Comparison of the lymph node dissection and complications between video-assisted thoracoscopic (VATS) esophagectomy and conventional esophagectomy via right thoracotomic / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Video-assisted thoracoscopic (VATS) esophagectomy has been performed for more than 10 years in China. However, compared with the conventional esophagectomy via right thoracotomy, whether VATS esophagectomy has more advantages or not in the lymph node (LN) dissection and prevention of perioperative complications is still controversial and deserves to be further investigated. The aim of this study was to explore whether there are significant differences in this issue between the two surgical modalities or not.</p><p><b>METHODS</b>The results of lymph node dissection and perioperative complications as well as other parameters in the patients treated by VATS esophagectomy and those by conventional esophagectomy via right thoracotomy at our department from May 1, 2009 to July 30, 2013 were compared using SPSS 16.0 in order to investigate whether there was any significant difference between these two treatment modalities in the learning curve stage of VATS esophagectomy.</p><p><b>RESULTS</b>One hundred and twenty-nine cases underwent VATS esophagectomy between May 1, 2009 and July 30, 2013, and another part 129 cases with the same preoperative cTNM stage treated by conventional esopahgectomy via right thoracotomy were selected in order to compare the results of lymph node dissection and perioperative complications as well as other parameters between those two groups of patients. There were no significant differences in the sex, age, lesion locations and cTNM stage between these two groups. The total LN metastatic rate in the VATS esophagectomy group was 35.7% and that of the conventional esophagectomy group was 37.2% (P > 0.05). The total average number of dissected lymph nodes was 12.1 vs. 16.2 (P < 0.001). The average dissected LN stations was 3.2 vs. 3.6 (P = 0.038). The total average number of dissected LN along the left recurrent laryngeal nerve was 2.0 vs. 3.7 (P = 0.012). The total average number of dissected LN along the right recurrent laryngeal nerve was 2.9 vs. 3.4 (P = 0.231). However, there was no significant difference in the total average number of dissected LN in the other thoracic LN stations, and in the perioperative complications between the two groups. The total postoperative complication rate was 41.1% in the VATS group versus 42.6% in the conventional group (P = 0.801). The cardiopulmonary complication rate was 25.6% vs. 27.1% (P = 0.777). The death rate was the same in the two groups (0.8%). The VATS group had less blood infusion (23.2% vs. 41.8%, P = 0.001) and shorter hospital stay (15.9 days vs. 19.2 days, P = 0.049) but longer operating time (161.3 min vs. 127.8 min, P < 0.01).</p><p><b>CONCLUSIONS</b>In the learning curve stage of VATS esophagectomy, compared with the conventional esophagectomy, less LN number and stations can be dissected in the VATS group due to un-skillful VATS manipulation, especially it is more difficult in the LN dissection along the left recurrent laryngeal nerve. Therefore, it is more suitable to select patients with early esophageal cancer without obvious enlarged lymph nodes for VATS esophagectomy in the learning curve stage.</p>

Comparison of thoracoscopic anatomical partial-lobectomy and thoracoscopic lobectomy on the patients with pT1aN0M0 peripheral non-small cell lung cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the short-term outcomes and pulmonary function loss between thoracoscopic anatomical partial-lobectomy and thoracoscopic lobectomy on the patients with pT1aN0M0 peripheral non-small cell lung cancer.</p><p><b>METHODS</b>The clinical data of 191 patients with pT1aN0M0 peripheral non-small cell lung cancer received thoracoscopic anatomical pneumonectomy between January 2013 and July 2013 in Department of Thoracic Surgery, Cancer Hospital Chinese Academy of Medical Sciences was analyze retrospectively. There were 71 patients underwent thoracoscopic anatomical partial-lobectomy and 120 patients underwent thoracoscopic lobectomy. Demographic features, operation time, blood loss, number of dissected lymph nodes, chest tube duration, drainage volume, postoperative hospital stay, postoperative complications, two-year progress and pulmonary function loss of FEV1% (percentage of the predicted forced expiratory volume in 1 second) at 6 months were retrospectively reviewed and compared by t test, rank-sum test, χ² test and Fisher exact test.</p><p><b>RESULTS</b>There were no significant differences in operation time, blood loss, number of dissected lymph nodes, chest tube duration, drainage volume, postoperative hospital stay, and postoperative complication rate (P > 0.05). The two-year progress rate between two groups did not differ significantly either (1.4% vs. 1.7%, χ² = 0.000, P = 1.000). Pulmonary function loss of FEV1% at 6 months was significantly smaller in thoracoscopic anatomical partial lobectomy group than thoracoscopic lobectomy group (14% ± 4% vs. 16% ± 4%, t = 2.408, P = 0.017).</p><p><b>CONCLUSIONS</b>Thoracoscopic anatomical partial-lobectomy is safe and feasible for patients with pT1aN0M0 peripheral non-small cell lung cancer. It could achieve equal short-term effect and reserve more pulmonary function compared with thoracoscopic lobectomy.</p>