Ohtsuka Takashi, Nomori Hiroaki, Horio Hirotoshi, Naruke Tsuguo, Suemasu Keiichi
Department of Thoracic Surgery, Saiseikai Central Hospital, Tokyo, Japan.
Chest. 2004 May;125(5):1742-6. doi: 10.1378/chest.125.5.1742.
Although several studies have shown that video-assisted thoracic surgery (VATS) for major pulmonary resection is less invasive than open thoracotomy, VATS for lung cancer has been performed in only a limited number of institutions. We aimed to review our experience of VATS for major pulmonary resections, and to determine its safety and adequacy in stage I lung cancer.
Between August 1999 and March 2003, we performed major pulmonary resection by VATS in 106 patients with lung cancer and preoperatively determined clinical stage I disease. We evaluated the number of procedures converted to open thoracotomy and the reasons for conversion, the intraoperative blood loss, interval between surgery and chest tube removal, length of postoperative hospital stay, postoperative complications, mortality rate, prognoses, and patterns of recurrence.
We successfully performed VATS in 95 patients, whereas in another 11 patients (10%) conversion to open thoracotomy was required. The operative procedures were lobectomy in 86 patients, segmentectomy in 8 patients, and bilobectomy in 1 patient. In 95 patients who underwent VATS, postoperative complications developed in 9 patients (9%), and 1 patient (1%) died from pneumonia. In the 86 patients without complications, the mean postoperative hospital stay was 7.6 days (range, 4 to 15 days). In a mean follow-up period of 25 months (range, 6 to 48 months) in patients with non-small cell lung cancer (NSCLC), including the one perioperative death, the 3-year survival rate was 93% in 82 patients with clinical stage I disease, and 97% in 68 patients with pathologic stage I disease. The 3-year disease-free survival rate was 79% in patients with clinical stage I disease, and 89% in patients with pathologic stage I disease. Local recurrence was observed in six patients (6%): recurrence in mediastinal lymph nodes in five patients, and in the bronchial stump in one patient.
Major pulmonary resection by VATS is acceptable in view of its low perioperative mortality and morbidity, and is an adequate procedure for the achievement of local control and good prognosis in patients with clinical stage I NSCLC.
尽管多项研究表明，电视辅助胸腔镜手术（VATS）用于主要肺切除的侵入性低于开胸手术，但VATS用于肺癌手术仅在少数机构开展。我们旨在回顾我们应用VATS进行主要肺切除的经验，并确定其在I期肺癌中的安全性和充分性。
1999年8月至2003年3月期间，我们对106例术前确诊为临床I期疾病的肺癌患者应用VATS进行主要肺切除。我们评估了中转开胸手术的例数及中转原因、术中失血量、手术至拔除胸管的间隔时间、术后住院时间、术后并发症、死亡率、预后及复发模式。
我们成功对95例患者实施了VATS手术，另外11例患者（10%）需要中转开胸手术。手术方式为肺叶切除术86例，肺段切除术8例，双肺叶切除术1例。在接受VATS手术的95例患者中，9例（9%）出现术后并发症，1例患者（1%）死于肺炎。在86例无并发症的患者中，术后平均住院时间为7.6天（范围4至15天）。在非小细胞肺癌（NSCLC）患者平均25个月（范围6至48个月）的随访期内，包括1例围手术期死亡患者，82例临床I期疾病患者的3年生存率为93%，68例病理I期疾病患者的3年生存率为97%。临床I期疾病患者的3年无病生存率为79%，病理I期疾病患者为89%。6例患者（6%）出现局部复发：5例患者纵隔淋巴结复发，1例患者支气管残端复发。
鉴于VATS进行主要肺切除的围手术期死亡率和发病率较低，是可以接受的，并且对于实现临床I期NSCLC患者的局部控制和良好预后是一种充分的手术方式。
