The Application Of Minimally Invasive Surgery In Central Lung Cancer

Part ?: Bronchial sleeve resection: a PSM analysis between minimally invasive surgery and thoracotomy Object the purpose of this study was to compare perioperative and oncologic outcomes of minimally invasive surgery(MIS)with that of thoracotomy in sleeve resection for patients with central lung cancer.Methods Between January 2013 and December 2017,557 consecutive patients undergoing sleeve resection were analyzed during this study.There were 55 cases of bilobectomy and right middle lobe lobectomy and these cases were excluded because these operations were rarely performed.Perioperative and oncologic outcomes were compared based on propensity scoring match.Results After 1:4 propensity scoring match,79 cases with MIS sleeve resection and 258 cases with thoracotomy sleeve resection was included in this study.There were no statistically significant differences in demographic and pathologic characteristics between these two groups.The operating time was 185.72 ± 69.17 minutes in MIS group and 148.68 ± 40.51 minutes in thoracotomy group(P < 0.001).The postoperative drainage volume was 1376.95 ± 865.91 ml in MIS group and 1991.29 ± 1397.51 ml in thoracotomy group(P < 0.001).The number of patients whose postoperative stay was more than 14 days was 30(11.63%)in thoracotomy group and 4(5.06%)in MIS group(P = 0.09).There were no significant differences in bleeding,numbers of dissected lymph nodes,numbers of positive lymph nodes and postoperative complication rates between MIS group and thoracotomy group.Overall survival rate in 3 years was 69.7% in MIS groups and 77.2% in thoracotomy group,without significant differences(P = 0.27).Cumulative recurrence rate was 35.2% in MIS groups and 28.8% in thoracotomy group,without significant differences(P = 0.20).Conclusions Minimally invasive sleeve resection was feasible and effective in patients with central lung cancer.Part ?: a PSM analysis between VATS and thoracotomy for pneumonectomyObject the purpose of this study was to compare perioperative and oncologic outcomes of video-assisted thoracoscopic surgery with that of thoracotomy in pneumonectomy for patients with central lung cancer.Methods Between January 2013 and December 2017,371 consecutive patients undergoing pneumonectomy were analyzed during this study.Perioperative outcomes were compared based on propensity scoring match.Results Before propensity scoring match,there were 37 cases in VATS group and 334 cases in thoracotomy group.There were some differences in demographic and pathologic characteristics between two groups,so we performed a propensity scoring match.After 1:4 propensity scoring match,35 cases with VATS pneumonectomy and 123 cases with thoracotomy pneumonectomy was included in this study.The operating time was longer in VATS group than that in thoracotomy group(185.37 ± 57.66 min vs.141.08 ± 44.41 min,P < 0.001).The postoperative length of stay,postoperative drainage days,postoperative drainage volume significantly less in VATS group than that in thoracotomy group.There was no significant difference in mortality and incidence of postoperative complications between the thoracotomy group and the thoracotomy group at 30 days after operation.The number of intraoperative lymph node dissection in thoracoscopy group was significantly higher than that in thoracotomy group.There were no significant differences in numbers of positive lymph nodes and radical resection rate between the two groups.Conclusions VATS pneumonectomy is feasible and effective in patients with central lung cancer in experienced medical center.Part ?: a PSM analysis between minimally invasive surgery and thoracotomy for lung cancer greater than 5 cmObjective The main purpose of this study was to prove the safety,feasibility and effectiveness of minimally invasive surgery by comparing the perioperative results of minimally invasive surgery and thoracotomy in the resection of lung tumors larger than 5cm in diameter.Methods The clinical data of 931 patients with tumor diameter larger than 5cm who were scheduled to undergo minimally invasive surgery or thoracotomy in our hospital from January 2013 to December 2017 were studied retrospectively.After matching the propensity score,we compared the perioperative results of the two groups.Results Before the propensity score was matched,there were 166 cases in the minimally invasive group and 765 cases in the thoracotomy group.The demographic and neoplastic characteristics of the two groups were not completely consistent,so we matched the propensity score.After matching the tendency score of 1: 1,there were 150 cases in minimally invasive group and 150 cases in thoracotomy group.There was no significant difference in the average operative time between the minimally invasive group and the thoracotomy group.the intraoperative blood loss in the minimally invasive group was significantly less than that in the thoracotomy group(132.33 ±121.81 ml vs.183.33 ±137.65 ml,p = 0.001).The postoperative length of stay and drainage volume in the minimally invasive surgery group were significantly shorter than those in the thoracotomy group.There was no significant difference in mortality and incidence of postoperative complications between the thoracotomy group and the thoracotomy group at 30 days after operation.There was no significant difference in the number of intraoperative lymph node dissection,the number of stations,the number of positive lymph nodes,the number of positive lymph nodes and the rate of radical resection between the minimally invasive surgery group and the thoracotomy group.Conclusion Compared with thoracotomy,minimally invasive surgery is safe,feasible and effective for lung tumors with tumor diameter larger than 5cm.