title: Surgical Outcome of Video-Assisted Thoracoscopic Surgery vs. Thoracotomy for Primary Lung Cancer >5 cm in Diameter.
abstract: OBJECTIVE
  The indications for video-assisted thoracoscopic surgery (VATS) for advanced-stage lung cancer are expanding, but the criteria vary among institutions. This study compared the minimal invasiveness and oncologic validity of VATS lobectomy and thoracotomy lobectomy for the treatment of large-diameter primary lung cancer.
  
  
  METHODS
  We retrospectively reviewed clinical features and surgical outcomes of 68 patients who underwent anatomical pulmonary resection for primary lung cancer of >5-cm diameter from July 2006 to March 2013. The patients were divided into a VATS group (Group V, n = 35) and a thoracotomy group (Group T, n = 33).
  
  
  RESULTS
  Group V exhibited less intraoperative bleeding (p = 0.012) and had a shorter length of postoperative hospital stay (p = 0.024). The 1- and 5-year overall survival rates were 91.3% and 39.3% in Group V and 84.8% and 56.9% in Group T, respectively (p = 0.48). Multivariate analysis showed that limited lymph node dissection contributed to local recurrence. The extraction bag lavage cytology in Group V revealed that the positivity rate was 35.7%.
  
  
  CONCLUSIONS
  VATS for primary lung cancer of >5-cm diameter is similar to thoracotomy in terms of surgical outcomes. Large tumors must be carefully maneuvered during VATS to prevent cancer cell spillage.
authors.affiliation: Department of General Thoracic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakano
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Endo
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Endo
authors.forename: Shinichi
authors.initials: S
authors.lastname: Otani
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Tsubochi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Tetsuka
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011013:Pneumonectomy; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D016896:Treatment Outcome