Perioperative Landiolol Infusion Reduces the Incidence of Atrial Fibrillation after Pulmonary Lobectomy: Postoperative Randomized Controlled Study

Background and Objective: Atrial fibrillation is a common complication after lung resection. We sought to determine the relationship between low-dose landiolol only intraoperatively administration and the incidence of atrial fibrillation development in patients who did not have atrial fibrillation before undergoing lung resection. Methods: Forty-five patients undergoing lung resection (lobectomy or bilobectomy), as indicated for lung cancer at Nippon Medical Hospital, between August 2012 and September 2013. Two patients were excluded from the final analysis. Patients were given either intravenous landiolol (n = 22) or placebo (n = 21) during lobectomy or bilobectomy only intraoperatively. This is prospective, randomized, placebo-controlled study. Main Outcome Measures: The primary end point was the incidence of sustained atrial fibrillation (≥30 min). Results: Postoperative atrial fibrillation occurred in 1 (4.5%) of the 22 patients in the landiolol group and 6 (28.6%) of the 21 patients in the placebo group. No serious adverse effects such as bradycardia and hypotention secondary to landiolol were observed. Conclusion: Low-dose landiolol infusion intraoperatively reduced the incidence of clinically significant atrial fibrillation in patients undergoing pulmonary lobectomy.

Emergency caudate lobectomy for ruptured hepatocellular carcinoma with multiple primary cancers

We report a case of metachronous multiple primary malignancies involving both rectum and liver with colonic metastasis from hepatocellular carcinoma(HCC) through hematogenous pathway.A 72-year-old woman was admitted to the emergency department with right upper abdominal pain for 4 h.Considering her surgical history of Mile's procedure plus liver resection for rectal cancer with liver metastasis three years ago and the finding of urgent computed tomography scan on admission,the preoperative diagnosis was spontaneous rupture of rectal liver metastasis located in caudate lobe and colonic metastasis from rectal cancer. The patient underwent an emergency isolated caudate lobectomy at a hemorrhagic shock status.Pathology reported a primary HCC in the caudate lobe and colonic metastasis of HCC with tumor embolus in the surrounding vessels of the intestine.No regional lymph node involvement was found.It is hypothesized that HCC may disseminate hematogenously to the ascending colon,thus making it a rare case.

Nonintubated thoracoscopic lobectomy plus lymph node dissection following segmentectomy for central type pulmonary masses

Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-related mortality combined （1）. About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed （2）. Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality （3）. More recently,

Thoracoscopic segmentectomy and lobectomy assisted by threedimensional computed-tomography bronchography and angiography for the treatment of primary lung cancer

BACKGROUND Anatomical segmentectomy has been proposed as a substitution for lobectomy for early-stage lung cancer.However,it requires technical meticulousness due to the complex anatomical variations of segmental vessels and bronchi.AIM To assess the safety and feasibility of three-dimensional computed-tomography bronchography and angiography(3D-CTBA)in performing video-assisted thoracoscopic surgery(VATS)for lung cancers.METHODS In this study,we enrolled 123 patients who consented to undergo thoracoscopic segmentectomy and lobectomy assisted by 3D-CTBA between May 2017 and June 2019.The image data of enhanced computed tomography(CT)scans was reconstructed three-dimensionally by the Mimics software.The results of preoperative 3D-CTBA,in combination with intraoperative navigation,guided the surgery.RESULTS A total of 59 women and 64 men were enrolled,of whom 57(46.3%)underwent segmentectomy and 66(53.7%)underwent lobectomy.The majority of tumor appearance on CT was part-solid ground-glass nodule(pGGN;55.3%).The mean duration of chest tube placement was 3.5±1.6 d,and the average length of postoperative hospital stay was 6.8±1.8 d.Surgical complications included one case of pneumonia and four cases of prolonged air leak lasting>5 d.Notably,there was no intraoperative massive hemorrhage,postoperative intensive-care unit stay,or 30-d mortality.Preoperative 3D-CTBA images can display clearly and vividly the targeted structure and the variations of vessels and bronchi.To reduce the risk of locoregional recurrence,the application of 3D-CTBA with a virtual 3D surgical margin help the VATS surgeon determine accurate distances and positional relations among the tumor,bronchial trees,and the intersegmental vessels.Three-dimensional navigation was performed to confirm the segmental structure,precisely cut off the targeted segment,and avoid intersegmental veins injury.CONCLUSION VATS and 3D-CTBA worked in harmony in our study.This combination also provided a new pattern of transition from lesion-directed location of tumors to computer-aided surgery for the management of early lung cancer.

Anatomic isolated caudate lobectomy: Is it possible to establish a standard surgical flow?

AIM To establish the surgical flow for anatomic isolated caudate lobe resection. METHODS The study was approved by the ethics committee of the Second Affiliated Hospital Zhejiang University School of Medicine(SAHZU). From April 2004 to July 2014, 20 patients were enrolled who underwent anatomic isolated caudate lobectomy at SAHZU. Clinical and postoperative pathological data were analyzed. RESULTS Of the total 20 cases, 4 received isolated complete caudate lobectomy(20%) and 16 received isolated partial caudate lobectomy(80%). There were 4 caseswith the left approach(4/20, 20%), 6 cases with the right approach(6/20, 30%), 7 cases with the bilateral combined approach(7/20, 35%), 3 cases with the anterior approach(3/20, 15%), and the hanging maneuver was also combined in 2 cases. The median tumor size was 5.5 cm(2-12 cm). The median intraoperative blood loss was 600 m L(200-5700 m L). The median intra-operative blood transfusion volume was 250 m L(0-2400 m L). The median operation time was 255 min(110-510 min). The median post-operative hospital stay was 14 d(7-30 d). The 1-and 3-year survival rates for malignant tumor were 88.9% and 49.4%, respectively. CONCLUSION Caudate lobectomy was a challenging procedure. It was demonstrated that anatomic isolated caudate lobectomy can be done safely and effectively.

Caudate lobectomy by the third porta hepatis anatomical method: a study of 16 cases

BACKGROUND: The treatment for primary tumor in the caudate lobe of the liver is difficult because of its unique anatomical location. This study was undertaken to improve operative techniques and results by a new anatomical method of caudate lobectomy. METHODS: Clinical data of 16 patients who had had caudate lobectomy for the liver from January 1996 to November 2004 were retrospectively analyzed. The third porta hepatis anatomical method was performed in all 16 patients. Operative time, intraoperative blood loss, postoperative complications were recorded. The 1-, 3-, and 5-year survival rates of 13 patients with caudate lobe carcinoma were followed up. Anatomical status, operative routes, operative procedures, liver blood supply were evaluated. RESULTS: The operation was successful in the 16 patients. The operative time was 255±70 minutes and blood loss 740±402 ml. None of the patients died from massive bleeding during the operation, nor did complications such as biliary fistula and liver failure occurred. In 13 patients with malignant tumor, 7 died from recurrence and metastasis of the tumor and the other 6 are still alive at the end of follow-up. One patient has survived for 6 years. The 1-, 3-, and 5-year survival rates in the 13 patients were 83.9%, 58.7% and 39.2%, respectively. CONCLUSION: Caudate lobectomy by the third porta hepatis anatomical method can improve operative effect and increase the resection probability for solitary tumor in the caudate lobe.

Robotic isolated partial and complete hepatic caudate lobectomy:A single institution experience

Background:Current reports on robotic hepatic caudate lobectomy are limited to Spiegel lobectomy.This study aimed to compare the safety and feasibility of robotic isolated partial and complete hepatic caudate lobectomy.Methods:Clinical data of 32 patients who underwent robotic resection of the hepatic caudate lobe in our department from May 2016 to January 2020 were retrospectively analyzed.The patients were divided into three groups according to the lobectomy location:left dorsal segment lobectomy(Spiegel lobectomy),right dorsal segment lobectomy(caudate process or paracaval portion lobectomy),and complete caudate lobectomy.General information and perioperative results of the three groups were compared and analyzed.Results:Among the 32 patients,none had conversion to laparotomy,three received intraoperative blood transfusion(9.38%),and none had complications of Clavien-Dindo gradeⅢor higher or died in the perioperative period.Among them,17 patients(53.13%)underwent Spiegel lobectomy,7(21.88%)underwent caudate process or paracaval portion lobectomy,and 8(25.00%)underwent complete caudate lobectomy.The operative time and blood loss in the left dorsal segment lobectomy group were significantly better than those in the right dorsal segment lobectomy and complete caudate lobectomy groups(operative time:P=0.010 and P=0.005;blood loss:P=0.005 and P=0.017,respectively).The postoperative hospital stay in the left dorsal segment lobectomy group was significantly shorter than that in the complete caudate lobectomy group(P=0.003);however,there was no difference in the postoperative hospital stay between the left dorsal segment lobectomy group and right dorsal segment lobectomy group(P=0.240).Conclusions:Robotic isolated partial and complete caudate lobectomy is safe and feasible.Spiegel lobectomy is relatively straightforward and suitable for beginners.

Choice of approach for hepatectomy for hepatocellular carcinoma located in the caudate lobe:Isolated or combined lobectomy?

AIM:To investigate the significance of the surgical approaches in the prognosis of hepatocellular carcinoma(HCC) located in the caudate lobe with a multivariate regression analysis using a Cox proportional hazard model.METHODS:Thirty-six patients with HCC underwent caudate lobectomy at a single tertiary referral center between January 1995 and June 2010.In this series,left-sided,right-sided and bilateral approaches were used.The outcomes of patients who underwent isolated caudate lobectomy or caudate lobectomy combined with an additional partial hepatectomy were compared.The survival curves of the isolated and combined resection groups were generated by the Kaplan-Meier method and compared by a log-rank test.RESULTS:Sixteen(44.4%) of 36 patients underwent isolated total or partial caudate lobectomy whereas 20(55.6%) received a total or partial caudate lobectomy combined with an additional partial hepatectomy.The median diameter of the tumor was 6.7 cm(range,2.1-15.8 cm).Patients who underwent an isolated caudate lobectomy had significantly longer operative time(240 min vs 170 min),longer length of hospital stay(18 d vs 13 d) and more blood loss(780 mL vs 270 mL) than patients who underwent a combined caudate lobectomy(P < 0.05).There were no perioperative deaths in both groups of patients.The complication rate was higher in the patients who underwent an isolated caudate lobectomy than in those who underwent combined caudate lobectomy(31.3% vs 10.0%,P < 0.05).The 1-,3-and 5-year disease-free survival rates for the isolated caudate lobectomy and the combined caudate lobectomy groups were 54.5%,6.5% and 0% and 85.8%,37.6% and 0%,respectively(P < 0.05).The corresponding overall survival rates were 73.8%,18.5% and 0% and 93.1%,43.6% and 6.7%(P < 0.05).CONCLUSION:The caudate lobectomy combined with an additional partial hepatectomy is preferred because this approach is technically less demanding and offers an adequate surgical margin.

Anterior transhepatic approach for total caudate lobectomy including spigelian lobe,paracaval portion and caudate process:A Brazilian experience

To the Editor:Nowadays,because of the infiltration of cholangiocarcinoma to the parenchyma and/or bile ducts of the caudate lobe,the inclusion of caudate lobe combined with a major hepatectomy remains the gold standard approach for a resectable hilar cholangiocarcinoma.Since the last years of the 20th century,some authors have begun to report isolated caudate lobe resection for hepatocellular

Robot-assisted lobectomy in a patient with poor lung function:Another advantage of robot-assisted thoracoscopic surgery

Patients with poor lung function have a high-risk for pulmonary complications following lobectomy.The development of minimally invasive thoracic surgical techniques allows sicker patients to safely undergo lung resection.Robotic lobectomy could benefit these higher risk patients.Here we present a case of a 58-year-old female patient with poor lung function presented with a 3-cm mass in her lower left pulmonary lobe,who successfully underwent lobectomy via robot-assisted thoracoscopic surgery.Her forced expiratory volume in one second was slightly improved compared to the preoperative value.Her forced vital capacity continued to improve in the follow-up period.There was no recorded recurrence during the three years follow-up period.

Complete Thoracoscopic Segmentectomy and Pulmonary Lobectomy in the Treatment of Small Pulmonary Nodules

Objective:To compare the clinical effect of complete thoracoscopic segmentectomy and pulmonary lobectomy for pulmonary nodules.Methods:In this study,176 patients with pulmonary nodules were treated in Changshu Hospital Affiliated to Nanjing University of Chinese Medicine from January 2019 to June 2021;according to the type of surgery,the patients were divided into group A(complete thoracoscopic segmentectomy)and group B(complete thoracoscopic pulmonary lobectomy),and the clinical effects were analyzed.Results:The intraoperative blood loss,postoperative drainage volume,postoperative hospitalization days,and lung function of patients in group A were significantly better than those in group B(P<0.05),while there was no significant difference in the number of dissected lymph nodes.Conclusion:The clinical effect of complete thoracoscopic segmentectomy for patients with small pulmonary nodules is more significant;it does not only ensure lymph node dissection,but also improve surgical-related indicators and treatment safety as well as speed up the recovery of pulmonary function.Its clinical application value is worthy of key analysis by medical institutions.

Application of Blocking Unilateral Main Pulmonary Artery in Pulmonary Lobectomy of Lung Cancer

OBJECTIVE To explore the application of blocking the unilateralmain pulmonary artery (MPA) in pulmonary lobectomy (PL) forpatients with stage Ⅱ and Ⅲ lung cancer, and to retrospectivelyanalyze the methods of surgery for blocking the unilateral mainpulmonary artery, perioperative indications, intraoperativeconcerns and postoperative cardio-pulmonary complications.METHODS During a period from January 2006 to January 2008,intra-pericardial, or extra-pericardial separation and blockade ofthe left or right MPA followed by completion of various PLs wereconducted for 30 lung cancer patients in stage-Ⅱ to Ⅲ with ill-defined anatomic structure of the pulmonary hilum and difficultpulmonary angiodiastasis.RESULTS In the 30 patients, 5 were diagnosed as stage-Ⅱb, 11stage-Ⅲa, and 14 stage-Ⅲb. During the surgery, giant tumors atthe superior pulmonary lobe, with a diameter of over 10 cm, wereseen in 13 cases, in which tumor invasion in the extra-pericardiacpulmonary artery was found in 5 cases. Hilar lymphadenectasiswith severe tumor adhesion to pulmonary blood vessel couldbe seen in 20 cases and partial tumorous invasion in thepericardium in 7. In most of the cases, adhesions existed aroundthe tumor, aorta, superior vena, and azygous vein. Invasion ofthe laryngeal and vagus nerves on the left side was found in 3cases. Of the 30 patients, simple PL was conducted in 12, andsleeve lobectomy combined with a pulmonary arterioplasty in18 cases. With a blockade of unilateral MPA, no intraoperativehemorrhea of pulmonary blood vessels occurred during surgery,when there was a clear surgical field of vision. Both PL andlymphadenectomy were smoothly completed in the 30 patients.The healthy pulmonary lobes with normal function were keptand total pneumonectomy was avoided. The time of blocking thepulmonary artery ranged from 10 to 30 min, and intraoperativeblood loss was from 200 to 300 ml. Postoperative complicatedacute pulmonary edema occurred in 5 patients and tachycardia in7 cases. Nevertheless, all patients recovered and left the hospitalafter treatment. No severe cardiopulmonary complications werefound in all patients of the group.CONCLUSION Blocking the unilateral MPA is effective todecrease the risk of intraoperative hemorrhea in the PL. It canshorten the time of surgery, improve the excision rate of lungcancer, and cut down on the rate of total pneumonectomy.

Robotic lobectomy-the future of minimally invasive lobectomy?

It has been almost 20 years since the first reports of minimally invasive lobectomies appeared. Despite the tremendous amounts of research performed on VATS lobectomy showing its benefit over open thoracotomy, a mere 32% of all lobectomies are performed via this technique in the Society for Thoracic Surgeons database and only 6% in the Nationwide Inpatient Sample （1）. So, why is it that in a recent review of clinical stage I lung cancers over 70% were still completed using open thoracotomy？（2）. Advocates of an open approach still cite the ability to sample and perform a ＂more thorough＂ lymphadenectomy, the instability of the VATS platform and the lack of precision with the fissure-less-dissection VATS technique as reasons to maintain the status quo.

Treatment of a densely fused fissure during thoracoscopic right middle lobectomy

Aim: To report a case of fused fissure between the right upper and middle lobes that we treated using a surgical stapler rather than a Ligasure device for the benefit of creating a better division between the right upper and middle lobes and to effectively seal the lung parenchyma. Case: A 2-year-old girl with congenital cystic adenomatoid malformation of the right middle lobe (RML) was referred to our institution for further management after a series of infections. The vein of the RML, which drains into the superior pulmonary vein, was isolated and divided using endoclips. The bronchus was then exposed and divided using endo-clips. The arteries of the RML could be identified and ligated, allowing a line demarcating the major fissure to be identified and dissected. A stapler device was then used to seal the lung parenchyma and create a division between the right upper and middle lobes. She is currently well after follow-up of 16 months, with no episodes of respiratory distress or recurrence of symptoms. Conclusion: Our technique for dividing the pulmonary vein, then the bronchus, then the pulmonary artery and finally the fused fissure is safe and could be applied whenever fused fissures are encountered during thoracoscopic pulmonary lobectomy.

Remote Cerebellar Hemorrhage after Frontal Lobectomy: Zebra Sign

Remote cerebellar hemorrhages (RCHs) are rare complications of intracranial or spinal interventions. We describe a patient with an RCH that occurred after a frontal lobectomy for an intracranial tumor. A 41-year-old female patient with a headache and partial seizures underwent a right frontal lobectomy upon detection of a right frontal mass. An RCH (zebra sign) was detected on a control cranial computed tomography (CT), which was performed upon detection of frontal lobe syndrome and mild ataxia in the patient postoperatively. Although the mechanism underlying the occurrence of RCHs after intracranial procedures is not clear, they have been attributed to an imbalance between intravascular pressure and cerebrospinal fluid (CSF) due to rapid drainage of the fluid, causing bleeding in the cerebellar parenchyma. Generally, bilateral superior cerebellar injury produces parallel flat hyperdense areas known as the zebra sign on CT. The prognosis of a cerebellar hemorrhage is generally good, and it can be treated with a conservative approach. Controlled drainage of CSF during surgery and selecting an appropriate surgical position perioperatively will reduce the risk of RCHs.

Preoperative and Postoperative Spirometry in Patients Undergoing Lobectomy for Sequelae of Pulmonary Tuberculosis

Objective: To assess preoperative and postoperative spirometry values in patients undergoing lobectomy for sequelae of pulmonary tuberculosis. Method: A total of 20 patients (10 males) with history of treatment for tuberculosis and presenting with symptomatic sequelae (repeat infection or hemoptysis) who sought assistance at the chest surgery outpatient clinic between 11.09.07 and 04.02.10, were selected for the study. Only patients that met theeligibility criteria (symptomatic, submitted to tuberculosis treatment) were included in the study. The age of patients ranged from 15 to 56 years (mean: 35.75 years). The average treatment time for tuberculosis was 6 months and onset of symptoms occurred between 01 and 32 years after treatment. To assess the impact of surgery on the variables VC, FVC, FEV1, FEV1/FVC, FEF and PEF preoperative values were compared with postoperative values at 1st, 3rd, 6th and 12th month using the paired t test. The level of significance (α) applied for all tests was 5% where a value of p 0.05 was considered significant. Results: 11 patients were treated because of recurrent infections and 9 because of haemoptysis. The most common lobectomy was right upper lobectomy (7 patients), followed by left upper lobectomy (6 patients), left lower lobectomy (6 patients), and right middle lobectomy (1 patient). There were no postoperative complications. There was no postoperative mortality. Conclusion: Based on the results of the present study, it can be concluded that, at the 12th postoperative month, spirometric parameters of patients with tuberculosis sequelae submitted to lobectomy had returned to preoperative levels.

Unexpected Intraoperative Resecting of Common Trunk of Pulmonary Vein Resulted in an Incidental Pneumonectomy from Left Upper Lobectomy

There is a wide range of anatomical variations in the pulmonary vessels. Some of these variations may cause surgical morbidity during general thoracic surgery. We intended to perform a left upper lobectomy for a 73-year-old male with suspected left lung cancer (lt.U, S3, 20 × 20 mm, P0, E0, D0, PM0, N0, T1aN0M0, c-stage IA). Preoperatively, we did not recognize the existence of the common trunk of the left pulmonary vein. After the open thoracotomy, due to a severe intrathoracic adhesion, we omitted releasing the adhesion of the lower lobe. We did not exactly confirm the location of the inferior pulmonary vein (IPV). After cutting the interlobular pulmonary arterial branchies, we resected the superior pulmonary vein (SPV) using auto sutures. After division of the lung parenchyma and incomplete fissures using auto sutures, we intended to resect the upper bronchus. However, we could not find an IPV at the normal IPV site. A thin IPV was found to be returned to the peripheral site of the resected SPV. The SPV and IPV formed a common trunk at the normal site of the SPV. Although we considered reconstructing the resected common trunk, we finally made a decision of performing an incidental pneumonectomy in order to prevent any postoperative complications on the reconstruction of the IPV such as thrombus occlusion at the anastomosis site and venous return congestion. Retrospectively, we confirmed the preoperative images of the computed tomographic scanning, which showed a narrow IPV that returned to the peripheral site of the SPV. It is important to confirm both accurate locations of the SPV and IPV when performing a lobectomy.

Anterior temporal lobectomy improved mood status and quality of life in Chinese patients with mesial temporal lobe epilepsy:a single-arm cohort study

Background: Many studies have emphasized that selective resection of epileptic lesions in temoral lobe is associated with better preservation of cognition function;whether this applies to patients with refractory mesial temporal lobe epilepsy (MTLE) remains unknown. The objective of this study was to evaluate changes in cognitive functions, mood status, and quality of life after anterior temporal lobectomy in patients with refractory MTLE. Methods: This single-arm cohort study assessed cognitive function, mood status, and quality of life, as well as electroencephalography findings, in patients with refractory MTLE who underwent anterior temporal lobectomy at Xuanwu Hospital from January 2018 to March 2019. Pre- and post-operative characteristics were compared to evaluate the effects of surgery. Results: Anterior temporal lobectomy significantly reduced the frequencies of epileptiform discharges. The overall success rate of surgery was acceptable. Anterior temporal lobectomy did not result in significant changes in overall cognitive functions (P > 0.05), although changes in certain domains, including visuospatial ability, executive ability, and abstract thinking, were detected. Anterior temporal lobectomy resulted in improvements in anxiety and depression symptoms and quality of life. Conclusions: Anterior temporal lobectomy reduced epileptiform discharges and incidence of post-operative seizures as well as resulted in improved mood status and quality of life without causing significant changes in cognitive function.

Completely video-assisted thoracoscopic lobectomy versus open lobectomy for non-small cell lung cancer greater than 5 cm：a retrospective study

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.

A Matched Comparison Study of Uniportal Versus Triportal Thoracoscopic Lobectomy and Sublobectomy for Early-stage Nonsmall Cell Lung Cancer

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.