Hybrid video-assisted and limited open (VALO) resection of superior sulcus tumors

• Published in: Surgery today (Tokyo, Japan) Vol. 46; no. 6; pp. 686 - 690
• Main Authors: Nun, Alon Ben, Simansky, David, Rokah, Merav, Zeitlin, Nona, Avi, Roni Ben, Soudack, Michalle, Golan, Nir, Apel, Sarit, Bar, Jair, Yelin, Alon
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-06-2016
• Subjects: Aged; Feasibility Studies; Female; Humans; Incidence; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pain, Postoperative - epidemiology; Pancoast Syndrome - surgery; Pneumonectomy - methods; Surgery; Surgical Oncology; Thoracic Surgery, Video-Assisted - methods; Thoracotomy - methods; Treatment Outcome; Video-Assisted Surgery; Surgical techniques; Lung cancer; Thoracoscopy/VATS
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-015-1225-0

Purpose
To compare the postoperative recovery of patients with superior sulcus tumors (Pancoast tumors) following conventional open surgery vs. a hybrid video-assisted and limited open approach (VALO).
Methods
The subjects of this retrospective study were 20 patients we operated on to resect a Pancoast tumor. All patients received induction chemo-radiation followed by surgery, performed via either a conventional thoracotomy approach (
n
 = 10) or the hybrid VALO approach (
n
 = 10). In the hybrid VALO group, lobectomy and internal chest wall preparation were performed using a video technique, with rib resection and specimen removal through a limited incision.
Results
There was no mortality in either group. Two patients from the thoracotomy group required mechanical ventilation, but there was no major morbidity in the hybrid VALO group. The operative times were similar for the two procedures. The average length of hospital stay was shorter and the average pain scores were significantly lower in the hybrid VALO group. The incidence of chronic pain was 10 % in the hybrid VALO group vs. 50 % in the thoracotomy group.
Conclusions
Hybrid VALO resection of Pancoast tumors is feasible and safe, resulting in faster patient recovery and a significantly lower incidence of severe chronic pain than open thoracotomy. We conclude that centers experienced with video-assisted lobectomy should consider hybrid VALO surgery as the procedure of choice for Pancoast tumors.