Video-assisted thoracic surgery for lung cancer in hemodialysis patients.

INTRODUCTION: In recent years, the number of hemodialysis patients has been continuously increasing. At the same time, the use of video-assisted thoracic surgery (VATS) for lung cancer has also increased. However, reports of the outcome of VATS in hemodialysis patients are still quite rare. METHODS: From 1995 to 2011, 14 patients with non-small cell lung cancer who were also receiving hemodialysis underwent lung resection by open thoracotomy or VATS at our institution. These patients were divided into two groups as follows: open (five men and four women, mean age: 68.7 years) and (2) VATS (three men and two women, mean age: 64.0 years). We compared the clinical outcomes of these two groups. RESULTS: Lobectomy was performed in eight patients in the open group, including one patient who also underwent a pneumonectomy, and in four patients in the VATS group, including one who also underwent a wedge resection. There were no significant difference between the groups' operation times, intraoperative blood loss, length of postoperative chest drainage, and length of postoperative hospitalization. There were no hospital deaths in either group. The 5-year survival rate was 42.9% in the open group and 37.5% in the VATS group. This difference was not significant (P=0.73). CONCLUSION: VATS lung resection for lung cancer patients on hemodialysis is considered an acceptable treatment modality, though the long-term survival rate of such patients is relatively low, which can be attributed to the diseases underlying the need for hemodialysis.

Is systemic node dissection for accuracy staging in clinical stage I non-small cell lung cancer worthwhile in the elderly?

OBJECTIVE: The therapeutic role of systematic node dissection (SND) for early lung cancer remains controversial. Elderly patients have a background of insufficient physiological function and comorbidity, and a shorter life expectancy than that of younger patients. Therefore, we have evaluated the impact on survival, local recurrence, and complications of not performing systematic lymph node dissection in the elderly. METHODS: A retrospective analysis of 126 patients, including the elderly (75 - 89 years), who underwent a lobectomy for clinical stage I was performed. The patients were grouped according to node dissection numbers after surgery, and finally separated into two groups (SG: sufficient group, dissections of more than 10 nodes and 3 or more mediastinal stations; IG: insufficient group, less than 10 nodes and one or two mediastinal stations). Postoperative morbidity and sites of recurrence were evaluated between the two groups, and the survival rates were analyzed at 5 years. RESULTS: Upstage was identified in 12.6% of patients: 7.3% in IG (n = 45), 15.2% in SG (n = 86). Postoperative mortality occurred in 2 cases (1.58%). The incidence of postoperative respiratory or cardiac complications was more frequent in the SG, while there were fewer complications in the IG. There was no significant difference in recurrence rates between the two groups. Both local and distant recurrence was observed in the two groups. The 5-year survival rates were 61.5% for the SG and 59.4% for the IG. There was no significant difference in the survival rate between the IG and SG patients. CONCLUSIONS: Proper staging and the avoidance of nontherapeutic lymph node dissection seems acceptable for clinical stage I lung cancer in the group of elderly patients.

Comparison between a case-matched analysis of left upper lobe trisegmentectomy and left upper lobectomy for small size lung cancer located in the upper division.

BACKGROUND: Although an increasing number of approaches for pulmonary segmentectomy to treat early lung cancer are being used, there have been few reports on left upper lobe trisegmentectomy, which is midway between single segmentectomy and lobectomy, for lung cancer. METHODS: We retrospectively reviewed the medical charts of 86 clinical stage I case-matched patients with a tumor size of less than 2.0 cm in diameter located in the left upper division who underwent resection between June 1998 and December 2005. The patients were divided into two groups as follows: LTS (31), left upper lobe trisegmentectomy; LUL (55), left upper lobectomy. We evaluated these groups with respect to several factors. RESULTS: The characteristics of the two groups (LTS vs. LUL) demonstrated no significant differences with respect to gender, histological type, tumor size, or upstaging of pathological node, or the mode of video-assisted thoracic surgery (VATS). Patients with LTS had a significantly lower pulmonary function compared to the LUL group. There were no significant differences between the two groups with respect to factors such as blood loss and duration of chest tube drainage. Morbidity and recurrence rates did not differ between the two groups, and there was no mortality in our series. The overall survival rate at 5 years was 69.7 % in the LTS and 72.5 % in the LUL group. There was no significant difference in survival rates between the LTS and the LUL group after resection. CONCLUSION: LTS may be suitable as a standard treatment if the tumor is small and the suspected margins are well away from the lingula.