Video-assisted thoracic surgery lobectomy: results in lung cancer

Abstract

Background: The application of video-assisted thoracic surgery (VATS) in major pulmonary resections is still far from routine in most hospitals, even though the safety and technical feasibility of the procedure have by now been amply demonstrated. This paper reports on the surgical technique used by the authors for VATS lobectomy, on their experience of the procedure and on the results obtained.

Methods: A retrospective study was performed of all patients undergoing VATS lobectomy at the our Thoracic Surgery Department ,between 1993 and 2009.The clinical records of all patients were reviewed, and the following variables were noted for purposes of analysis: patient age and sex; clinical diagnosis; staging; date of surgery; type of surgery; conversion to conventional surgery and grounds for conversion; duration of surgery; intraoperative, postoperative and long-term complications; postoperative stay, final diagnosis and staging; and death rates.

Results: A total of 349 VATS lobectomies were performed over the study period (292 men, 57 women; mean age 59.7) The aetiology was non-small-cell lung carcinoma (NSCLC) in 313 patients and benign processes in 26;four patients had carcinoid tumours, and a further six required lobectomy due to metastases. The overall conversion rate was 9.4%. Mean duration of lobectomy was 148 minutes, and median duration 92 minutes. Mean postoperative was 3.9 days. The morbidity rate was 12.89 %, mostly involving minor complications. Perioperative mortality was 1.43%. There were no intraoperative deaths. The overall five-year survival rate for patients with NSCLC was 80.1%.

Conclusions: VATS lobectomy is a safe and technically-viable procedure that meets oncological criteria for lung-cancer surgery. Major pulmonary resection using VATS should be considered the procedure of choice for a number of benign processes and for early-stage bronchogenic carcinoma (T1-T2 N0 M0).

Keywords: VATS; Video-assisted thoracic surgery; lobectomy; lung cancer; minimally invasive surgical procedures; thoracoscopy.

Fig. 1. The incisions for our approach to video-assisted thoracic surgical lobectomy.

Fig. 2. Dissection and stapling of upper lobe pulmonary vein and anterior arterial trunk in the right upper lobectomy

Fig. 3. Arterial dissection for stapling the vessel in the left lower lobectomy.

Fig. 4. The endostapler across a lower lobe bronchus and completion of the remaining fissure and stapling. The lobe going into the bag for removal.