Results of video-assisted thoracic surgery for stage I/II non-small cell lung cancer

Akinori Iwasaki, Takayuki Shirakusa, Takeshi Shiraishi, Satoshi Yamamoto
European Journal of Cardio-thoracic Surgery 2004, 26 (1): 158-64

OBJECTIVE: The best indicators for VATS are not well known. Therefore, we review here a series of patients who underwent VATS lobectomy and segmentectomy at our hospital, and we attempt to identify the factors that influence the survival of VATS patients and the backgrounds of such patients.

METHODS: A thoracoscopic curative approach was attempted in 140 patients (100 lobectomy, 40 segmentectomy) from January 1994 to December 2002. We retrospectively reviewed the VATS patients with non-small cell lung cancer (NSCLC). All patients were subject to lobectomy or segmentectomy, including dissection of hilar and mediastinal lymph nodes that were in pathological stage (p-Stage) I or II. Our VATS approach was a hybrid technique, employing three ports and a small (7 cm diameter) utility thoracotomy to allow access for the instrument and a view.

RESULTS: The Kaplan-Meier probabilities of survival at 5 years were VATS, 77.3%. According to a univariate analysis of survival curves, the significant prognostic factors (P < 0.05) in the patients with VATS in p-Stage I and II were gender, type of histology, and T factor. In addition, the grades of differentiation, surgical procedure (lobectomy vs. segmentectomy), and extent of metastasis to the hilar lymph node (N0 vs. N1) in VATS were not found to be significant prognostic factors. A multivariate prognostic factor in VATS showed that the histologic cell type, gender, and T factor were predominant. All of the VATS cases that included these three favorable factors (adenocarcinoma, T1, female) were alive.

CONCLUSION: Stringent selection of candidates for VATS in NSCLC at pathological stages I and II could be an acceptable and valuable approach.

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