No abstract

Answering the question about contraindications for video-assisted thoracic surgery (VATS) in stage IIIA non-small cell lung cancer (NSCLC) is not simple, as stage IIIA relates to a heterogeneous group of bronchogenic carcinomas with locoregional involvement by extension of the primary tumor as well as ipsilateral nodal involvement posing a significant challenge in terms of surgical indication. VATS is imposing over open surgery as the standard of surgical care for early stage lung cancer, showing benefits in postoperative pain, recovery, morbidity and preservation of lung function while being equivalent in terms of oncologic outcome. To date the role of minimally invasive surgery in stage IIIA lung cancer has been reviewed only in few aspects: the practice of VATS in stage IIIA lung cancer has to be considered carefully in relation to the patient's clinical background taking also into account the surgical experience of the operating surgeons. Up to date, the choice of VATS in stage IIIA lung cancer seems to be feasible in selected cases with at least equivalent outcomes in comparison to open surgery. With the progression of the learning curve of the VATS technique as well as the development of dedicated instrumentation it is plausible that a larger number of cases of stage IIIA lung cancer will be treated through VATS in the near future. The aim of this review article is to describe feasibility, technical aspects and outcomes of VATS lobectomy in patients with stage IIIA NSCLC.

Sleeve resection comprises 3.1 % to 27.7 % of all anatomic lung resections performed in Germany. Anastomotic insufficiency is a feared complication that should be avoided. When anastomotic insufficiency does lead to secondary pneumonectomy, postoperative morbidity and mortality is high (30 % to 80 %). It is therefore very important to standardize the technique of sleeve resection as well as postoperative care. The time-point of postoperative follow-up and the interpretation of endobronchial healing have not yet been defined. In this paper anastomotic healing is described and interpreted with the help of a 5-step classification that allows bronchoscopic evaluation and classification of the anastomosis. The aim is to provide a standardized algorithm for postoperative care after sleeve resection. The basis of this classification and postoperative care measures derived from it are described and illustrated with the help of clinical examples.

Background and ObjectivesIt is unclear how much additional perioperative risk a sleeve lobectomy could pose in comparison to lobectomy. The objective of this analysis was to compare the complication rate, 30‐day mortality, and overall survival between lobectomy and sleeve lobectomy without prior neoadjuvant treatment in non‐small–cell lung cancer (NSCLC).MethodsThis is a retrospective study using our prospective database for quality assurance in our hospital. Inclusion criteria for our study was a completed lobectomy or sleeve lobectomy for primary treatment of NSCLC.ResultsIn 506 patients, the tumor was treated by means of standard lobectomy. In 252 patients with central tumor localization, sleeve lobectomy was performed. Postoperative complications occurred in n:148 (29.24%) patients of the lobectomy group and in n = 76 (30.15%) of the sleeve group. The mortality rate difference between the two groups was statistically significant and favored the lobectomy group (0.78% vs. 4.76%, p = .007). Five year survival was 69.97% for the lobectomy and 65.59% for the sleeve group (p = .829).ConclusionSleeve lobectomy for primary surgical treatment of NSCLC has comparable perioperative complications with lobectomy. Sleeve lobectomy does not seem to negatively influence survival. Postoperative mortality was higher in the sleeve group.