title: Outcomes of Hybrid Video Assisted Thoracoscopic Surgery for Pulmonary Metastasectomy.
abstract: BACKGROUND
  Pulmonary metastasectomy is an acceptable treatment option in various metastatic lesions. The role of minimally invasive surgery for metastasectomy remains controversial. We report on a recently described hybrid video-assisted thoracoscopic surgery (hVATS) technique in the community hospital setting.
  
  
  METHODS
  Using a retrospective study design, data on 61 patients undergoing 67 resections between April 2000 and January 2008 was collected at a single institution. Patient demographics, pathology, and clinical outcome data were recorded. Kaplan Meier estimates and multivariate Cox regression were used to assess survival and prognostic factors, respectively.
  
  
  RESULTS
  Mean patient age was 61.7 years. The majority of lesions were solitary, unilateral, and genitourinary or gastrointestinal in origin (69%). R0 resection was achieved in 97% of cases with the most common operation being lobectomy. Mean length of stay was 4.4 days. Mean follow-up was 39.7 months and 5-year overall survival was 63.2% for the cohort; median survival was not reached. The number of lesions (univariate only) and tumor size over 4 cm influenced overall survival.
  
  
  CONCLUSIONS
  Hybrid VATS is a safe and feasible technique in the community medical center setting and warrants additional investigation as an alternative strategy in the management of pulmonary metastases.
authors.affiliation: Division of Surgical Oncology (AR, KT), Division of Bariatric & Gastrointestinal Surgery (LGW), Department of Surgery, Virginia Commonwealth University School of Medicine and Massey Cancer Center, Richmond, VA; Thoracic Surgery Associates, Bon Secours Memorial Regional Medical Center, Mechanicsville, VA (CGL); Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center Shreveport, Louisiana, USA (RHK).
authors.forename: Ali
authors.initials: A
authors.lastname: Raza
authors.affiliation: Division of Surgical Oncology (AR, KT), Division of Bariatric & Gastrointestinal Surgery (LGW), Department of Surgery, Virginia Commonwealth University School of Medicine and Massey Cancer Center, Richmond, VA; Thoracic Surgery Associates, Bon Secours Memorial Regional Medical Center, Mechanicsville, VA (CGL); Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center Shreveport, Louisiana, USA (RHK).
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Takabe
authors.affiliation: Division of Surgical Oncology (AR, KT), Division of Bariatric & Gastrointestinal Surgery (LGW), Department of Surgery, Virginia Commonwealth University School of Medicine and Massey Cancer Center, Richmond, VA; Thoracic Surgery Associates, Bon Secours Memorial Regional Medical Center, Mechanicsville, VA (CGL); Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center Shreveport, Louisiana, USA (RHK).
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.affiliation: Division of Surgical Oncology (AR, KT), Division of Bariatric & Gastrointestinal Surgery (LGW), Department of Surgery, Virginia Commonwealth University School of Medicine and Massey Cancer Center, Richmond, VA; Thoracic Surgery Associates, Bon Secours Memorial Regional Medical Center, Mechanicsville, VA (CGL); Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center Shreveport, Louisiana, USA (RHK).
authors.forename: C Gregory
authors.initials: CG
authors.lastname: Lockhart
authors.affiliation: Division of Surgical Oncology (AR, KT), Division of Bariatric & Gastrointestinal Surgery (LGW), Department of Surgery, Virginia Commonwealth University School of Medicine and Massey Cancer Center, Richmond, VA; Thoracic Surgery Associates, Bon Secours Memorial Regional Medical Center, Mechanicsville, VA (CGL); Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center Shreveport, Louisiana, USA (RHK).
authors.forename: Roger H
authors.initials: RH
authors.lastname: Kim
keywords: VATS; hybrid surgery; minimally invasive surgery; pulmonary metastases