Minimally invasive open surgery (MIOS) for clinical stage I lung cancer: diversity in minimally invasive procedures

Abstract

Background Many thoracic surgeons have tried to make lung cancer surgery less invasive. Among the minimally invasive approaches that are currently available, it is controversial which is optimal. Minimally invasive open surgery, i.e. hybrid video-assisted thoracic surgery, has been adopted for lung cancer surgery at our institute. The objective of this study was to evaluate minimally invasive open surgery in terms of perioperative outcomes over the most recent 5 years. Methods Between 2015 and 2019, 2738 patients underwent pulmonary resection for lung cancer at National Cancer Center Hospital, Japan. Among them, 2174 patients with clinical stage I lung cancer who underwent minimally invasive open surgery were included. Several perioperative parameters were evaluated. Results The patients consisted of 1092 men (50.2%) and 1082 women (49.8%). Lobectomy was performed in 1255 patients (57.7%), segmentectomy in 603 (27.7%) and wide wedge resection in 316 (14.5%). Median blood loss was 30 ml (interquartile range: 15–57 ml) for lobectomy, 17 ml (interquartile range: 10–31 ml) for segmentectomy and 5 ml (interquartile range: 2–10 ml) for wide wedge resection. Median operative time was 120 min (interquartile range: 104–139 min) for lobectomy, 109 min (interquartile range: 98–123 min) for segmentectomy and 59 min (interquartile range: 48–76 min) for wide wedge resection. Median length of postoperative hospital stay was 4 days (interquartile range: 3–5 days). The 30-day mortality rate was 0.08% for lobectomy, 0.17% for segmentectomy and 0.00% for wide wedge resection. Conclusions Minimally invasive open surgery for clinical stage I lung cancer is a feasible approach with a low mortality and a short hospital stay. Oncological outcomes need to be investigated.

Regional ventilation distribution before and after laparoscopic lung parenchymal resection

“…The types of resection (e.g. lobectomy, wedge resection) may also have influences (Asamura et al 2017, Divisi et al 2020, Nakagawa et al 2021. Patients usually experience partial loss of lung function after surgery (Feng et al 2022).…”

Fissure-first bilobectomy of a giant lung abscess combined with a squamous cell carcinoma via a minimally invasive open surgery

“…Despite the widespread use of this technique in lobectomy cases, to the best of our knowledge, there has been no report on a fissureless bilobectomy to date. We herein report a successful bilobectomy in a case with a giant lung abscess combined with a squamous cell carcinoma and describe the technical significance especially regarding the minimally invasive open surgery (MIOS) [6,7].…”

Minimally invasive sleeve lobectomy: it is important to pass excellent techniques to the next generation

“…Recently, minimally invasive approaches have been widely applied to surgery for lung cancer, particularly early-stage lung cancer, and several studies have demonstrated the usefulness of these approaches compared to conventional thoracotomy ( 1 ). These minimally invasive approaches are sometimes used for more complicated lung cancer surgery, such as bronchial sleeve lobectomy ( 2 , 3 ).…”

“…Minimally invasive approaches have become a landmark in the era of minimally invasive surgery. However, few studies have investigated the differences between these minimally invasive approaches in terms of invasiveness, safety, and oncological quality, not only in surgery for early-stage lung cancer, but also in complicated lung cancer surgery ( 1 ). Accordingly, thoracic surgeons do not yet know which approaches are the most appropriate for sleeve lobectomy for lung cancer.…”

“…The length of the skin incision can be extended from 5 to 8 cm depending on the status of lung cancer, the difficulty of the surgical procedures, the surgeons` skill and that of the other members of the operative team. The most important advantage of the hybrid VATS approach is that it can be easily converted to standard thoracotomy in an emergency such as PA injury ( 1 ). Accordingly, it is reasonable that operative procedures would begin thorough a hybrid VATS approach and this should be maintained as much as possible.…”