Background Completely video-assisted thoracoscopic Iobectomy is a reasonable treatment for early-stage non-small-cell lung cancer （NSCLC）.At present,the indication for this procedure is stage la and Ib peripheral lu...Background Completely video-assisted thoracoscopic Iobectomy is a reasonable treatment for early-stage non-small-cell lung cancer （NSCLC）.At present,the indication for this procedure is stage la and Ib peripheral lung cancer （（〈-）5 cm）; however,for larger tumors,it remains controversial whether this surgical technique is comparable to open Iobectomy.This study aimed to evaluate the safety,completeness,and efficacy of thoracoscopic Iobectomy,and to compare this technique with open Iobectomy for the treatment of non-small-cell lung cancer when the tumor＇s diameter was greater than 5 cm.Methods From May 2001 to April 2011,802 patients underwent a Iobectomy for treatment of non-small-cell lung cancer at our center.In 133 patients,the tumor was 〉 5 cm.There were 98 men and 35 women,median age 63 years （range：29-81 years）.We divided the patients into two groups,group V （completely video-assisted thoracoscopic surgery）,and group T （open Iobectomy）,and evaluated the two groups for age,gender,tumor size,pathological type,location,duration of surgery,blood loss,lymph node dissection,pathological stage,time of drainage,hospitalization,complications,overall survival and recurrence.Results There were 46 cases in group V and 87 cases in group T.Age,gender,tumor size,location,pathological type and stage were similar between the two groups.Group V had shorter operative duration （（186.5±62.8） minutes vs.（256.7±67.5） minutes,P 〈0.001） and reduced bleeding （（218.5±174.6） ml vs.（556.9±187.2） ml,P 〈0.001）.There were no significant differences between the two groups in complications,lymph node dissection,time of drainage and hospitalization.The recurrence between the two groups was equivalent （2.4% vs.3.8%,P=0.670）.The overall survival at 1,2 and 3 years was 95.1%,81.6% and 69.6% for group V and 88.3%,78.8% and 64.0% for group T.Kaplan-Meier survival curves showed that there was no significant differences between the two groups （P=0.129）.Conclusions Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety,completeness,and efficacy,but had a shorter operative duration,and reduced bleeding.This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size 〉 5 cm.展开更多
Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperati...Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperative pain,and faster resumption of a normal lifestyle.However,there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer.Concerns regarding safety,the extent of mediastinal lymph node dissection,and long-term survival have made some surgeons apprehensive of its validity for lung cancer.In this paper,we review the development of thoracoscopy,the present status of VATS for early stage of non-small cell lung cancer(NSCLC),and comparison between VATS and open thoracotomy in the management of NSCLC.展开更多
Background The feasibility of completing a Iobectomy by completely video-assisted thoracoscopic surgery （cVATS） in the management of bronchiectasis is unclear. By retrospectively comparing the outcomes from the Iobe...Background The feasibility of completing a Iobectomy by completely video-assisted thoracoscopic surgery （cVATS） in the management of bronchiectasis is unclear. By retrospectively comparing the outcomes from the Iobectomies that used thoracotomy vs. cVATS, we determined the appropriateness of the minimally invasive cVATS approach in the management of bronchiectasis. Methods Between June 2001 and October 2010, 60 patients with bronchiectasis underwent surgery, of which 56 Iobectomies were performed. All Iobectomies were carried out by either thoracotomy or cVATS approach. Pulmonary vessels and bronchi were manipulated by ligation or stapler in the thoracotomy group, while they were dissected by endo-cutters in the cVATS group. Results There were 21 patients in the thoracotomy group and 35 patients in the cVATS group. Two cVATS patients （5.7%） converted. The difference in operation time, chest tube duration, lengths of hospitalization, and morbidity were not significantly different between the two groups （P 〉0.05）. The blood loss was less in the cVATS group （P=0.015）. A total of 52.4% and 62.9% of patients were postoperatively asymptomatic in the thoracotomy and cVATS groups respectively, and symptomatic improvement was obtained in 38.1% patients by thoracotomy vs. 31.4% patients by cVATS. Conclusion cVATS Iobectomy is safe and effective for the management of bronchiectasis, especially for the patients with localized lesions.展开更多
Background： Both uniportal and triportal thoracoscopic lobectomy and sublobectomy are feasible for early-stage non-small cell lung cancer （NSCLC）. The aim of this study was to compare the perioperative outcomes of ...Background： Both uniportal and triportal thoracoscopic lobectomy and sublobectomy are feasible for early-stage non-small cell lung cancer （NSCLC）. The aim of this study was to compare the perioperative outcomes of uniportal and triportal thoracoscopic Iobectomy and sublobectomy for early-stage NSCLC. Methods： A total of 405 patients with lung lesions underwent thoracoscopic lobectomy or sublobectomy through a uniportal or triportal procedure in approximately 7-month period （From November 2014 to May 2015）. A propensity-matched analysis, incorporating preoperative variables, was used to compare the short-term outcomes of patients who received uniportal or triportal thoracoscopic lobectomy and sublobectomy. Results： Fifty-eight patients underwent uniportal and 347 patients underwent triportal pulmonary resection. The conversion rate for uniportal and triportal procedure was 3.4% （2/58） and 2.3% （8/347）, respectively. The complication rate for uniportal and triportal procedure was 10.3% and 9.5%, respectively. There was no perioperative death in either group. Most patients had early-stage NSCLC in both groups （uniportal： 45/47, 96%; triportal： 313/343, 91%）. Propensity score-matching analysis demonstrated no significant differences in operation time, intraoperative blood loss, numbers of dissected lymph nodes, number of stations of lymph node dissected, duration of chest tube, and complication rate between uniportal and triportal group for early-stage NSCLC. However, the duration of postoperative hospitalization was longer in the uniportal group （6.83 ± 4.17 vs. 5.42 ± 1.86 d, P = 0.036） compared with the triportal group. Conclusions： Uniportal thoracoscopic lobectomy and sublobectomy is safe and feasible, with comparable short-term outcomes with triportal thoracoscopic pulmonary resection. Uniportal lobectomy and sublobectomy lead to similar cure rate as triportal Iobectomy and sublobectomy for early NSCLC.展开更多
文摘Background Completely video-assisted thoracoscopic Iobectomy is a reasonable treatment for early-stage non-small-cell lung cancer （NSCLC）.At present,the indication for this procedure is stage la and Ib peripheral lung cancer （（〈-）5 cm）; however,for larger tumors,it remains controversial whether this surgical technique is comparable to open Iobectomy.This study aimed to evaluate the safety,completeness,and efficacy of thoracoscopic Iobectomy,and to compare this technique with open Iobectomy for the treatment of non-small-cell lung cancer when the tumor＇s diameter was greater than 5 cm.Methods From May 2001 to April 2011,802 patients underwent a Iobectomy for treatment of non-small-cell lung cancer at our center.In 133 patients,the tumor was 〉 5 cm.There were 98 men and 35 women,median age 63 years （range：29-81 years）.We divided the patients into two groups,group V （completely video-assisted thoracoscopic surgery）,and group T （open Iobectomy）,and evaluated the two groups for age,gender,tumor size,pathological type,location,duration of surgery,blood loss,lymph node dissection,pathological stage,time of drainage,hospitalization,complications,overall survival and recurrence.Results There were 46 cases in group V and 87 cases in group T.Age,gender,tumor size,location,pathological type and stage were similar between the two groups.Group V had shorter operative duration （（186.5±62.8） minutes vs.（256.7±67.5） minutes,P 〈0.001） and reduced bleeding （（218.5±174.6） ml vs.（556.9±187.2） ml,P 〈0.001）.There were no significant differences between the two groups in complications,lymph node dissection,time of drainage and hospitalization.The recurrence between the two groups was equivalent （2.4% vs.3.8%,P=0.670）.The overall survival at 1,2 and 3 years was 95.1%,81.6% and 69.6% for group V and 88.3%,78.8% and 64.0% for group T.Kaplan-Meier survival curves showed that there was no significant differences between the two groups （P=0.129）.Conclusions Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety,completeness,and efficacy,but had a shorter operative duration,and reduced bleeding.This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size 〉 5 cm.
基金The authors thank for the financial support from the Fundamental Research Funds for the Central Universities(HUST 2010JC051)Youth Chenguang project of Science and Technology of Wuhan City(No.201050231077).
文摘Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperative pain,and faster resumption of a normal lifestyle.However,there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer.Concerns regarding safety,the extent of mediastinal lymph node dissection,and long-term survival have made some surgeons apprehensive of its validity for lung cancer.In this paper,we review the development of thoracoscopy,the present status of VATS for early stage of non-small cell lung cancer(NSCLC),and comparison between VATS and open thoracotomy in the management of NSCLC.
文摘Background The feasibility of completing a Iobectomy by completely video-assisted thoracoscopic surgery （cVATS） in the management of bronchiectasis is unclear. By retrospectively comparing the outcomes from the Iobectomies that used thoracotomy vs. cVATS, we determined the appropriateness of the minimally invasive cVATS approach in the management of bronchiectasis. Methods Between June 2001 and October 2010, 60 patients with bronchiectasis underwent surgery, of which 56 Iobectomies were performed. All Iobectomies were carried out by either thoracotomy or cVATS approach. Pulmonary vessels and bronchi were manipulated by ligation or stapler in the thoracotomy group, while they were dissected by endo-cutters in the cVATS group. Results There were 21 patients in the thoracotomy group and 35 patients in the cVATS group. Two cVATS patients （5.7%） converted. The difference in operation time, chest tube duration, lengths of hospitalization, and morbidity were not significantly different between the two groups （P 〉0.05）. The blood loss was less in the cVATS group （P=0.015）. A total of 52.4% and 62.9% of patients were postoperatively asymptomatic in the thoracotomy and cVATS groups respectively, and symptomatic improvement was obtained in 38.1% patients by thoracotomy vs. 31.4% patients by cVATS. Conclusion cVATS Iobectomy is safe and effective for the management of bronchiectasis, especially for the patients with localized lesions.
文摘Background： Both uniportal and triportal thoracoscopic lobectomy and sublobectomy are feasible for early-stage non-small cell lung cancer （NSCLC）. The aim of this study was to compare the perioperative outcomes of uniportal and triportal thoracoscopic Iobectomy and sublobectomy for early-stage NSCLC. Methods： A total of 405 patients with lung lesions underwent thoracoscopic lobectomy or sublobectomy through a uniportal or triportal procedure in approximately 7-month period （From November 2014 to May 2015）. A propensity-matched analysis, incorporating preoperative variables, was used to compare the short-term outcomes of patients who received uniportal or triportal thoracoscopic lobectomy and sublobectomy. Results： Fifty-eight patients underwent uniportal and 347 patients underwent triportal pulmonary resection. The conversion rate for uniportal and triportal procedure was 3.4% （2/58） and 2.3% （8/347）, respectively. The complication rate for uniportal and triportal procedure was 10.3% and 9.5%, respectively. There was no perioperative death in either group. Most patients had early-stage NSCLC in both groups （uniportal： 45/47, 96%; triportal： 313/343, 91%）. Propensity score-matching analysis demonstrated no significant differences in operation time, intraoperative blood loss, numbers of dissected lymph nodes, number of stations of lymph node dissected, duration of chest tube, and complication rate between uniportal and triportal group for early-stage NSCLC. However, the duration of postoperative hospitalization was longer in the uniportal group （6.83 ± 4.17 vs. 5.42 ± 1.86 d, P = 0.036） compared with the triportal group. Conclusions： Uniportal thoracoscopic lobectomy and sublobectomy is safe and feasible, with comparable short-term outcomes with triportal thoracoscopic pulmonary resection. Uniportal lobectomy and sublobectomy lead to similar cure rate as triportal Iobectomy and sublobectomy for early NSCLC.
