Severe intraoperative complications during VATS Lobectomy compared with thoracotomy lobectomy for early stage non-small cell lung cancer.
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Video-assisted thoracic surgery (VATS) lobectomy has been proved to have shorter hospital stay, less perioperative complications and less pain compared with lobectomy by thoracotomy, but severe intraoperative complications during VATS lobectomy is rare reported. We compared intraoperative safety between VATS lobectomy and lobectomy by thoracotomy.659 patients with postoperative stage I and IIa non-small cell lung cancer (NSCLC) who underwent lobectomy in China-Japan Friendship Hospital from February 2008 to June 2012 were analyzed retrospectively, in which 277 were performed by thoracotomy, 357 performed by VATS, and 25 performed by VATS converted to open. Outcomes were analyzed to compare the incidence of significant bleeding, with conversion cases were included into VATS group.Ten severe intraoperative complications were identified in 10 patients (6 in VATS, 4 in open), with no intraoperative deaths. The incidence of severe intraoperative complications was similar between VATS group and thoracotomy group [1.57% (6/382) vs. 1.44% (4/277), P=1.0]. Most severe intraoperative complications were related to the injury of major pulmonary vessels (9/10), and most of these complications occurred during upper lobectomy (8/10). There was no statistically significant difference in blood loss (242.85±220.47 vs. 240.43±144.36, P=0.865), and operative time (198.00±75.24 vs. 208.05±61.97, P=0.061) between the open and VATS groups, respectively, but blood loss and operative time are significant different after elimination of conversion cases (214.34±151.85 vs. 240.43±144.36, P<0.01; 193.24±72.64 vs. 208.05±61.97, P<0.01).Our preliminary study demonstrated that the incidence of severe intraoperative complication during VATS lobectomy was low and similar to open lobectomy. The severe intraoperative complications during VATS lobectomy are manageable and the surgeons need to take proper caution in performing VATS lobectomy.Keywords:
Thoracotomy
VATS lobectomy
Cardiothoracic surgery
Abstract Objective To compare outcomes between thoracoscopic and thoracotomy lobectomy for patients with cN0‐pN2 NSCLC. Methods One hundred eighty‐two cN0 patients (including 29 pN2) underwent VATS lobectomy between September 2006 and December 2009, and 204 cN0 patients (including 47 pN2) underwent thoracotomy lobectomy between July 2000 and December 2009. Pre‐ and intraoperative status and postoperative survival between two groups were compared. Results There was no difference in preoperative conditions between two groups except Quantity of smoking. Operation time and blood loss of VATS group was significantly lower than thoracotomy group. Number of dissected lymph node (LN) stations was 3.3 ± 1.1 in VATS group versus 3.3 ± 1.3 in thoracotomy group, and the total number of LN was 12.7 ± 8.9 in VATS group versus 10.5 ± 7.2 in thoracotomy group. One‐ and 3‐year disease‐free survival rate was 82.6% in VATS group versus 72.0% in thoracotomy group, and 49.3% in VATS group versus 51.3% in thoracotomy group ( P = 0.996). One‐ and 3‐year survival rate was 84.9% in VATS group versus 71.2% in thoracotomy group, and 64.0% in VATS group versus 42.7% in thoracotomy group ( P = 0.121). Conclusions VATS lobectomy is comparable with thoracotomy in both safety and curability for the treatment of cN0‐pN2 NSCLC, without necessity of conversion to open surgery. J. Surg. Oncol. 2012; 106:431–435. © 2012 Wiley Periodicals, Inc.
Thoracotomy
VATS lobectomy
Cardiothoracic surgery
Video-assisted thoracoscopic surgery
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Objective To compare the clinical effect of video-assisted thoracoscopic surgery(VATS) and conventional thoracotomy for pulmonary lobectomy.Methods A total of 60 patients undergoing pulmonary lobectomy were divided into two groups randomly by surgical approach.Group A received VATS,and Group B received conventional thoracotomy.Results The length of incision of Group A was significantly shorter than that of Group B(P0.01).The intraoperative blood loss and the drainage volume at the first postoperative day in Group A was significantly less than those in Group B(P0.01).The postoperative hospital stay of Group A presented a significantly shorter than that of Group B(P0.01),and the morbidity rate was significantly lower in Group A(P0.05).There was no statistically significance in the operating time between the two groups(P0.05).Conclusion VATS for lobectomy has the advantage of less surgical invasion,fewer complications,and quicker postoperative recovery.
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VATS lobectomy
Video-assisted thoracoscopic surgery
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Thoracoscopy
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Video-assisted thoracoscopic surgery
Cardiothoracic surgery
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Three-dimensional (3D) vision systems are now available for thoracic surgery. It is unclear whether 3D video-assisted thoracic surgery (VATS) is superior to 2D VATS systems. This study aimed to compare the operative and perioperative data between 2D and 3D VATS lobectomy (VTL) and to identify the actual role of 3D VTL in thoracic surgery.A two-institutional comparative study was conducted from November 2013 to November 2014 at Liaoning Cancer Hospital & Institute and the First Affiliated Hospital of Guangzhou Medical University, China, of 300 patients with resectable non-small cell lung cancer (NSCLC). Patients were assigned to receive either the 3D VATS (n=150) or 2D VATS (n=150) lobectomy. The operative and perioperative data between 2D VATS and 3D VATS were compared.Although there was no significant difference between the two groups regarding the incidence of each single complication, a significantly less operative time was found in the 3D VATS group (145 min) than in the 2D VATS group (176 min) (P=0.006). Postoperative mortality rates in 3D VATS and 2D VATS groups were both 0%.No significant difference was found between groups for estimated blood loss (P=0.893), chest drainage tube placement time (P=0.397), length of hospital stay (P=0.199), number of lymph nodes resected (P=0.397), postoperative complications (P=0.882) and cost of care (P=0.913).Early results of this study demonstrate that the 3D VATS lobectomy procedure can be performed with less operative time. 3D VATS and 2D VATS lobectomy are both safe procedures in first-line surgical treatment of NSCLC.
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Surgical treatment of stage I non-small cell lung cancer (NSCLC) can be performed either by thoracotomy or by employing video-assisted thoracic surgery (VATS). The aim of this study was to evaluate the feasibility of VATS lobectomy for pathologic stage I NSCLC.Between December 2003 and December 2007, 529 patients with pathologic stage I NSCLC underwent lobectomies (373 thoracotomy, 156 VATS). Patients in both groups were selected after being matched by age, gender and pathologic stage using propensity score method, to create two comparable groups: thoracotomy and VATS groups, and the overall survival, recurrence-free survival, complication and length of hospitalization were compared between these two groups.After the patients were matched by age, gender and pathologic stage, 272 patients remained eligible for analysis, 136 in each group (mean age of 59.5 years; 70 men, 66 women; 80 stage IA, 56 stage IB). There was no statistical difference in other preoperative clinical characteristics between the two groups. No hospital mortality was observed in both groups. Overall 3-year survival rate was 97.4% in thoracotomy group and 96.6% in VATS groups (p=0.76). During the follow-up, 20 patients (14.7%) developed recurrence in thoracotomy group, including loco- regional recurrence in 7, distant metastasis in 13. In VATS group, 13 patients (9.6%) developed recurrence, including loco-regional recurrence in 4, distant metastasis in 9. Three-year recurrence-free survival rate was 81.8% in thoracotomy group and 85.3% in VATS groups (p=0.43). There was no significant difference in postoperative complications between thoracotomy and VATS groups (30 cases in 22 patients vs. 19 cases in 17 patients, p=0.65, odds ratio=1.19). The mean hospital stay of VATS group was 2 days shorter than that of thoracotomy group (8.8±6.5 days vs. 6.3±3.3 days, p<0.05).VATS lobectomy for pathologic stage I lung cancer is a feasible operation with shorter hospitalization, while surgical outcome is comparable to thoracotomy lobectomy.
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Video-assisted thoracic surgery (VATS) is currently considered a 'gold standard' approach for pulmonary lobectomy in patients with early-stage lung cancer, displaying equal or superior results compared with an open traditional approach. In patients with limited pulmonary function, VATS lobectomy may reduce the impact of surgery and allow outcomes similar to patients with normal pulmonary function. The preliminary analysis of our initial, single center series of VATS lobectomy showed less complications and shorter postoperative length of stay compared with a historical series of open lobectomy patients. Patients with reduced predicted preoperative FEV1% (ppoFEV1%) who underwent VATS lobectomy had similar outcomes compared with patients with normal ppoFEV1, but longer postoperative length of stay.
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Objective To investigate the application of VATS lobectomy in elderly patients with early peripheral lung cancer. Methods 64 patients with early peripheral lung cancer from January 2011 to January 2013 were randomly divided into two groups according to order of admission, each group had 32 cases, and the control group was given the traditional thoracotomy while the observation group was given laparoscopic lobectomy. The surgery and postoperative complications were compared between the two groups. Results There was no significant difference in operative time between the two groups; the blood loss, the length of incision, postoperative pain scores and the average hospital stay were(82.10±5.92) ml,(3.02±0.12) cm,(4.35±0.53) points and(5.32±0.72) d, and significantly less than those in the control group(P0.05); the complication rate of the observation group was 6.25%, which was significantly lower than 15.63% of the control group(P0.05). Conclusions The VATS lobectomy is significantly effective in the treatment of early peripheral lung cancer,,with little trauma and bleeding, and rapid postoperative recovery advantages.
VATS lobectomy
Thoracotomy
Lung cancer surgery
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Video-assisted thoracic surgery (VATS) has been recommended as more optimal surgical technique than traditional thoracotomy for lobectomy in lung cancer, but it is not well defined. Here, we compared VATS and traditional thoracotomy based on clinical data. From November 2008 to November 2010, 180 patients underwent lobectomy for non-small-cell lung cancer (NSCL) identified by computerized tomography. Of them, 83 cases were performed with VATS and 97 by thoracotomy. Clinical parameters, consisting of blood loss, operating time, number of lymph node dissection, days of pleural cavity drainage, and length of stay were recorded and evaluated with t test. No significant difference was observed between the VATS and thoracotomy groups in the average intraoperative blood loss, number of lymph node dissections, and days of pleural cavity drainage. While the average operating time in the VATS group was significantly longer than that in thoracotomy group, recurrence was only present in one case, as opposed to 7 cases in the thoracotomy group In conclusion, similar therapeutic effects were demonstrated in VATS and thoracotomy for NSCL. However, VATS lobectomy was associated with fewer complications, recurrence and shorter length of stay.
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Objective To compare the clinical effect of video-assisted thoracoscopic surgery(VATS) and conventional lobectomy in treatment of chest trauma.Methods 87patients with chest trauma were divided into two groups:44 cases of the VATS group(observation group) were treated by VATS,and 43 cases of the conventional lobectomy group(control group) were treated by conventional lobectomy surgery,the clinical effects were compared.Results The healing rate of the two groups were 95.5% and 95.3%,the difference was not significant(P 0.05) .The mean operation time,blood loss and hostility time were(83.2 ± 13.5) min、(92.5 ± 21.3) ml and(7.3 ± 1.8) d,the indexes were better than the control group(P 0.05) .Conclusion Both of VATS and conventional lobectomy surgery have good efficacy,but VATS can shorten the operation time and hostility time,reduce the blood loss.
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VATS lobectomy
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