Long-term survival after videothoracoscopic lobectomy for stage I lung cancer.
OBJECTIVE
The aim of this study was to evaluate our personal experience and survival curves after video-assisted thoracic surgery (VATS) lobectomies for stage I lung cancer, in comparison with the results reported in existing literature.


METHODS
Retrospective analysis of our experience and an overview of literature.


METHODS
Department of Surgery, San Giuseppe Hospital, University of Milan.


METHODS
From October 1991 to December 2001, of 257 patients with clinical stage I lung cancer, 193 patients underwent VATS lobectomy, 7 patients were declared inoperable at thoracoscopic exploration, and 57 patients were converted (18 patients for oncologic reasons and 39 patients for technical reasons).


RESULTS
We observed no intraoperative mortality and no recurrence. Survival data were analyzed with the Kaplan-Meier method along with a log-rank test for statistical significance. The global survival rates at 3 years and 5 years were 77.7% and 63.64%, respectively. T1N0 patients had a better survival curve at 3 years and 5 years (83.50% and 70.21%, respectively) compared to T2N0 patients (71.13% and 56.12%). Patients < 70 years of age had better 3-year and 5-year survival rates (82.37% and 73.32%, respectively) than those > 70 years of age (57.49% and 37.09%). This difference was statistically significant (p < 0.01).


CONCLUSIONS
Our results after the VATS approach match the "best" results reported in literature following conventional surgery. Minimally invasive surgery seems to imply reduced tissue damage and decreased impairment of immunologic function. VATS lobectomy permits radical oncology as accurately as lobectomy by thoracotomy, provided that long-established standards are respected. In spite of technical difficulties, it could therefore become a valid alternative in treating stage I lung cancer.
Roviaro
Giancarlo
G
University of Milan, Ospedale Maggiore Policlinico IRCCS, Milan, Pad. Zonda, Via Francesco Sforza, 35, 20122 Milan, Italy. gian.roviaro@unimi.it
Varoli
Federico
F
Vergani
Contardo
C
Nucca
Ombretta
O
Maciocco
Marco
M
Grignani
Fabrizio
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D002283:Carcinoma, Bronchogenic / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality* / Q000473:pathology; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D020775:Thoracic Surgery, Video-Assisted