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.
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ABSTRACT: To assess the feasibility and safety of the video-assisted thoracoscopy surgery (VATS) systematic lymph node dissection in resectable non-small cell lung cancer (NSCLC). The clinical data of patients with NSCLC who underwent VATS or thoracotomy combined with lobectomy and systematic lymphadenectomy from January 2001 to January 2008 were retrospectively analyzed to identify their demographic parameters, number of dissected lymph nodes and postoperative complications. A total of 5,620 patients were enrolled in this study, with 2,703 in the VATS group, including 1,742 men (64.4%), and 961 women (35.6%), aged 59.5±10.9 years; and 2,917 in the thoracotomy group, including 2,163 men (74.2%), and 754 women (25.8%), aged 58.5±10.4 years. Comparing the VATS with the thoracotomy groups, the mean operative time was 146 vs. 157 min, with a significant difference (P<0.001); and the average blood loss was 162 vs. 267 mL, with a significant difference (P<0.001). Comparing the two groups of patients data, the number of lymph node dissection: 18.03 in the VATS group and 15.07 in the thoracotomy group on average, with a significant difference (P<0.001); postoperative drainage time: 4.5 days in the VATS group and 6.37 days in the thoracotomy group on average, with a significant difference (P<0.001); postoperative hospital stay: 6.5 days in the VATS group and 8.37 days in the thoracotomy group on average, with a significant difference (P<0.001); proportion of postoperative chylothorax: 0.2% (4/2,579) in the VATS group and 0.4% (10/2,799) in the thoracotomy group, without significant difference (P>0.05). For patients with resectable NSCLC, VATS systematic lymph node dissection is safe and effective with fewer postoperative complications, and significantly faster postoperative recovery compared with traditional open chest surgery.01/2014; 6(1):45-51. DOI:10.3978/j.issn.2072-1439.2014.01.07
The Annals of thoracic surgery 03/2014; 97(3):1125. DOI:10.1016/j.athoracsur.2013.09.005 · 3.45 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. · 0.49 Impact Factor