Clinical Study Of Pulmonary Lobectomy By Video-Assisted Thoracoscopic Surgery For Patients With Lung Cancer

BACKGUOUND Since the extensive application of minimally invasive surgical techniques in the thoracic surgeries in 1990s,video-assisted thoracic surgery(VATS)has become one of the standard approaches for many thoracic surgeons among their daily practice.Furthermore,the recent version of evidence-based NCCN guidelines clinical pracatice in oncology(V.1.2007)has recommended that video-assisted thoracic surgery may be considered as a feasible option rather than an alternative for patients that have surgically resectable non-small cell lung cancer.However,the several variation of this techniques as well as its exact role in the surgical management of lung cancer,especially in the early stage non-small cell lung cancer,has not yet been clearly defined and evaluated.Some surgeons still expressed concern about the ability to maintain surgical oncologic and dissection principles while performing VATS procedures and precluded the wider application in the surgical management of lung cancer.Thus,it is necssary to conduct the clinical study of pulmonary lobectomy by VATS for patients with lung cancer,especially the principle to which the surgery confer,indication and long-term survival rate,and so on. OBJECTIVE Our study is to evaluate the feasibility,long-term survival rate and prospects for development of pulmonary resection of radical cure by video-assisted thoracic surgery for patients with stageⅠandⅡnon-small cell lung cancer.METHODS From April 1996 to December 1999,Our hospital had treated 42 cases of clinic stageⅠandⅢnon-small cell lung cancer by VATS,among 38 cases of lobectomy and systemic lymph node dissection.The clinic materials were reviewed and compared with other 42 cases of clinic stageⅠandⅢnon-small cell lung cancer receiving pulmonary lobectomy through thoracotomy in the same period.RESULTS In VATS group,4 cases(9.5%)were converted to open surgery,the number and ambit of lymph nodes dissected in the VATS group was comparable to those dissected in the conventional thoracic surgery group.No significant differences were decected between two groups in hilum of lung lymph nodes dissected[(2.4±0.6)vs(2.8±0.9),P＞0.05],mediastinal lymph nodes dissected[(7.8±2.2)vs(8.5±2.8),P＞0.05].In two groups,the incidence rates of postoperative complication were respectively 10.53%and 19.05%and there was no significant difference(P＞0.05).the one-year postoperative local recurrence rate and distant metastasis rate were respectively 2.63%,7.89%and 4.76%,9.52%,the three-year and five-year postoperative survival rates were respectively 76.3%,60.5%and 69.05%,52.38%and there was no significant difference(P＞0.05).Operative bleeding,the mean frequency of analgesic treatment,the average duration of chest tube drainage,Chess drainage and out-of-bed activity time in the conventional thoracic surgery group were significantly higher(P＜0.05)than those in the VATS group.But in the VATS group longer mean operation time,higher operation costs and hospitalization costs were observed.CONCLUSION It is technically feasible to perform pulmonary resection and systemic dissection of hilar and mediastinal lymph nodes by video-assisted thoracoscopic surgery for patients with lung cancer,which does maintain surgical oncologic and dissection principles and gain the same effect as the standard open procedure.And it has minimal damage,shorter recovery,less bleeding and less damage to lung and heart function and immune function, which is a safe and feasible technique.VATS may be considered as a good option for patients with stageⅠand partⅡandⅢa non-small cell lung cancer,which is well worth developing and promoting.