Long-term prognosis of video-assisted limited surgery for early lung cancer

• Published in: European journal of cardio-thoracic surgery 2010-02, Vol.37 (2), p.456-460
• Main Authors: Sugi, Kazuro, Kobayashi, Seiki, Sudou, Manabu, Sakano, Hisashi, Matsuda, Eisuke, Okabe, Kazunori
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Biological and medical sciences; Bronchoscopy; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Cardiology. Vascular system; Endoscopy; Epidemiologic Methods; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Limited surgery; Long-term prognosis; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Node Excision; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Pneumology; Pneumonectomy - methods; Prognosis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Thoracic Surgery, Video-Assisted - methods; Thoracoscopy-assisted surgery; Tomography, X-Ray Computed; Treatment Outcome; Tumors of the respiratory system and mediastinum; VATS
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2009.07.017

Objective: The present intervention study was conducted to prospectively evaluate the long-term prognosis for video-assisted limited surgery, such as wedge resection and segmentectomy, for clinically early lung cancers depending on findings in high-resolution computed tomography (HRCT). Subjects and methods: Patients were enrolled in the study between 2001 and 2004, and followed up for five subsequent years. Of these patients, those with a clinical stage IA lung cancer mainly comprising a ground glass-opacity (GGO) less than 1.5 cm across underwent thoracoscopic wedge resection of the lung (Group A). Patients with a tumour less than 2.0 cm in diameter, not classified in Group A, underwent video-assisted segmentectomy and hilar lymph node dissection with lobe-specific mediastinal nodes sampling (Group B). For patients with a tumour less than 3.0 cm in diameter, not classified in to any of the foregoing two groups, underwent video-assisted lobectomy and hilar and mediastinal lymph node dissection (Group C). Results: During the case registration period, 159 patients were registered for enrolment in the study (21 for Group A, 43 for Group B and 95 for Group C). Of the patients in Groups A and B, 28% were shifted to a surgical procedure involving a larger volume resected; 6% of the entire study population were shifted to thoracotomy. All patients completed the 5-year follow-up. The recurrence-free survival rate was 100% for Group A, 90.5% for Group B and 94.5% for Group C, with no significant difference among the groups. The total recurrence rate was 11.9% with localised recurrences observed in 6.3% of the patients and remote recurrences in 5.7%. The localised recurrences observed included stump recurrence in one case of Group B, and malignant pleural effusions/pleural dissemination in two cases of Group B and one case of Group C. Intrathoracic lymph node recurrences were observed in one case of Group B and five cases of Group C. Conclusions: The present intervention study showed that thoracoscopic-limited surgery for clinically early lung cancers depending on findings in preoperative HRCT is feasible and appropriate from the viewpoint of oncology.