Video-assisted Thoracoscopic Lobectomy with Small Auxiliary Incision:Report of 63 Cases / 中国微创外科杂志

ABSTRACT

Objective To explore the indications and safety of video-assisted thoracoscopic lobectomy with small auxiliary incision for benign pulmonary diseases and non-small cell lung cancer.Methods Between May 1996 and April 2007,63 cases of lobectomy were performed by video-assisted thoracoscopy.Before the operation,18 of the patients were diagnosed with benign pulmonary diseases,and 45 had pulmonary mass or malignancies.Lobectomy of the right lung was carried out on 47 patients,including the right upper lobe resection in 12,the middle lobe in 8,and the lower in 27.The other 16 patients received resection of the left upper lobe(5)or left lower lobe(11).Results Thoracoscopic lobectomy was completed in all the 63 patients,in 6 of them the incision was lengthened during the operation.No perioperative death occurred.The chest tube was withdrawn 4 to 7 days(mean,4.5 days)after the operation.Postoperative pathological examination showed NSCLC in 37 patients(58.7%),metastatic lung cancer in 1(1.6%),carcinoid tumor in 1(1.6%),and benign conditions in 24(38.1%).Among the 37 patients with NSCLC,8 were at stage Ⅰa,13 at stage Ⅰb,14 at stage Ⅱa,3 at stage Ⅱb,6 at stage Ⅲa,1 at stage Ⅲb,and 2 at stage Ⅳ.Of the patients with malignancies,34 were followed up for 2 to 60 months(2 to 12 months in 7,13 to 24 months in 10,25 to 36 months in 6,37 to 48 months in 6,and 49 to 60 months in 3),2 of them survived 11 years,5 of the patients(14.7%)died of tumor recurrence or metastasis,1(2.9%)survived with tumor,and 28(82.4%)lived free of tumor.The 1-and 3-year survival rate of the patients with stage Ⅰ or Ⅱ cancer were 100%(19/19)and 90%(9/10)respectively.In the patients with stage Ⅲ cancer,5 received follow-up,3 of them died of recurrence of metastasis.In the 2 patients who had stage Ⅳ cancer,1 died of metastasis.Conclusion Video-assisted thoracoscopic lobectomy is a safe and effective procedure and can be a regular surgical treatment for benign pulmonary disease,and peripheral type non-small cell lung cancer at stage Ⅰ or Ⅱ.