Assessment of node dissection for clinical stage I primary lung cancer by VATS

• Published in: European journal of cardio-thoracic surgery Vol. 27; no. 5; pp. 745 - 752
• Main Authors: Watanabe, Atsushi, Koyanagi, Tetsuya, Obama, Takuro, Ohsawa, Hisayoshi, Mawatari, Tohru, Takahashi, Noriyuki, Ichimiya, Yasunori, Abe, Tomio
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01-05-2005; Elsevier Science
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Biological and medical sciences; Cardiology. Vascular system; Drainage; Feasibility Studies; Female; Humans; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Medical sciences; Middle Aged; Neoplasm Staging; Pleural Effusion; Pneumology; Pneumonectomy; Postoperative Complications; Primary lung cancer; Sentinel Lymph Node Biopsy - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Systematic node dissection; Thoracic Surgery, Video-Assisted; Thoracotomy; Tumors of the respiratory system and mediastinum; Video-assisted thoracic surgery; Primary lung cancer; Systematic node dissection; Video-assisted thoracic surgery; Lung disease; Endoscopic surgery; Respiratory disease; Lung cancer; Thorax; Phlebology; Video recording; Clinical stage; Treatment; Primary; Bronchus disease; Circulatory system; Cardiology; Dissection
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2005.02.007

Objective: The feasibility of systematic node dissection (SND) for stage I primary lung cancer by video-assisted thoracic surgery (VATS) remains controversial. The aim of this study was to assess the feasibility of SND by VATS. Methods: Four hundred and eleven patients with clinical stage I primary lung cancer were enrolled in this study. Two hundred and twenty-one patients, VATS group, underwent a major pulmonary resection with SND by VATS through a minithoracotomy (30–70mm) and two access ports; 190 patients, open thoracotomy (OT) group, did so through anterolateral thoracotomy. The two groups were compared regarding clinical data including number of dissected nodes in each nodal station for evaluating the feasibility of SND by VATS. Results: In the right side, the total number (N) of nodes dissected (VATS 31 vs OT 31, P=0.899), N of mediastinal nodes dissected (20 vs 21, P=0.553), and N of dissected nodes in each nodal station were similar between the two groups. In the left side, total N of nodes dissected (28 vs 27, P=0.714), N of mediastinal nodes dissected (16 vs 17, P=0.333), and N of dissected nodes in each nodal station were similar between the two groups. There were three (1.4%) and five (2.6%) operation related deaths in the VATS group and OT group, respectively (P=0.48). Chest tube duration was shorter in the VATS group than the OT group (5.8 vs 7.6 days, P=0.001). The incidences of chylothorax, recurrent laryngeal nerve injury and pleural effusion requiring thoracentesis after surgery were similar between the two groups (3 vs 4, P=0.709; 5 vs 3, P=0.480, 3 vs 8, P=0.122). The 5-year actuarial recurrence-free survival rate and cumulative survival rate of pathological stage IA cases were similar between the two groups (88.6 vs 92.4%, P=0.698; 92.9 vs 86.5%, P=0.358). Conclusions: The SND by VATS was as technically feasible as SND through OT regarding number of dissected nodes and morbidity. It seems acceptable as an oncological treatment for clinical stage I lung cancer.