Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases.

OBJECTIVE

To analyse the evolution of the video-assisted thoracoscopic (VATS) approach for lobectomy and results during the first 3 years of program.

METHODS

From 1(st) July-2007 to 31(th) July-2010 we carried out 200 lobectomies by VATS. In February 2009 we started performing VATS lobectomies with only 2 incisions .We have analyzed both annual and overall outcomes regarding type of approach, conversion rate, surgical time, lymphadenectomy and overall survival.

RESULTS

Distribution of the cases per year were as follows: first-year 32, second-year 65, third-year 103. Overall conversion rate was 14,5% (first-year 25%, second-year 20%, third-year 7.8%; p = 0.017). Surgical approach was: 4 ports (1 case), 3 ports (99 cases, 100% in first-year), 2 ports (99 cases, 80% in third-year), single-port (1 case, third-year) Mean surgical time in successful VATS was 193.8 min (210.8 first-year, 207.9 second-year, 181.1 third-year; p = 0.011), mean number of lymph nodes were 11.9 (9.3 first-year, 10.1 second-year, 13.9 third-year; p = 0.003) and mean explored stations was 4.2 (3.6 first-year, 3.8 second-year, 4.5 third-year; p < 0.001). Globally median chest tube duration was 3 days. Median length of stay was 4 days. The disease-free survival at 30 months was 85% for Stage I patients and 62% for non-stage I patients.

CONCLUSIONS

As we gain more experience over time, with more cases performed each year and less invasive approaches, results improve in terms of less surgical time and more extended lymphadenectomies. Furthermore, we have observed a clear evolution in our surgical approach to a less invasive 2-port approach. In selected cases we have implemented the single-port lobectomy.