Reichert Martin, Kerber Stefanie, Amati Anca-Laura, Bodner Johannes
Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Street 7, 35392, Giessen, Germany,
Surg Endosc. 2015 Aug;29(8):2407-9. doi: 10.1007/s00464-014-3952-5. Epub 2014 Nov 26.
Video-assisted thoracoscopic surgery (VATS) has gained increasing acceptance for surgical therapy of early stage non small cell lung cancer (NSCLC). Even for extended pulmonary resections in advanced tumor stages, increasing evidence suggests feasibility and safety of the VATS approach. However, so far very little experience has been reported on VATS management of sulcus superior tumors.
We report on a 56-year-old female patient with a left-sided anterior sulcus superior adenocarcinoma (cT3 cN1 cM0), which was completely resected by VATS after induction radiochemotherapy.
The surgical procedure was performed completely minimally invasively via a three-incision anterior thoracoscopic approach. The total operating time was 285 min (composed of 116 min for hilar lobectomy, 103 min for sulcus superior preparation and chest wall resection, and 26 min for systematic en-bloc lymph node dissection). The single chest tube was removed on postoperative day two and the patient was discharged on postoperative day six. No intraoperative and no postoperative complications were observed. Histopathology confirmed a complete (R0) resection of an ypT2aN0M0 bronchogenic adenocarcinoma.
With increasing experience even extended pulmonary resections are safe and feasible by a video-assisted thoracoscopic approach. We propose that in sulcus superior tumors without tumor invasion of vascular structures VATS can be considered.
电视辅助胸腔镜手术（VATS）在早期非小细胞肺癌（NSCLC）的手术治疗中越来越被接受。即使对于晚期肿瘤阶段的扩大肺切除术，越来越多的证据表明VATS方法的可行性和安全性。然而，到目前为止，关于VATS治疗肺上沟肿瘤的经验报道非常少。
我们报告了一名56岁女性患者，患有左侧前肺上沟腺癌（cT3 cN1 cM0），在诱导放化疗后通过VATS完全切除。
手术通过三切口前胸腔镜入路完全微创进行。总手术时间为285分钟（包括肺门叶切除术116分钟、肺上沟准备和胸壁切除术103分钟以及系统性整块淋巴结清扫术26分钟）。术后第二天拔除单根胸管，患者术后第六天出院。未观察到术中及术后并发症。组织病理学证实为ypT2aN0M0支气管源性腺癌的完全（R0）切除。
随着经验的增加，即使是扩大肺切除术通过电视辅助胸腔镜入路也是安全可行的。我们建议，对于没有血管结构受肿瘤侵犯的肺上沟肿瘤，可以考虑VATS。
