Is Video-Assisted Thoracoscopic Surgery Suitable for Resection of Primary Lung Cancer?

Abstract

We investigated the validity of thoracoscopic surgery-in patients with primary lung cancer undergoing lobectomy. 14 primary lung cancer patients treated by typical VATS lobectomy and one by anatomical segmentectomy, were compared with 56 patients with Stage-I lung cancer undergoing standard lobectomy (control group), the results focusing on the lymph-nodes dissected. All 14 lobectomy patients showed primary lesions of size less than 3 cm. Following classification of the lymph-nodes into groups I (hilar lymph node) and II (mediastinal lymph node), we compared results according to the sites of the lobectomies conducted. Numbers of dissected lymph-nodes were similar in patients whether undergoing standard thoracotomy or VATS lobectomy. We also investigated what histological types of cancer should be treated by VATS lobectomy by comparing preoperative and operative staging in the control group. The results showed that in most patients with squamous-cell carcinoma judged as T1 N0 M0 the staging corresponded, the other patients actually being in N1 (Stage II). Of Patients with adenocarcinoma of T1 N0 M0, however, 14% had lymph-node metastasis even into the superior mediastinum, i.e., Stage III. The overall findings suggest at present that VATS lobectomy should be applied preferably to patients with a histological typing such as squamous cell carcinoma or alveolar cell carcinoma of relatively early stage, i.e. preoperative Stage I.

Video-assisted thoracic surgery (VATS) lobectomy for typical bronchopulmonary carcinoid tumors

“…It is a commonly held view that in the treatment of carcinoids, pulmonary excision must be associated with the removal of the regional lymph nodes. This principle was applied systematically in this group of patients, thus providing further confirmation that VATS makes it possible to perform a proper lymphadenectomy, as has been demonstrated by other authors [7,12].…”

“…It seems, however, to have been proven that VATS lobectomy, for the cases indicated, is a proper procedure from the point of view of respect for oncological principles [7,12]. Other pathologies for which VATS lobectomy has been proposed-i.e., benign conditions and solitary metastases that cannot be excised by means of limited resection [13,15,22]-have not provoked as much controversy, but this is in all probability due to the statistically small number of cases treated.…”

Video-assisted thoracoscopic surgery (VATS) segmentectomy for small peripheral lung cancer tumors: intermediate results

“…Less destruction of respiratory muscle under the VATS procedure has also been reported to result in preserved respiratory function after surgery [6]. The possible technical inaccuracy of VATS, especially in lymph node dissection, has been viewed with apprehension since the procedure was first introduced; however, recent advances in thoracoscopic techniques and equipment have improved both the safety and the accuracy of VATS procedures [5,7,16]. This technical reliability, together with the proven lower invasiveness of VATS procedures, makes such procedures a viable option for lung cancer surgery.…”

“…The procedures of dissection and the appropriate section of vessels and bronchus were selected based on previously reported techniques for VATS lobectomy [4,5,7]. After careful dissection, the pulmonary arteries and veins to the affected segment were lifted with vascular tape and sectioned with a vascular endocutter.…”

Long‐term patient outcome 10 years after video‐assisted thoracoscopic surgery lobectomy for non‐small‐cell lung cancer

“…In these cases, 3‐ and 5‐year survivals rates were similar to conventional thoracotomy (67.6% versus 57.7% and 45.4% versus 41.1%, respectively) for cN0‐pN2 NSCLC (21). We previously reported that lymph node dissection can technically be the same procedure regardless of whether it is performed using VATS or conventional thoracotomy (22). Sagawa et al presented a prospective trial in which the average number of remnant lymph nodes after VATS lobectomy was 1.2 and nodal involvements were not observed in the remnant lymph nodes (23).…”