Intraoperative conversion during video-assisted thoracoscopy resection for lung cancer does not alter survival

Abstract OBJECTIVES The aim of this study was to assess the long-term outcomes of patients treated by anatomical pulmonary resection with the video-assisted thoracoscopic surgery (VATS) approach, VATS requiring intraoperative conversion to thoracotomy or an upfront open thoracotomy for lung cancer surgery. METHODS We performed a retrospective single-centre study that included consecutive patients between January 2011 and December 2018 treated either by VATS (with or without intraoperative conversion) or open thoracotomy for non-small-cell lung cancer (NSCLC). Patients treated for a benign or metastatic condition, stage IV disease, multiple primary lung cancer or by resection, such as pneumonectomies or angioplastic/bronchoplastic/chest wall resections, were excluded. RESULTS Among 1431 patients, 846 were included: 439 who underwent full-VATS, 94 who underwent VATS-conversion (21 emergent, 73 non-emergent) and 313 treated with upfront open thoracotomy. The median follow-up was 37 months. There were no statistical differences in stage-specific overall survival between the full-VATS, VATS-conversion, and open thoracotomy groups, with 5-year OS for stage I NSCLC of 76%, 72.3% and 69.4%, respectively (P = 0.47). There was a difference in disease-free survival for stage I NSCLC, with 71%, 60.2% and 53%, respectively at 5 years (P = 0.013). Fewer complications occurred in the full-VATS group (pneumonia, arrhythmia, length of stay), but complication rates were similar between the VATS-conversion and thoracotomy groups. CONCLUSIONS VATS resection for NSCLC with intraoperative conversion does not appear to alter the long-term oncological outcome relative to full-VATS or open upfront thoracotomy. Postoperative complications were higher than for full-VATS and comparable to those for thoracotomy. VATS should be favoured when possible.

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Video-assisted thoracoscopic surgery versus open lobectomy for stage I lung cancer: A meta-analysis of long-term outcomes

Experimental and Therapeutic Medicine ◽

10.3892/etm.2012.485 ◽

2012 ◽

Vol 3 (5) ◽

pp. 886-892 ◽

Cited By ~ 19

Author(s):

ZHENGJUN LI ◽

HONGXU LIU ◽

LE LI

Keyword(s):

Lung Cancer ◽

Thoracoscopic Surgery ◽

Meta Analysis ◽

Stage I ◽

Long Term Outcomes ◽

Video Assisted ◽

Stage I Lung Cancer ◽

Open Lobectomy ◽

Video Assisted Thoracoscopic Surgery

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Video-assisted thoracoscopic lobectomy versus open thoracotomy conventional lobectomy for stage I non-small cell lung cancer

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd012641 ◽

2017 ◽

Author(s):

Anne Olland ◽

Jeremie Reeb ◽

Erik Sauleau ◽

Nicolas Meyer ◽

Marion Bernard-Schweitzer ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Small Cell ◽

Stage I ◽

Open Thoracotomy ◽

Small Cell Lung ◽

Video Assisted ◽

Thoracoscopic Lobectomy

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Uniportal video-assisted thoracic surgery and perioperative pirfenidone for lung cancer and idiopathic pulmonary fibrosis: a case report

Journal of International Medical Research ◽

10.1177/03000605211016998 ◽

2021 ◽

Vol 49 (9) ◽

pp. 030006052110169

Author(s):

Ayae Saiki ◽

Teruaki Mizobuchi ◽

Kaoru Nagato ◽

Fumihiro Ishibashi ◽

Junichi Tsuyusaki ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Primary Lung Cancer ◽

Lung Cancer Surgery ◽

Lower Lobe ◽

Chest Computed Tomography ◽

Video Assisted ◽

Acute Exacerbations

Patients with idiopathic pulmonary fibrosis (IPF) occasionally experience acute exacerbations after surgery for lung cancer. Several recent studies have revealed a prophylactic effect of perioperative pirfenidone treatment on postoperative acute exacerbations of IPF in patients with lung cancer. A 75-year-old woman consulted with her pulmonologist because of an IPF shadow detected by follow-up chest computed tomography 2 months after surgical treatment of biliary cancer. Another 7 months later, chest computed tomography showed a 23- × 14-mm nodule located in the right lower lobe with high accumulation of fluorodeoxyglucose detected by positron emission tomography, resulting in a radiological diagnosis of primary lung cancer with IPF. We administered perioperative pirfenidone treatment followed by right lower lobectomy using uniportal video-assisted thoracoscopic surgery after attaining a pathological diagnosis of adenocarcinoma. The patient developed no acute exacerbations of IPF during the postoperative period, and she had no recurrence of lung cancer for 15 months after surgery. We successfully used a combination of perioperative antifibrotic medication and minimally invasive surgery after lung cancer surgery in a patient with IPF.

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Uniportal video-assisted thoracoscopy surgery in lung cancer: largest experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319868651 ◽

2019 ◽

Vol 27 (7) ◽

pp. 559-564

Author(s):

Balasubramanian Venkitaraman ◽

Jiang Lei ◽

Wu Liang ◽

Cai Jianqiao

Keyword(s):

Lung Cancer ◽

Thoracoscopic Surgery ◽

Primary Lung Cancer ◽

Median Number ◽

Short Term ◽

Female Ratio ◽

Oncological Outcomes ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

Background Uniportal video-assisted thoracoscopic surgery is one of the latest development in minimal invasive thoracic surgery. It is being increasing applied in various parts of the world for the treatment of lung cancer. Although the technique has become popular, there is a lack of largescale literature addressing the safety and oncological outcomes. We aimed to describe our experience, highlighting the short-term outcomes and oncological efficacy. Methods From July 2013 to December 2017, 441 uniportal video-assisted thoracoscopic procedures were carried out in patients with primary lung cancer and no metastatic disease. The male-to-female ratio was 240:201. The median age of the patients was 63 years (range10 to 85 years). Results The median number of mediastinal lymph node stations dissected and median number of mediastinal nodes were 5 and 14, respectively. Ten or more nodes were dissected in 93.1% of patients. All surgeries were complete R0 resection. Minor postoperative morbidity according to the Clavien-Dindo classification was 4%. Seven patients experienced major morbidity requiring intensive care management. There was no 30-day mortality. Conclusion Uniportal video-assisted thoracoscopic anatomical resection for lung cancer appears to have similar postoperative outcomes to multiport surgery in terms of short-term morbidity and oncological efficacy. Uniportal video-assisted thoracoscopic surgery can be offered as a standard of care for lung cancer surgery in centers with adequate surgical expertise. Long-term follow-up will be needed to establish the long-term oncological outcomes.

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Video-assisted thoracoscopic lobectomy is feasible for selected patients with clinical N2 non-small cell lung cancer

Scientific Reports ◽

10.1038/s41598-020-72272-4 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Jae Kwang Yun ◽

Geun Dong Lee ◽

Sehoon Choi ◽

Hyeong Ryul Kim ◽

Yong-Hee Kim ◽

...

Keyword(s):

Lung Cancer ◽

Thoracoscopic Surgery ◽

Cohort Analysis ◽

Survival Outcomes ◽

Open Thoracotomy ◽

Term Survival ◽

Long Term Survival ◽

Video Assisted ◽

Advanced Stage Lung Cancer

Abstract Few studies have evaluated the usefulness of video-assisted thoracoscopic surgery (VATS) for advanced-stage lung cancer. We aimed to evaluate the feasibility of VATS for treating clinical N2 (cN2) lung cancer. A retrospective cohort analysis was performed with data from 268 patients who underwent lobectomy for cN2 disease from 2007 to 2016. Using propensity score-based inverse probability of treatment weighting (IPTW), perioperative and long-term survival outcomes were compared. We performed VATS and open thoracotomy on 121 and 147 patients, respectively. Overall, VATS was preferred for patients with peripherally located tumors (p < 0.001). After IPTW-adjustment, all preoperative information became similar between the groups. Compared to thoracotomy, VATS was associated with shorter hospitalization (7.7 days vs. 9.1 days, p = 0.028), despite equivalent complete resection rates (92.6% vs. 90.5%, p = 0.488) and dissected lymph nodes (mean, 31.9 vs. 29.4, p = 0.100). On IPTW-adjusted analysis, overall survival (50.5% vs. 48.4%, p = 0.127) and recurrence-free survival (60.5% vs 44.6%, p = 0.069) at 5 years were also similar between the groups. Among selected patients with resectable cN2 disease and peripherally located tumors, VATS is feasible, associated with shorter hospitalization and comparable perioperative and long-term survival outcomes, compared with open thoracotomy.

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Mortality for robotic- versus video-assisted lobectomy treated stage I non-small cell lung cancer patients

JNCI Cancer Spectrum ◽

10.1093/jncics/pkaa028 ◽

2020 ◽

Author(s):

Yong Cui ◽

Eric L Grogan ◽

Stephen A Deppen ◽

Fei Wang ◽

Pierre P Massion ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell ◽

Stage I ◽

Open Thoracotomy ◽

Small Cell Lung ◽

Post Surgery ◽

Short And Long Term ◽

Nsclc Patients ◽

Long Term Mortality

Abstract Background To address the United States Food & Drug Administration’s recent safety concern on robotic surgery procedures, we compared short- and long-term mortality for stage I non-small cell lung cancer (NSCLC) patients treated by robotic-assisted thoracoscopic surgical lobectomy (RATS-L) versus video-assisted thoracoscopic surgical lobectomy (VATS-L). Methods From the National Cancer Database, we identified 18,908 stage I NSCLC patients who underwent RATS-L or VATS-L as the primary operation from 2010 to 2014. Cox proportional hazards models were used to estimate hazard ratios (HRs) for short- and long-term mortality using unmatched and propensity score-matched analyses. All statistical tests were two-sided. Results Patients treated by RATS-L had higher 90-day mortality than those with VATS-L (6.6% vs. 3.8%; P=.03) if conversion to open thoracotomy occurred. After excluding first-year observation, multiple regression analyses showed RATS-L was associated with increased long-term mortality, compared to VATS-L, in cases with tumor size ≤20 mm: HRs were 1.33 (95%CI: 1.15-1.55), 1.36 (95%CI: 1.17-1.58) and 1.33 (95%CI: 1.11-1.61) for unmatched, N:1 matched and 1:1 matched analyses, respectively, in the intention-to-treat analysis. Among patients without conversion to an open thoracotomy, the respective HRs were 1.19 (95%CI: 1.10-1.29), 1.19 (95%CI: 1.10-1.29) and 1.17 (95%CI: 1.06-1.29). Similar associations were observed when follow-up time started 18- or 24-months post-surgery. No statistically significant mortality difference was found for patients with tumor size >20 mm. These associations were not related to case volume of VATS-L/RATS-L performed at treatment institutes. Conclusions Patients with small (≤20 mm) stage I NSCLC treated with RATS-L had statistically significantly higher long-term mortality risk than VATS-L after one-year post-surgery.

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