New approaches to the minimally invasive treatment of lung cancer.
VATS lobectomies have now been performed for 12 years since the first VATS lobectomy. Although some controversies remain regarding the safety, morbidity, and mortality of that procedure, the procedure is clearly gaining momentum. The purpose of this paper is to review the current literature about the procedure.


METHODS
Between 1992-2004, we performed 1100 VATS lobectomies in 595 (54.1%) women and 505 men (45.9%), mean age=71.2 years. Diagnoses were as follows: benign disease (53), pulmonary met (27), Lymphoma (5) and lung cancer (1015). 641 (63.1%) of the primary lung cancers were adenocarcinoma. With visualization on a monitor, anatomic hilar dissection and lymph node sampling or dissection were performed, primarily through a 5 cm incision without spreading the ribs.


RESULTS
There were 9 deaths (0.8%)-none were intra-operative or due to bleeding. 932 patients had no postoperative complications (84.7%). Blood transfusion was required in 45/1100 (4.1%). Length of stay was median 3 days, mean 4.78 days. 180 patients were discharged on POD 1 or 2 (20%). Conversion to a thoracotomy occurred in 28 patients (2.5%). 5 patients developed recurrence in the incisions (0.57%). In 2003, 89% of 224 lobectomies were performed with VATS.


CONCLUSIONS
VATS lobectomy with anatomic dissection can be performed with low morbidity and mortality. The risk of intraoperative bleeding or recurrence in an incision seems minimal.
McKenna
Robert J
RJ
Department of Cardiothoracic Surgery, Cedars-Sinai Health System, Los Angeles, California 90048, USA. mckennar@cshs.org
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods; D016896:Treatment Outcome