utd_medknow
Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :607
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
Resource links
 »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
 »  Article in PDF (268 KB)
 »  Citation Manager
 »  Access Statistics
 »  Reader Comments
 »  Email Alert *
 »  Add to My List *
* Registration required (free)  

 
  In this article
 »  Abstract
 » Introduction
 »  Materials and Me...
 » Results
 » Discussion
 » Conclusion
 »  References
 »  Article Tables

 Article Access Statistics
    Viewed1971    
    Printed65    
    Emailed0    
    PDF Downloaded306    
    Comments [Add]    

Recommend this journal

 

  Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 51  |  Issue : 6  |  Page : 37-41
 

Short term curative effect of video assisted thoracoscopic lobectomy for early-stage lung cancer


Department of Thoracic Surgery, Jining No.1 People's Hospital, Jining 272011, China

Date of Web Publication24-Feb-2015

Correspondence Address:
Dr. Y X Li
Department of Thoracic Surgery, Jining No.1 People's Hospital, Jining 272011
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.151993

Rights and Permissions

 » Abstract 

Objective: To investigate the feasibility, safety and short term efficacy of video assisted thoracoscopic (VATS) lobectomy for patients with early-stage lung cancer. Methods: We reviewed clinical data of 138 consecutive patients with early stage lung cancer who underwent lobectomy in the First People's Hospital of Jining during the January 2010 to May 2012. Of them, 71 cases were performed complete VATS, male 39 cases, female 32 cases, age (57.9 ± 10.6) years old; 67 cases were performed thoracotomy, male 36 cases, female 31 cases, age (60.3 ± 8.2) years old. Clinical features were collected and compared. Results: Operations of two groups were successfully finished. Compared with thoracotomy group, the differences in intraoperative blood loss (147 ± 113 ml vs. 146 ± 91 ml), number of lymph node dissection group (3.1 ± 1.3 vs. 3.4 ± 1.3), the number of lymph node dissection (9.9 ± 3.6 vs. 10.0 ± 3.6), and vision analog score (VAS) of postoperative 1st and 3rd day in VATS group were not statistically significant (P > 0.05). Statistical differences were observed in operation time (119 ± 27 min vs. 135 ± 29 min), the thoracic drainage tube time (3.0 ± 0.9 d vs. 3.8 ± 1.2 d), postoperative hospital stay (8.0 ± 2.1 d vs. 10.2 ± 5.4 d), postoperative VAS of 30th day (2.6 ± 0.7 vs. 3.2 ± 1.1), and postoperative complications (8.5% vs. 19.4%) between the two groups (P < 0.05). Conclusion: Video assisted thoracoscopic lobectomy for early lung cancer is safe and effective, with fewer traumas, fewer complications, faster postoperative recovery, milder chronic chest pain, and other advantages. At the same time, the lymph node dissection of VATS lobectomy is similar to that of thoracotomy.


Keywords: Lobectomy, lung cancer, lymph node dissection, video assisted thoracoscopic surgery


How to cite this article:
Cai H B, Li Y X, Li Z. Short term curative effect of video assisted thoracoscopic lobectomy for early-stage lung cancer. Indian J Cancer 2014;51, Suppl S2:37-41

How to cite this URL:
Cai H B, Li Y X, Li Z. Short term curative effect of video assisted thoracoscopic lobectomy for early-stage lung cancer. Indian J Cancer [serial online] 2014 [cited 2021 Nov 30];51, Suppl S2:37-41. Available from: https://www.indianjcancer.com/text.asp?2014/51/6/37/151993



 » Introduction Top


At present, lung cancer has become the most common cancer in men worldwide, accounting for 17% of new cancer cases and 23% of the death cases. [1] The morbidity and mortality increased sharply in the developing world, especially in female patient. [2],[3] In China, lung cancer becomes the most common cancer and the leading cancer death both in urban and rural areas. [4],[5] Although there are many methods for treating lung cancer at present, the recognized option of choice for the treatment of early-stage and mid-stage nonsmall cell lung cancer (NSCLC) is surgical excision and the standard surgical approach is lobectomy combined with systematic lymph node dissection. The past decade has seen an increase in the use of video assisted thoracoscopic (VATS) for early stage lung cancer. With the accumulation of experience and widespread use of technological innovation worldwide, VATS lobectomy has been developing rapidly since the 1990s. [6],[7],[8] Many published studies had demonstrated encouraging outcomes of this procedure when compared with conventional thoracotomy, including reduced incidence of arrhythmias, pneumonia, pain and lower levels of inflammatory markers, shorter length of hospital stay, milder pain, less intraoperative blood loss, more rapid return to normal activities, earlier ability to receive adjuvant therapy, and higher postoperative quality of life. [8],[9],[10],[11],[12],[13],[14] In 2006, minimally invasive surgical treatment of lung cancer was written in NSCLC clinical practice guidelines of National Comprehensive Cancer Network (NCCN). [15] The 2013 version of the NCCN guidelines recommended that VATS is a reasonable and acceptable approach for patients with no anatomic or surgical contraindications, as long as there is no compromise of standard oncologic dissection principles of thoracic surgery. [16] Despite encouraging results were achieved for patients with NSCLC who underwent VATS, there are many doubts regarding the role of VATS in lobectomy for the treatment of lung cancer. [17],[18]

Video assisted thoracoscopic lobectomy for NSCLC was implemented in March 2007 in our unit, and the procedure is performed skilled. The objective of this study is to further confirm the superiority of VATS lobectomy for NSCLC to thoracotomy.


 » Materials and Methods Top


Clinical data and grouping

This study was approved by the institutional review board of the First People's Hospital of Jining. Written informed consent was obtained from each patient.

In this retrospective study, we reviewed clinical data of 207 consecutive patients with early stage lung cancer who underwent lobectomy in the First People's Hospital of Jining during the January 2010 to May 2012. Patient's characteristics and clinical data were collected from individual patient records and then analyzed in an electronic database anonymously. The majority of patients without obvious clinical symptoms and the lesions were found mainly by means of the medical examination. All the operations were performed by 3 surgeons and 1 of them conducted VATS operations. Of these 207 patients, patients received neoadjuvant therapy, bi-lobectomy or pneumonectomy and patients with tumor >5 cm in diameter were excluded. Eventually, 138 patients with clinical stage I and stage II NSCLC, who underwent lobectomy, were included to this retrospective observational study. Of them, 71 cases received VATS, and 67 cases received thoracotomy.

Pathologic evidence of lung cancer was obtained in all patients by transbronchial biopsy, sputum cytology, or transcutaneous lung biopsy under computed tomography (CT) guidance. If no prior preoperative pathologic diagnosis was established, intraoperative frozen section specimens confirmed the pathologic diagnosis. All patients underwent CT scan of the lung and upper abdomen, bone scintigraphy scan and magnetic resonance imaging of the brain to rule out the extrathoracic metastasis of the disease prior to surgery. Tumor staging was according to the 7 th edition of the TNM (UICC) classification. Various factors including age, sex, pathological type, location, operative duration, blood loss, lymph node dissection, TNM stage, time of drainage, duration of hospitalization and complications were compared between two groups. The Clinical features are shown in [Table 1].
Table 1: Patient characteristics

Click here to view


Surgical procedure

All patients underwent general anesthesia with double lumen endotracheal intubation and single lung ventilation. The patient was placed in the lateral decubitus position. The surgeon stood at the ventral position of the patient, and the whole operation procedure was implemented according to thoracoscopic display. Thoracoscopic lobectomy was performed through three or four incisions. We placed thoracoscope in the 7 th or 8 th intercostal space in the middle or anterior axillary line. The main operating port incision was located at the anterior axillary line in the 4 th or 5 th intercostal space, and the length was about 3 cm, and the port just facing hilus of the lung was best. The 1.5 cm auxiliary operating port was placed in the triangle of auscultation. If necessary, we added second auxiliary operating port at the posterior axillary line in the 8 th or 9 th intercostal space. Ribs were not retracted. The lung and the pleural space were carefully inspected for the presence of unexpected metastatic disease. According to the different situations of fissures, the management sequence of pulmonary arteries, veins and bronchial was different. Pulmonary artery, vein, bronchus, and fissure were divided using an Endoscopic Linear Cutters. The pulmonary artery with smaller diameter (<7 cm) was ligated using Hem-o-lok. Systematic lymph node dissection was performed conventionally. The sequence of conventional thoracotomy lobectomy was basically similar to that of lobectomy performed via thoracoscopy.

Operation time, intraoperative blood loss, number of lymph node dissection group, the number of lymph node dissection, the thoracic drainage tube time, postoperative hospital stay, vision analogue score (VAS) of postoperative 1 rd , 3 rd , 30 th day, and postoperative complications were assessed for each patient. Perioperative data of the two groups are shown in [Table 2] and [Table 3].
Table 2: Perioperative data

Click here to view
Table 3: Perioperative complications and death (n)

Click here to view


Early postoperative ambulation was performed in two groups. The pleural cavity was irrigated with Iodophor disinfection solution for patients with poor quality of lung and postoperative pulmonary air leakage time lasting >7 days. Drainage volume <150 ml, drainage liquid with shallow color, no air leakage, and a good pulmonary inflation by chest X-ray were the decannulation indication of thoracic drainage tube.

All patients underwent follow-up after surgery. The death, tumor recurrence or other adverse events were recorded.

Statistical analysis

The SPSS 17.0 software (SPSS Inc., USA) was used for the statistical analysis. Variables were compared between the VATS and the thoracotomy groups. Student t-test and Chi-square or Fisher's exact test were applied for analysis of continuous variables and categorical data respectively. A possibility value of 0.05 or less was considered statistically significant.


 » Results Top


Patient characteristics

The characteristics of the two groups are shown in [Table 1]. There was no significant difference in gender, age, location of the tumor, histologic type and pTNM stage between the two groups. Among 138 patients with NSCLC, 71 cases were performed VATS, male 39 cases, female 32 cases, age (57.9 ± 10.6) years old; 67 cases were performed thoracotomy, male 36 cases, female 31 cases, age (60.3 ± 8.2) years old. In VATS group, 2 cases were converted to thoracotomy for lymph node and left truncus anterior artery tight adhesion. Surgical procedures were performed successfully in both groups. The main postoperative complications included pulmonary infection, arrhythmia (atrial fibrillation), poor lung reexpansion, and persistent air leakage (lasting ≥7 days). There were 1 case chylothorax and 1 case bronchopleural fistula in VATS and thoracotomy group respectively, cured by conservative therapy. Perioperative death occurred in one case in the thoracotomy group, caused by acute respiratory distress syndrome.

Compared with thoracotomy group, VATS group intraoperative blood loss (147 ± 113 ml vs. 146 ± 91 ml), number of lymph node dissection group (3.1 ± 1.3 vs. 3.4 ± 1.3), the number of lymph node dissection (9.9 ± 3.6 vs. 10.0 ± 3.6), and VAS of postoperative 1 rd and 3 rd day were not statistically significant (P > 0.05). There were statistical differences in operation time (119 ± 27 min vs. 135 ± 29 min), the thoracic drainage tube time (3.0 ± 0.9 d vs. 3.8 ± 1.2 d), postoperative hospital stay (8.0 ± 2.1 d vs. 10.2 ± 5.4 d), VAS of postoperative 30 th day (2.6 ± 0.7 vs. 3.2 ± 1.1), and postoperative complications (8.5% vs. 19.4%) between the two groups (P < 0.05).

Totally, 59 cases were followed-up in VATS group, the rate of follow-up was 83.1%, and the median postoperative follow-up period was 8 months (range, 3-17 months). There were 1 case brain metastasis and 1 case hepatic metastasis, and the remaining patients were found no abnormality by imaging examination. In thoracotomy group, 58 cases were followed-up, the rate of follow-up was 86.6%, and the median postoperative follow-up period was 9 months (range, 2-18 months). 1 case mediastinal lymph nodes enlargement in and 2 cases bone metastasis were diagnosed in the group. There was no death in two groups.


 » Discussion Top


With people's health awareness growing and improvement in imaging technology, more and more early-stage lung cancer was diagnosed. [19] So, we must choose an optimal procedure for the treatment of lung cancer to reduce the mortality rate. According to evidence-based medicine, there is no significant difference between curative effect of thoracoscopic lobectomy and thoracotomy lobectomy for stage I NSCLC. [6],[11],[12],[13],[20],[21],[22] However, adopting VATS or thoracotomy for the treatment of early stage lung cancer has been controversial, and conflicting evidence exists in the form of large retrospective studies that failed to show any significant benefit from VATS. [23] Its adoption has been variable, likely due to perceived technical challenges when compared to an open approach and a concern for intraoperative complications, especially whether VATS is radical or not. [9] Complete mediastinal lymphadenectomy is the core component of the multidisciplinary therapy in resectable NSCLC. Murthy et al. reported that in patients with early-stage lung cancer, thorough lymphadenectomy might confer an important survival benefit even if sampled lymph nodes were found to be negative. [24] Whether VATS allows thorough mediastinal lymph node dissection and can achieve comparable effects to thoracotomy have been controversial. At present, compared with thoracotomy, the results varied in different reported studies on the use of VATS for lobectomy combined with lymphadenectomy of resectable NSCLC. [25],[26],[27],[28],[29],[30] In this study, the range of lymphadenectomy met the NCCN Clinical Practice Guidelines in both groups. [16] And the number of lymph node dissection station and the number of lymph node dissection were 3.1 ± 1.3 and 9.9 ± 3.6 respectively in VATS group, while it were 3.4 ± 1.3 and 10.0 ± 3.6 respectively in thoracotomy group. There was no significant differences between the two groups (P > 0.05), which is consistent with previous reports. [28],[29],[30] VATS can provide a good surgical field, and the mediastinal structures can be more clearly identified and exposed. In this way, we are able to clean out more mediastinal lymph node, reducing the incidence of residual lymph nodes.

The safety of VATS lobectomy in combination with systematic lymphadenectomy for esectable NSCLC is another concern. Compared with thoracotomy group, VATS group intraoperative blood loss (119 ± 27 min vs. 135 ± 29 min), the thoracic drainage tube time (3.0 ± 0.9 d vs. 3.8 ± 1.2 d), postoperative hospital stay (8.0 ± 2.1 d vs. 10.2 ± 5.4 d), and postoperative complications (8.5% vs. 19.4%) were statistically significant (P < 0.05), which is consistent with previous studies. [8],[12],[13],[22] The reasons for this result are that VATS incision is obviously smaller than that in thoracotomy, not affecting the most of chest muscles, not cutting and shoving off the rib, and avoiding intercostal nerve damage. And accurate dissection without damaging small blood vessels and lymph nodes, reduces lymphatic drainage and the occurrence of postoperative chylothorax, allowing earlier postoperative extubation and shorter postoperative hospital stays. And VATS shortens the thoracic open and close time, reduces the bleeding and oozing caused by large incision, accelerates postoperative recovery too, compared with the traditional thoracotomy.

In VATS group, chylothorax occurred in 1 case with right upper lung lobe cancer and the postoperative thoracic drainage around 500 ml every day, cured by conservative therapy. The reason may be the thoracic duct branch was injured when we performed lymph node dissection at 2R and 4R group. A total of 6 patients experienced postoperative pulmonary air leakage lasting time >7 days in two groups. The patients were cured by the Iodophor disinfectant pleural lavage, and chest drainage tubes were removed within 10 days. The specific mechanism and effect of Iodophor disinfection solution for the treatment of postoperative pulmonary air leakage need further verification. In VATS group, the rate of conversion to thoracotomy was low, which might benefit from the rational selection of patients and skilled operation.

Compared with thoracotomy group, VAS of postoperative 1 st , 3 rd , and 30 th day had the advantage in VATS group (P < 0.05), as seen similarly in other studies. [31],[32] The main reason might be the intercostal nerve, which was crushed by careless operation and compressed by postoperative drainage tube. The large trauma of thoracotomy made patients can't cough hard enough to clear the airways and have late ambulation. Which placed them at higher risk for complications including increased incidence of arrhythmias, pneumonia, atelectasis. [33]

In our clinical work, we summarize some experiences, and we must emphasize that this procedure should be performed only by experienced thoracic surgeons for a selective indication in clinical practice. Our experience is as follows: (1) The quality and precision of thoracoscopic dissection is superior to thoracotomy. With the help of the advantage, operation should be performed step by step, controlling hemorrhage and staxis, keeping the operative field and vision clean. (2) The pulmonary artery should be dissected sufficient length, to avoid damage to the branch of targeted pulmonary artery, which supplies blood for nontargeted lung lobe. Nail pulmonary artery processed by Endoscopic Linear Cutters, sometimes may cause hemorrhage because of twist and pull. We can choose the vascular clamp or Hem-o-lok or silk ligature. (3) Conversion from video-assisted thoracoscopic lobectomy to thoracotomy or video-assisted minithoracotomy should be promptly performed in case of tumor invasion, lymph node calcification on the targeted pulmonary vessels, or intraoperative hemorrhage, etc. (4) The damage to the branch of thoracic duct should be found and treated in time, when we implement dissection of 4R group lymph node; the left recurrent laryngeal nerve should arouse our attention to avoid the nerve injury when we clean the 4 L group lymph nodes; In the left chest operation, dissection of 7 th group of lymph node should be performed before lobectomy because carinal exposure is difficult and tissue stretch easily leads to rupture of blood vessels and bronchial stump injury; we should pay attention to the interspace of lymph nodes and esophagus, to avoid injury of esophagus in both sides of 7 th group lymphadenectomy. (5) Compared to thoracotomy, extensive pleural adhesion released by thoracoscopy has the advantage of having full view.


 » Conclusion Top


The results of the current study demonstrate that completely thoracoscopic lobectomy is safe, feasible and effective for the treatment of early lung cancer, with smaller trauma, fewer complications, faster postoperative recovery and slighter chronic chest pain. We believe that with the development of clinical skills and thoracoscopic techniques, minimally invasive operation will gradually become the first choice for treatment of lung cancer.

Some limitations in the present study need to be acknowledged. First, the limitations of this study include the retrospective analysis, selection bias, and single institutional study. Second, the sample size was small and follow-up period was relative short. Longer follow-up and more patients' number in both groups may make the results more convincing.

 
 » References Top

1.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90.  Back to cited text no. 1
    
2.
Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013;63:11-30.  Back to cited text no. 2
    
3.
Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014;64:9-29.  Back to cited text no. 3
    
4.
Chen W, Zheng R, Zhang S, Zou X, Zhao P, He J. Lung cancer incidence and mortality in China, 2009. Thorac Cancer 2013;4:102-8.  Back to cited text no. 4
    
5.
Zeng H, Zheng R, Zhang S, He J, Chen W. Lung cancer incidence and mortality in China, 2008. Thorac Cancer 2013;4:53-8.  Back to cited text no. 5
    
6.
Oparka JD, Yan TD, Walker WS. Twenty years of video-assisted thoracoscopic surgery: The past, present, and future. Thorac Cancer 2013;4:91-4.  Back to cited text no. 6
    
7.
Zeng GQ, Shao WL, Ren YG, He JX. Mini-invasive surgery in lung cancer: Current status and future considerations. Thorac Cancer 2012;3:88-90.  Back to cited text no. 7
    
8.
Zhou W, Chen X, Zhang H, Zhang H, Zhao M. Video-assisted thoracic surgery lobectomy for unexpected pathologic N2 non-small cell lung cancer. Thorac Cancer 2013;4:287-94.  Back to cited text no. 8
    
9.
Kim SH, Kim HK, Choi YS, Kim K, Kim J, Shim YM. Pleural recurrence and long-term survival after thoracotomy and thoracoscopic lobectomy. Ann Thorac Surg 2013;96:1769-75.  Back to cited text no. 9
    
10.
Chen FF, Zhang D, Wang YL, Xiong B. Video-assisted thoracoscopic surgery lobectomy versus open lobectomy in patients with clinical stage I non-small cell lung cancer: A meta-analysis. Eur J Surg Oncol 2013;39:957-63.  Back to cited text no. 10
    
11.
Papiashvilli M, Sasson L, Azzam S, Hayat H, Schreiber L, Ezri T, et al. Video-assisted thoracic surgery lobectomy versus lobectomy by thoracotomy for lung cancer: Pilot study. Ann Thorac Surg 2013;96:943-9.  Back to cited text no. 11
    
12.
Paul S, Sedrakyan A, Chiu YL, Nasar A, Port JL, Lee PC, et al. Outcomes after lobectomy using thoracoscopy vs thoracotomy: A comparative effectiveness analysis utilizing the Nationwide Inpatient Sample database. Eur J Cardiothorac Surg 2013;43:813-7.  Back to cited text no. 12
    
13.
Nicastri DG, Wisnivesky JP, Litle VR, Yun J, Chin C, Dembitzer FR, et al. Thoracoscopic lobectomy: Report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg 2008;135:642-7.  Back to cited text no. 13
    
14.
Jiang G, Yang F, Li X, Liu J, Li J, Zhao H, et al. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for administration of adjuvant chemotherapy after lobectomy for non-small cell lung cancer. World J Surg Oncol 2011;9:170.  Back to cited text no. 14
    
15.
Ettinger DS, Bepler G, Bueno R, Chang A, Chang JY, Chirieac LR, et al. Non-small cell lung cancer clinical practice guidelines in oncology. J Natl Compr Canc Netw 2006;4:548-82.  Back to cited text no. 15
    
16.
Ettinger DS, Akerley W, Borghaei H, Chang AC, Cheney RT, Chirieac LR, et al. Non-small cell lung cancer, version 2.2013. J Natl Compr Canc Netw 2013;11:645-53.  Back to cited text no. 16
    
17.
Park BJ, Zhang H, Rusch VW, Amar D. Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy. J Thorac Cardiovasc Surg 2007;133:775-9.  Back to cited text no. 17
    
18.
Yamashita JI, Kurusu Y, Fujino N, Saisyoji T, Ogawa M. Detection of circulating tumor cells in patients with non-small cell lung cancer undergoing lobectomy by video-assisted thoracic surgery: A potential hazard for intraoperative hematogenous tumor cell dissemination. J Thorac Cardiovasc Surg 2000;119:899-905.  Back to cited text no. 18
    
19.
Pillai RN, Ramalingam SS. Advances in the diagnosis and treatment of non-small cell lung cancer. Mol Cancer Ther 2014;13:557-64.  Back to cited text no. 19
    
20.
Lewis RJ, Caccavale RJ, Sisler GE, Mackenzie JW. One hundred consecutive patients undergoing video-assisted thoracic operations. Ann Thorac Surg 1992;54:421-6.  Back to cited text no. 20
    
21.
Campione A, Ligabue T, Luzzi L, Ghiribelli C, Voltolini L, Paladini P, et al. Comparison between segmentectomy and larger resection of stage IA non-small cell lung carcinoma. J Cardiovasc Surg (Torino) 2004;45:67-70.  Back to cited text no. 21
    
22.
Ilonen IK, Räsänen JV, Knuuttila A, Salo JA, Sihvo EI. Anatomic thoracoscopic lung resection for non-small cell lung cancer in stage I is associated with less morbidity and shorter hospitalization than thoracotomy. Acta Oncol 2011;50:1126-32.  Back to cited text no. 22
    
23.
Gopaldas RR, Bakaeen FG, Dao TK, Walsh GL, Swisher SG, Chu D. Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients. Ann Thorac Surg 2010;89:1563-70.  Back to cited text no. 23
    
24.
Murthy SC, Reznik SI, Ogwudu UC, Farver CF, Arrossi A, Batizy LH, et al. Winning the battle, losing the war: The noncurative "curative" resection for stage I adenocarcinoma of the lung. Ann Thorac Surg 2010;90:1067-74.  Back to cited text no. 24
    
25.
Scott WJ, Allen MS, Darling G, Meyers B, Decker PA, Putnam JB, et al. Video-assisted thoracic surgery versus open lobectomy for lung cancer: A secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg 2010;139:976-81.  Back to cited text no. 25
    
26.
Sagawa M, Sato M, Sakurada A, Matsumura Y, Endo C, Handa M, et al. A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: Can it be perfect? Ann Thorac Surg 2002;73:900-4.  Back to cited text no. 26
    
27.
Watanabe A, Koyanagi T, Ohsawa H, Mawatari T, Nakashima S, Takahashi N, et al. Systematic node dissection by VATS is not inferior to that through an open thoracotomy: A comparative clinicopathologic retrospective study. Surgery 2005;138:510-7.  Back to cited text no. 27
    
28.
Merritt RE, Hoang CD, Shrager JB. Lymph node evaluation achieved by open lobectomy compared with thoracoscopic lobectomy for N0 lung cancer. Ann Thorac Surg 2013;96:1171-7.  Back to cited text no. 28
    
29.
Palade E, Passlick B, Osei-Agyemang T, Günter J, Wiesemann S. Video-assisted vs open mediastinal lymphadenectomy for Stage I non-small-cell lung cancer: Results of a prospective randomized trial. Eur J Cardiothorac Surg 2013;44:244-9.  Back to cited text no. 29
    
30.
Ramos R, Girard P, Masuet C, Validire P, Gossot D. Mediastinal lymph node dissection in early-stage non-small cell lung cancer: Totally thoracoscopic vs thoracotomy. Eur J Cardiothorac Surg 2012;41:1342-8.  Back to cited text no. 30
    
31.
Varela G, Brunelli A, Rocco G, Marasco R, Jiménez MF, Sciarra V, et al. Predicted versus observed FEV1 in the immediate postoperative period after pulmonary lobectomy. Eur J Cardiothorac Surg 2006;30:644-8.  Back to cited text no. 31
    
32.
Cheng D, Downey RJ, Kernstine K, Stanbridge R, Shennib H, Wolf R, et al. Video-assisted thoracic surgery in lung cancer resection: A meta-analysis and systematic review of controlled trials. Innovations (Phila) 2007;2:261-92.  Back to cited text no. 32
    
33.
Watanabe A, Osawa H, Watanabe T, Mawatari T, Ichimiya Y, Takahashi N, et al. Complications of major lung resections by video-assisted thoracoscopic surgery. Kyobu Geka 2003;56:943-8.  Back to cited text no. 33
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
Print this article  Email this article
 

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  © 2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow