring lung resection for cancer; this is even more necessary when VATS is performed.     

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.     

History of limited resection for non-small cell lung cancer.

A retrospective study of limited resection for lung cancer in a large number of patients was first reported in the 1970s. The reported outcome of segmentectomy was comparable to that of standard lobectomy. The North American Lung Cancer Study Group (LCSG) performed a randomized controlled clinical trial to compare limited resection (segment or wedge) with lobectomy for T1N0 (stage IA) non-small cell lung cancer (NSCLC) in the 1980s. The study revealed a significant excess of intrathoracic recurrence rate and a tendency to poorer survival in the limited resection group. Since then, limited resection has not been considered the standard operation for lung cancer. However, this situation is gradually changing, because the recent introduction of chest computed tomography (CT) to mass surveys has made peripherally located lung cancer detectable at the earliest stage. Several recent non-randomized studies of intentional limited resection from Japan demonstrated good outcomes comparable to those of lobectomy. Organ-sparing wedge resection without systematic dissection of lymph nodes may be suitable for some types of small lung cancers detected only by CT. Our meta-analysis of published data comparing survival rates after limited resection and lobectomy for stage I lung cancer revealed that limited resection was comparable to lobectomy. Further studies are necessary to define precise targets of intentional limited resection for lung cancer.