title: Video-assisted thoracoscopic surgery with posterior spinal reconstruction for the resection of upper lobe lung tumors involving the spine.
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) is associated with less morbidity and recovery time compared with traditional open thoracotomy (OT) for the resection of early stage non-small cell lung cancer (NSCLC). Local invasion of NSCLC into adjacent vertebrae confers a TNM T status of T4. Anatomical lobectomy by VATS with simultaneous posterior spinal reconstruction (PSR), as a single procedure, offers advantages to selected patients judged as suitable candidates for resection.
  
  
  OBJECTIVE
  To report the preliminary results of a novel, multidisciplinary surgical technique for the treatment of upper lobe lung cancers with direct extension to the spine.
  
  
  METHODS
  Consecutive case series.
  
  
  METHODS
  Eight adults who underwent PSR with either VATS or OT for the treatment of a T4 (vertebral body invasion) NSCLC.
  
  
  METHODS
  Total operative time, estimated blood loss, length of hospital stay, postoperative tumor recurrence and metastasis, survival, reoperations, and any other intraoperative or postoperative complication.
  
  
  METHODS
  Eight consecutive patients who underwent instrumented PSR with corpectomy for the treatment of an upper lobe NSCLC at a single institution were identified. Either VATS (n=4) or OT (n=4) was performed at the time of the reconstruction in each patient. All tumors were stage III NSCLC without metastasis.
  
  
  RESULTS
  Patients who underwent VATS and OT were aged 54±11 and 54±2.9 years, respectively. Mean operative time and blood loss were similar between the groups: VATS: 367±117 minutes versus OT: 518±264 minutes; VATS: 813±463 mL versus OT: 1,250±1,500 mL. Mean follow-up was 16±13 months after surgery. Complications occurred in all eight patients. One OT patient had wound dehiscence requiring a tissue flap, and another suffered from a septic shock. No wound complications developed after VATS. Death secondary to tumor recurrence occurred once in each group. For the six surviving patients, 23±15 months (range, 4.5-43 months) have elapsed since surgery.
  
  
  CONCLUSIONS
  Video-assisted thoracoscopic surgery with PSR is a novel and viable method for the complete resection of T4 NSCLC.
authors.affiliation: Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S. Euclid Ave., West Pavilion Suite 11300, Campus Box 8233, St. Louis, MO 63110, USA.
authors.forename: Geoffrey E
authors.initials: GE
authors.lastname: Stoker
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Buchowski
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Patterson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D019651:Plastic Surgery Procedures / Q000379:methods*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013906:Thoracoscopy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D020535:Video-Assisted Surgery / Q000379:methods*