Locoregional control of thoracoscopic lobectomy with selective lymphadenectomy for lung cancer.
BACKGROUND
In this retrospective study, we review our experience with video-assisted thoracic surgery (VATS) lobectomy with selective lymphadenectomy for clinical stage I lung cancer and report the long-term results.


METHODS
From April 1999 to December 2006, 355 patients with clinical stage I lung cancer underwent a VATS lobectomy. The perioperative data, morbidity, mortality, and long-term survival of each patient were reviewed.


RESULTS
A thoracoscopic lobectomy was performed successfully in 348 patients (T1 N0, 237 patients; T2 N0, 111 patients), and a selective lymphadenectomy was performed in 268. Seven procedures (2.0%) were uneventfully converted to a thoracotomy and were excluded. The median operation time was 192 minutes, and the median blood loss was 100 mL. The median postoperative stay was 6 days. There were no intraoperative deaths; 2 patients died within 30 days of operation (mortality; 0.6%); 1 died of bacterial pneumonia and the other of postoperative interstitial pneumonia exacerbation. Postoperative complications occurred in 54 patients (16% morbidity). Major complications included prolonged air leak (3.7%), bacterial pneumonia (3.4%), and mild arrhythmia (3.4%). Pathologic upstaging was noted in 67 patients (19%). At a median follow-up of 43 months, total recurrence occurred in 66 cases (26 locoregional and 40 distant). The locoregional recurrence rate was 0.021 per person per year. The overall and 5-year locoregional recurrence-free survival rates were 78.5% and 76.6%, respectively.


CONCLUSIONS
Our findings suggest that performing VATS lobectomy with selective lymphadenectomy for clinical stage I lung cancer is safe and results in acceptable locoregional control.
Ichinose
Junji
J
Department of Thoracic Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan. i_junji@ba2.so-net.ne.jp
Kohno
Tadasu
T
Fujimori
Sakashi
S
Mun
Mingyon
M
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted