title: New Approach to Complete Video-assisted Thoracoscopic Lobectomy in T2 and T3 Non-Small Cell Lung Cancer.
abstract: Complete video-assisted thoracoscopic surgery (c-VATS) for lung cancer is minimally invasive because of the small incision required. c-VATS has recently become a standard procedure for treatment of stage IA/IB lung cancer. However, a long thoracic incision or extensive costal rib resection is required in patients with large lung tumors. We herein introduce an improved VATS lobectomy procedure for patients with T2 and T3 lung cancer. In this technique, resected tissue is removed through a small upper abdominal midline incision below the xiphoid through the retrosternal-extraperitoneal pathway. Five patients who underwent this new procedure were compared against 10 control patients who underwent hybrid VATS lobectomy. Significantly fewer patients who underwent c-VATS lobectomy complained of severe postoperative pain; however, there was no significant difference in the postoperative hospital stay between the two groups. The present study demonstrates that c-VATS lobectomy can be performed with minimal operative pain and without need for a long thoracic incision or extensive rib resection, even in patients with large lung tumors (T2 and T3). These results suggest that the indications for c-VATS lobectomy in patients with T2 and T3 non-small cell lung cancer can be expanded by implementation of our approach, which involves removal of the freed lobe through an abdominal incision.
authors.affiliation: Department of Surgery, Karatsu Red Cross Hospital, Karatsu, Saga, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Cancer Therapy and Research, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ohnishi@surg1.med.kyushu-u.ac.jp.
authors.forename: Hideya
authors.initials: H
authors.lastname: Onishi
authors.affiliation: Department of Surgery, Karatsu Red Cross Hospital, Karatsu, Saga, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Furugaki
authors.affiliation: Department of Surgery, Karatsu Red Cross Hospital, Karatsu, Saga, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Yunotani
authors.affiliation: Department of Surgery, Hamanomachi Hospital, Fukuoka, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, Japan.
authors.forename: Nobuko
authors.initials: N
authors.lastname: Tsuruta
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Cancer Therapy and Research, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Katano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011184:Postoperative Period; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*
keywords: T2 and T3; VATS; non-small cell lung cancer