Surgical therapy for early stage non small cell lung cancer: VATS versus Thoracotomy

Do Kim Que, Nguyen Trung Anh


Tóm tắt

Objectives: Non-Small Cell Lung Cancer (NSCLC) is the common cancer and the leading cause death of cancer. Lobectomy and lymph node dissection is optimal surgical treatment method for early stage of NSCLC. Video-assisted thoracoscopic surgery (VATS) approach is less trauma, quickly recovery, whereas those who advocate thoracotomy claim it as an ontologically superior procedure.

The aims of the study are to evaluate the role of Video-Assisted Thoracoscopic Surgery for treating the patients who have early stage of NSCLC and comparing with conventional thoracotomy.

Methods: All of patients with NSCLC in stage IA - IIB underwent lobectomy and lymph node dissection through VATS or thoracotomy are collected. Patient characteristics are compared. Operative data, complications are assessed and survived is assessed by Kaplan–Meier and Cox proportional hazards analysis. Follow-up from 14 to 66 months.

Results: From May 2008 to August 2016, 57 patients with NSCLC stage IA - IIB underwent an attempt at VATS lobectomy and 60 patients underwent thoracotomy. There are 75 males and 42 females, mean age is 56.3, range 31 - 84. Lobectomy was performed in 106 cases and bilobectomy was performed in 11 cases. The mean operating time in VATS group is 157 minutes longer than conventional thoracotomy, which was 124 minutes. There was no statistic difference between 2 groups separated based on characteristics of patients. In 57 cases VATS, 5 cases were converted to thoracotomy. There was one death in conventional thoracotomy group. One patient had bleeding, needed to be re-operationed to control bleeding in each group. Prolonged air-leak presented in 7 cases (10.7%) in thoracotomy and 2 cases (3.8%) in VATS group. Hospitalization is 18.4 days in thoracotomy group and 12.8 days in VATS group. The 5-year OS rate was 67.8% in the VATS group and 71.6% in the thoracotomy group (p = 0.156). The 5-year DFS rate was 59.6% in the VATS group and 65.9% in the thoracotomy group (p = 0.065). Survival by Cox model was no different for VATS versus thoracotomy (hazard ratio 0.82; P = .21)

Conclusion: Video-assisted thoracoscopic surgery is effective and safe method for surgical treatment of early stage of NSCLC. Surgery remains the primary therapy in the treatment of early-stage lung cancer. VATS was associated with less complication and shorter length of hospital stay. The 5 years survival is similar in VATS and conventional thoracotomy approach.


Tài liệu tham khảo

1. Boffa DJ, Kosinski AS, Paul S, Mitchell JD, Onaitis M: Lymph node evaluation by open or video-assisted approaches in 11,500 anatomic lung cancer resections. Ann Thorac Surg 2012; 94:347–53.
2. McKenna RJ Jr: Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. J Thorac Cardiovasc Surg 1994; 107:879–882.
3. Merritt RE, Hoang CD, Shrager JB: Lymph node evaluation achieved by open lobectomy compared with thoracoscopic lobectomy for N0 lung cancer. Ann Thorac Surg 2013; 96:1171–1177.
4. Sakuraba M, Miyamoto MH, Oh S et al., “Video-assisted thoracoscopic lobectomy vs. conventional lobectomy via open thoracotomy in patients with clinical stage IA non-small cell lung carcinoma,” Interactive Cardiovascular and Thoracic Surgery, 2007; 6 (5):614–617.
5. Shigemura N, Akashi A, Nakagiri T, Ohta M, Matsuda H: Complete versus assisted thoracoscopic approach: A prospective randomized trial comparing a variety of video-assisted thoracoscopic lobectomy techniques. Surg Endosc 2004; 18:1492–1497.
6. Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA, “Surgery for early-stage non-small cell lungcancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy,” Annals of Thoracic Surgery, 2008; 86 (6): 2008–2018.
7. Winton T, Livingston R, Johnson D, Rigas J, Johnston M, Butts C, Cormier Y, Goss G, Inculet R, Vallieres E, Fry W, Bethune D, Ayoub J, Ding K, Seymour L, Graham B, Tsao MS, Gandara D, Kesler K, Demmy T, Shepherd FA, National Cancer Institute of Canada Clinical Trials Group; National Cancer Institute of the United States Intergroup JBR.10 Trial Investigators: Vinorelbine plus cisplatin vs. observation in resected non-small cell lung cancer. New Eng J Med 2005; 352:2589–2597.
8. Yan TD, Black D, Bannon PG, McCaughan BC: Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small cell lung cancer. J Clin Oncol 2009; 27:2553–2562.

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