Analysis of complicated procedure of completely thoracoscopic lobectomy / 中华胸心血管外科杂志

ABSTRACT

Objective Summarize 58 cases with complicated primary lung cancer that accepted completely thoracoscopic lobectomy procedure in People's Hospital of Peking University,to evaluate the procedure of completely thoracoscopic lobectomy in these complicated cases.Methods Between Sep 2006 and Jun 2011,58 cases accepted completely thoracoscopic lobetomy were reviewed.34 male,24 female,aged (59.2 ± 11.4) years.The maximal diameter of solid tumors was(5.50 ± 2.92 )cm.The complicated condition including ①maximal diameter of solid tumor ≥5 cm ; ② Compound lobectomy; ③ post newadjuvant chemotherapy; ④ tummor invased portion of chest wall.The main procedure including three main components①multiple devices co-operation through a single incision; ② Separate the fissure liketunnel style ; ③ cutting off bronchial artery priority to all step of lobectomy.Results All procedures were carried out smoothly with no death or serious complication.The average surgical duration was( 215.6 ± 60.9 ) min,and average blood loss was ( 271.0 ± 188.3 ) ml.The median postoperative chest tube drainage duration was(8.0 ± 4.7 ) d,and median postoperative hospital stay was ( 11.3 ± 5.9 ) d.There were 14 cases (24.1％ ) of conversion to open thoracotomy and 7 cases ( 12.1％ ) of complications.① There were 34 cases that maximal diameter of solid tumor was ≥5 cm,The average maximal diameter of tumors was( 6.7 ± 2.3) cm,The average surgical duration was( 206.6 ± 49.3 ) min,and average blood loss was (277.1 ± 194.4 ) ml.The median postoperative chest tube drainage duration was (8.3 ± 4.2 ) d,and median postoperative hospital stay was ( 11.9 ± 6.2 ) d.There were 8 cases (23.5％) of conversion to open thoracotomy and 6 cases ( 17.6 ％ ) complications; ②There were 16 cases of Compound lobectomy,The average maximal diameter of tumors was(4.2 ± 3.4 ) cm,The average surgical duration was (213.8 ± 70.0 )min,and average blood loss was(235.6 ± 139.2 ) ml.The median postoperative chest tube drainage duration was( 8.6 ± 6.3 )d,and median postoperative hospital stay was( 12.4 ±6.0) d.There were 4 cases (25％) of conversion to open thoracotomy and 2 cases ( 12.5 ％ ) complications;③There were 5 cases of VATs lobectomy that post newadjuvant chemotherapy,The average maximal diameter of tumors was(3.1 ±0.8) cm,The average surgical duration was(226.0 ±36.3 ) min,and average blood loss was(246.0 ± 219.8) ml.The median postoperative chest tube drainage duration was( 5.6 ± 1.1 ) d,and median postoperative hospital stay was( 7.4 ± 0.5 ) d.There were 2 cases (40％) of conversion to open thoracotomy and no complications; ④There were 3 cases that tumor invased portion of chest wall.The average maximal diameter of tumors was(3.0 ± 2.0)cm,The average surgical duration was(310.0 ± 105.4) min,and average blood loss was(433.3 ± 305.5 ) ml.The median postoperative chest tube drainage duration was( 5.6 ± 2.1 ) d,and median postoperative hospital stay was ( 6.6 ± 2.1 ) d.There were no conversion to open thoracotomy and complications.Conclusion As the skills and experience of thoracoscopic lobectomy improving,Some relative complexity cases and relative contraindications may become relative indications for completely thoracoscopic procedure.As long as the methods and technical processes used properly,these complicated cases of primary lung cancer does not prolong the operation time,not increase bleeding and interfere the reeovery of patients.