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J Thorac Cardiovasc Surg 2006;132:507-512
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stage IA lung cancer: A multi-institutional study

Norihisa Shigemura, MDa,b,*, Akinori Akashi, MDa, Soichiro Funaki, MDa, Tomoyuki Nakagiri, MDb, Masayoshi Inoue, MDb, Noriyoshi Sawabata, MDb, Hiroyuki Shiono, MDb, Masato Minami, MDb, Yukiyasu Takeuchi, MDc, Meinoshin Okumura, MDb, Yoshiki Sawa, MDb

a Division of General Thoracic Surgery, Takarazuka Municipal Hospital, Hyogo
b Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
c Department of Surgery, Osaka General Medical Center, Osaka, Japan

Received for publication December 14, 2005; revisions received March 3, 2006; accepted for publication March 28, 2006.

* Address for reprints: Norihisa Shigemura, MD, Department of Surgery (E1), Osaka University Graduate School of Medicine, E1, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan (Email: drshige0714{at}yahoo.co.jp).

BACKGROUND: Although video-assisted thoracic surgery (VATS) has been in use for more than a decade, its application to major lung resection for lung cancer is still not widely practiced. The success of a cancer operation is judged by the long-term survival of the treated patients. Therefore, the goal of the present study was to evaluate long-term outcomes associated with various video-assisted lobectomy techniques and conventional surgery in patients with peripheral non–small cell lung cancer less than or equal to 2 cm in diameter (stage IA).

METHODS: A multi-institutional, retrospective review was performed in 145 consecutive patients. Patients with clinical stage IA disease, with tumor size less than or equal to 2 cm in diameter, from three institutions underwent a complete VATS (c-VATS, n = 56), an assisted VATS (a-VATS, n = 34), or a conventional open (open, n = 55) approach for pulmonary lobectomy and lymph node dissection.

RESULTS: Patients undergoing lobectomy and lymph node dissection with c-VATS had less blood loss, faster recovery, shorter hospitalization, and longer operating times than did patients undergoing the lobectomy with the a-VATS and open approaches. At a mean follow-up of 38.8 months, Kaplan-Meier probabilities of survival at 5 years were as follows: c-VATS, 96.7%; a-VATS, 95.2%; open, 97.2%. There was no significant difference in the rate of recurrence among the 3 different procedures.

CONCLUSION: VATS lobectomy, a safe procedure with earlier return to normal activities, can be regarded as an acceptable cancer operation for the patients with peripheral non–small cell lung cancer less than or equal to 2 cm in diameter (clinical stage IA) with the same long-term survivals as open surgery.

Abbreviations and Acronyms ACT = Active Tracer AC-301; a-VATS = assisted video-assisted thoracic surgery; CI = confidence index; CT = computed tomography; c-VATS = complete video-assisted thoracic surgery; NSCLC = non–small cell lung cancer; VATS = video-assisted thoracic (thoracoscopic) surgery


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