Abstract
Objectives
The objective of this study was to assess the safety of video-assisted thoracoscopic surgery (VATS) completion lobectomy (CL) for non-small cell lung cancer (NSCLC) after diagnostic wedge resection by comparing with standard VATS lobectomy (SL).
Methods
Data were retrieved from an institutional database of consecutive VATS lobectomies between January 1st 2007 and December 31st 2013. Patients were grouped into CL or SL. Patient characteristics, operative data, converted procedures, complications, and mortality was compared using Pearson Chi square, Fisher’s exact test, or Mann–Whitney U test.
Results
In total 80 CL and 958 SLs were performed. There were no significant differences in median operating time, median chest drain duration or median length of stay. Median operative bleeding was 100 mL (IQR 50–238) in the CL group compared to 75 mL (IQR 25–200) in the SL group (p = 0.01). There were no differences between groups in major or minor complications. Median time from VATS wedge resection to CL was 33 days (IQR 27–41). Conversion rate was 1.3 % in the CL group and 2.6 % in the SL group (p = 0.72). 30-day mortality was 0 vs. 1.1 % for the CL group and the SL group accordingly (p > 0.99).
Conclusions
This study comparing short-term surgical outcome and complications after surgical treatment of NSCLC indicates that VATS completion lobectomy after diagnostic wedge resection seems safe when looking at a relatively short time interval between the two procedures.
Similar content being viewed by others
Notes
The Capital Region and Region Zealand are two regions of total five in Denmark. Population: approximately 2.6 million.
References
McKenna RJ Jr. Surgical management of primary lung cancer. Semin Oncol. 2007;34:250–5.
Wolf AS, Richards WG, Jaklitsch MT, Gill R, Chirieac LR, Colson YL, et al. Lobectomy versus sublobar resection for small (2 cm or less) non-small cell lung cancers. Ann Thorac Surg. 2011;92:1819–23.
Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM. Executive summary: diagnosis and management of lung cancer, 3rd ed: american College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:7S–37S.
Pan X, Fu S, Shi J, Yang J, Zhao H. The early and long-term outcomes of completion pneumonectomy: report of 56 cases. Interact CardioVasc Thorac Surg. 2014;19:436–40.
Tabutin M, Couraud S, Guibert B, Mulsant P, Souquet PJ, Tronc F. Completion pneumonectomy in patients with cancer: postoperative survival and mortality factors. J Thorac Oncol. 2012;7:1556–62.
Nomori H, Mori T, Izumi Y, Kohno M, Yoshimoto K, Suzuki M. Is completion lobectomy merited for unanticipated nodal metastases after radical segmentectomy for cT1 N0 M0/pN1-2 non-small cell lung cancer? J Thorac Cardiovasc Surg. 2012;143:820–4.
Byers TE, Vena JE, Rzepka TF. Predilection of lung cancer for the upper lobes: an epidemiologic inquiry. J Natl Cancer Inst. 1984;72:1271–5.
Kinsey CM, Estepar RS, Zhao Y, Yu X, Diao N, Heist RS, et al. Invasive adenocarcinoma of the lung is associated with the upper lung regions. Lung Cancer. 2014;84:145–50.
Petersen RH, Hansen HJ. Learning thoracoscopic lobectomy. Eur J Cardiothorac Surg. 2010;37:516–20.
Hansen HJ, Petersen RH, Christensen M. Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach. Surg Endosc. 2011;25:1263–9.
McElnay P, Casali G, Batchelor T, West D. Adopting a standardized anterior approach significantly increases video-assisted thoracoscopic surgery lobectomy rates. Eur J Cardiothorac Surg. 2014;46:100–5.
Berry MF, D’Amico TA, Onaitis MW, Kelsey CR. Thoracoscopic approach to lobectomy for lung cancer does not compromise oncologic efficacy. Ann Thorac Surg. 2014;98:197–202.
Falcoz PE, Puyraveau M, Thomas PA, Decaluwe H, Hurtgen M, Petersen RH, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg. 2016;49:602–9.
Laursen LO, Petersen RH, Hansen HJ, Jensen TK, Ravn J, Konge L. Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy. Eur J Cardiothorac Surg. 2016;49:870–5.
Taioli E, Lee DS, Lesser M, Flores R. Long-term survival in video-assisted thoracoscopic lobectomy vs open lobectomy in lung-cancer patients: a meta-analysis. Eur J Cardiothorac Surg. 2013;44:591–7.
Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol. 2009;27:2553–62.
Bender MT, Ferraris VA, Saha SP. Modern management of thoracic empyema. South Med J. 2015;108:58–62.
Kara HV, Balderson SS, D’Amico TA. Challenging cases: thoracoscopic lobectomy with chest wall resection and sleeve lobectomy-Duke experience. J Thorac Dis. 2014;6:S637–40.
Kato M, Onishi H, Furugaki K, Yunotani S, Matsumoto K, Tsuruta N, et al. New approach to complete video-assisted thoracoscopic lobectomy in T2 and T3 non-small cell lung cancer. Anticancer Res. 2015;35:3585–9.
Pischik VG. Technical difficulties and extending the indications for VATS lobectomy. J Thorac Dis. 2014;6:S623–30.
Hanna JM, Berry MF, D’Amico TA. Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open. J Thorac Dis. 2013;5:182–9.
Acknowledgments
The authors wish to thank Lykke Østergaard Laursen for her contribution to statistical calculations.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. René Horsleben Petersen is speaker for Covidien, Medela and Takeda and Dr. Henrik Jessen Hansen is speaker for Covidien, Medela and Bard. Dr. Bo Laksáfoss Holbek received a research grant from Dr. Fritz Karner and wife Edith Karner Foundation for promoting and optimizing the perioperative patient trajectory.
Rights and permissions
About this article
Cite this article
Holbek, B.L., Petersen, R.H. & Hansen, H.J. Is it safe to perform completion lobectomy after diagnostic wedge resection using video-assisted thoracoscopic surgery?. Gen Thorac Cardiovasc Surg 64, 203–208 (2016). https://doi.org/10.1007/s11748-016-0633-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-016-0633-4