title: Fully endoscopic major pulmonary resection for stage I bronchial carcinoma: initial results.
abstract: BACKGROUND
  Several case-series studies of major pulmonary resection (MPR) by video-assisted thoracic surgery (VATS) for non-small-cell lung cancer (NSCLC) have been published, but fully endoscopic MPR is still very rarely performed. Our objective here was to report the outcomes in 71 patients recently managed using fully endoscopic MPR for NSCLC.
  
  
  METHODS
  From 2007 to 2009, 635 patients with NSCLC underwent MPR (pneumonectomy, lobectomy or segmentectomy). Among them, 71 (11%) had features strongly suggesting clinical stage I NSCLC and were managed by fully endoscopic MPR, with no utility incision. Lobectomy was performed in 63 patients and segmentectomy in eight patients. Conversion to thoracotomy was required in two (2.8%) patients, because of a fused fissure in one and tight pleural adhesions in the other. Radical lymphadenectomy was performed in all patients.
  
  
  RESULTS
  Of the 69 patients managed endoscopically, none died and none experienced intraoperative complications. Mean operating time was 226±38 minutes (range, 137-307 minutes) and mean intraoperative blood loss was 111±93mL (range, 0-450mL). The final histological examination showed stage I NSCLC in 52 patients, NSCLC with node involvement in nine patients (pN1 in 6 and pN2 in 3) and other types of malignancies in eight patients. Mean number of nodes removed was 21±8 after right-sided lymphadenectomy and 23±8 after left-sided lymphadenectomy and the mean number of dissected node sites was 3 (range, 2-5). The postoperative morbidity rate was 23%. Mean postoperative hospital stay length was 6.9±2 days (range, 3-12).
  
  
  CONCLUSIONS
  Fully endoscopic MPR is safe and meets the criteria for oncological surgery.
authors: Département thoracique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France. dominique.gossot@imm.fr
authors: D
authors: D
authors: Gossot
authors: Ph
authors: P
authors: Girard
authors: C
authors: C
authors: Raynaud
authors: J-B
authors: JB
authors: Stern
authors: R
authors: R
authors: Caliandro
authors: P
authors: P
authors: Validire
authors: D
authors: D
authors: Debrosse
authors: P
authors: P
authors: Magdeleinat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods / Q000706:statistics & numerical data; D002283:Carcinoma, Bronchogenic / Q000473:pathology / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D019723:Endoscopes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation / Q000379:methods