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. 2020 Oct;12(10):5729-5738.
doi: 10.21037/jtd-20-1840.

The prognosis of stage I non-small cell lung cancer with visceral pleural invasion and whole pleural adhesion after video-assisted thoracoscopic lobectomy: A single center retrospective study

Youngkyu Moon  1 , Si Young Choi  1 , Mi Hyoung Moon  2
Affiliations

The prognosis of stage I non-small cell lung cancer with visceral pleural invasion and whole pleural adhesion after video-assisted thoracoscopic lobectomy: A single center retrospective study

Youngkyu Moon et al. J Thorac Dis. 2020 Oct.

Abstract

Background: In cases of peripheral lung cancer with visceral pleural invasion and severe pleural adhesion, the question arises as to whether video-assisted thoracoscopic surgery (VATS) is a safe operation. The purpose of this study was to evaluate whether whole pleural adhesion is a risk factor for recurrence of cancer when performing VATS lobectomy for stage I non-small cell lung cancer (NSCLC) with visceral pleural invasion.

Methods: From 2010 to 2018, 123 consecutive patients who were diagnosed as stage I NSCLC with visceral pleural invasion and who underwent VATS lobectomy, were reviewed retrospectively. Those patients with partial pleural adhesion were excluded. The prognoses of the patients in the whole pleural adhesion group were compared with those of the non-adhesion group.

Results: The clinicopathological characteristics were not found to differ between the two groups, with the exception of age. The mean age of the whole pleural adhesion group was found to be greater than that of the non-adhesion group (70.6 vs. 64.4, P=0.002). The 5-year recurrence-free survival rates for the whole pleural adhesion group and the non-adhesion group were 64.8% and 70.9% respectively, and they were not statistically different (P=0.545). In multivariate analysis, the extent of lymph node dissection (hazard ratio =13.854, P=0.023) was a significant risk factor for recurrence. Whole pleural adhesion was not a risk factor for recurrence.

Conclusions: Whole pleural adhesion was not a risk factor for recurrence after VATS lobectomy in stage I NSCLC with visceral pleural invasion. However, the extent of lymph node dissection was identified as an important prognostic factor.

Keywords: Lung cancer; pleural adhesion; video-assisted thoracoscopic surgery (VATS); visceral pleural invasion.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-1840). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Pleural adhesiolysis in a patient with whole pleural adhesion. (A) A picture where space is secured after blunt dissection around the working incision. (B) A picture of delicate pleural adhesiolysis using curved instruments.
Figure 2
Figure 2
Comparisons of (A) recurrence free survival and (B) disease-specific survival between the whole pleural adhesion group and the non-adhesion group in patients with stage IB non-small cell lung cancer with visceral pleural invasion after video-assisted thoracoscopic lobectomy.
See this image and copyright information in PMC

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