Outcomes of unexpected pathologic N1 and N2 disease after video-assisted thoracic surgery lobectomy for clinical stage I non-small cell lung cancer.
ABSTRACT The objective of this study was to assess early and late outcomes of pathologic N1 or N2 disease unexpectedly detected in patients undergoing video-assisted thoracic surgery lobectomy for clinical stage I non-small cell lung cancer.
We retrospectively reviewed the clinical and pathologic features of patients with unexpected N1 or N2 disease after video-assisted thoracic surgery lobectomy for clinical stage I disease and their early and late outcomes, including survival and recurrence pattern.
Between 2004 and 2008, 547 patients with clinical stage I disease underwent video-assisted thoracic surgery lobectomy, and of these, 89 were found to have pathologic N1 (n = 49) or N2 (n = 40) disease. No in-hospital mortality was noted during the postoperative period. For patients receiving adjuvant treatment, the median time interval between discharge from surgical intervention and start of adjuvant treatment was 24 days. The median follow-up time was 21.3 months. The 3-year overall survival was 98% for patients with N1 disease and 89% for patients with N2 disease. During follow-up, 33 (37%) patients had a recurrence. The pattern of recurrence was locoregional in 7, distant in 21, and both in 5 patients. The 3-year disease-free survival was 59% for patients with N1 disease and 33% for patients with N2 disease.
For patients with pathologic N1 or N2 disease after video-assisted thoracic surgery lobectomy, survival was comparable with that after lobectomy through a thoracotomy. Even if lymph node metastasis is unexpectedly detected during video-assisted thoracic surgery lobectomy for clinical stage I disease, there is no need to convert to conventional thoracotomy.
- The Annals of thoracic surgery 03/2014; 97(3):1125. · 3.45 Impact Factor
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ABSTRACT: To compare outcomes between thoracoscopic and thoracotomy lobectomy for patients with cN0-pN2 NSCLC. One hundred eighty-two cN0 patients (including 29 pN2) underwent VATS lobectomy between September 2006 and December 2009, and 204 cN0 patients (including 47 pN2) underwent thoracotomy lobectomy between July 2000 and December 2009. Pre- and intraoperative status and postoperative survival between two groups were compared. There was no difference in preoperative conditions between two groups except Quantity of smoking. Operation time and blood loss of VATS group was significantly lower than thoracotomy group. Number of dissected lymph node (LN) stations was 3.3 ± 1.1 in VATS group versus 3.3 ± 1.3 in thoracotomy group, and the total number of LN was 12.7 ± 8.9 in VATS group versus 10.5 ± 7.2 in thoracotomy group. One- and 3-year disease-free survival rate was 82.6% in VATS group versus 72.0% in thoracotomy group, and 49.3% in VATS group versus 51.3% in thoracotomy group (P=0.996). One- and 3-year survival rate was 84.9% in VATS group versus 71.2% in thoracotomy group, and 64.0% in VATS group versus 42.7% in thoracotomy group (P=0.121). VATS lobectomy is comparable with thoracotomy in both safety and curability for the treatment of cN0-pN2 NSCLC, without necessity of conversion to open surgery.Journal of Surgical Oncology 03/2012; 106(4):431-5. · 2.64 Impact Factor
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ABSTRACT: Major lung resection using minimally invasive techniques - video-assisted thoracoscopic surgery (VATS) - was first described 20years ago. However, its development has been slow in many countries because the value of this approach has been questioned. Different techniques and definitions of VATS are used and this can be confusing for physicians and surgeons. The benefit of minimally invasive thoracic surgery was not always apparent, while many surgeons pointed to suboptimal operative outcomes. Recently, technological advances (radiology, full HD monitor and new stapler devices) have improved VATS outcomes. The objectives of this review are to emphasize the accepted definition of VATS resection, outline the different techniques developed and their results including morbidity and mortality compared to conventional approaches. Minimally invasive thoracic surgery has not been proven to give superior survival (level one evidence) compared to thoracotomy. A slight advantage has been demonstrated for short-term outcomes. VATS is not a surgical revolution but rather an evolution of surgery. It should be considered together with the new medical environment including stereotactic radiotherapy and radiofrequency. VATS seems to be more accurate in the treatment of small lung lesions diagnosed with screening CT scan. In the academic field, VATS allows easier teaching and diffusion of techniques.Revue des Maladies Respiratoires 04/2014; 31(4):323-335. · 0.50 Impact Factor