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Comparison of Long-Term Outcomes Between Minimally Invasive Pulmonary Resection With and Without Video-Assisted Mediastinoscopic Lymphadenectomy for Left-Sided Lung Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to assess the long-term outcomes of video-assisted mediastinoscopic lymphadenectomy (VAMLA) combined with video-assisted thoracic surgery (VATS) for left-sided lung cancer pulmonary resection.

Patients and Methods

We retrospectively reviewed 1194 consecutive patients who underwent VATS anatomical resection for left-sided lung cancer between January 2007 and December 2016. Using propensity score-based inverse probability of treatment weighting (IPTW), perioperative outcomes and long-term survival outcomes were compared.

Results

Among 1194 patients, 295 (24.7%) underwent additional VAMLA (VATS + VAMLA group) and 899 patients (75.3%) underwent VATS only (VATS group). The proportion of patients with advanced N stage were higher in the VATS + VAMLA group (24.7%) than in the VATS group (18.3%). After IPTW adjustment, all baseline profiles between the two groups became similar. The long-term overall survival (OS) and recurrence-free survival (RFS) rates were similar between the VATS + VAMLA group and the VATS group (5-year OS, 77.8% versus 79.3%, p = 0.957; 5-year RFS, 69.6% versus 70.1%, p = 0.498). However, among patients with borderline pulmonary function (FEV1 ≤ 60% or DLCO ≤ 60%), the VATS + VAMLA group (n = 23) had a better prognosis than the VATS group (n = 36) (5-year OS, 67.4% versus 46.7%, respectively; p = 0.047; 5-year RFS, 74.6% versus 53.5%, respectively; p = 0.027).

Conclusions

VAMLA might be a good complement to VATS for left-sided lung cancer, wherein optimal mediastinal lymph node dissection is not feasible under one-lung ventilation, such as when patients have borderline pulmonary function.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea

    Jae Kwang Yun MD, PhD, Seungmo Yoo MD, Geun Dong Lee MD, PhD, Sehoon Choi MD, PhD, Hyeong Ryul Kim MD, PhD, Kim Dong Kwan MD, PhD, Seung-Il Park MD, PhD & Yong-Hee Kim MD, PhD

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  1. Jae Kwang Yun MD, PhD
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  2. Seungmo Yoo MD
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  3. Geun Dong Lee MD, PhD
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  4. Sehoon Choi MD, PhD
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  5. Hyeong Ryul Kim MD, PhD
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  6. Kim Dong Kwan MD, PhD
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  7. Seung-Il Park MD, PhD
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  8. Yong-Hee Kim MD, PhD
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Correspondence to Yong-Hee Kim MD, PhD.

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Yun, J.K., Yoo, S., Lee, G.D. et al. Comparison of Long-Term Outcomes Between Minimally Invasive Pulmonary Resection With and Without Video-Assisted Mediastinoscopic Lymphadenectomy for Left-Sided Lung Cancer. Ann Surg Oncol 29, 2830–2839 (2022). https://doi.org/10.1245/s10434-021-11191-8

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  • DOI: https://doi.org/10.1245/s10434-021-11191-8

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