Minimally-invasive surgery for lung cancer called video-assisted thoracic surgery or VATS is a relatively new procedure performed almost exclusively at academic centers. Now, a preliminary study to be presented this month at the annual CHEST meeting in Philadelphia is giving surgeons an early look at its benefits.
Conventional or open surgery for lung cancer requires a six to 10-inch incision, cutting the major muscles overlying the chest. The surgeon spreads the ribs apart with a retractor in order to view and gain access to the lung, sometimes even removing a portion of one rib. With open surgery or VATS, the surgeon removes either a section of the lung or the affected lobe.
VATS is performed with two to four small incisions (the main incision is only 2 inches long). Instead of spreading the ribs, the surgeon gains access to the lungs through a space between the ribs. By inserting a small camera, the surgeon has a magnified view of the organs on a monitor in the operating room.
"Anecdotally, we've observed similar outcomes with open surgery and VATS, but we've seen a significant advantage with VATS concerning quality of life matters," says Walter Scott, M.D., a thoracic surgeon at Fox Chase Cancer Center, one of few surgeons in the country who performs this highly-specialized surgery. "Now, we have well-analyzed comparison data that supports what we've observed in our patients."
For the study, Scott and his colleagues analyzed the records of 140 lobectomy patients who underwent VATS (74 patients) and open surgery (66 patients) for stage I non-small cell lung cancer. Five of the 74 VATS lobectomies were converted to open procedures. Operative mortality was 1/66 (1.5 percent) for open surgery and 1/74 (1.5 percent) for VATS.
"The most exciting finding is that our patients go home much sooner when they have VATS compared to open surgery," Scott says. The post-operative hospital stay was four days for VATS patients and seven days for open surgery patients (P<0.0001).
"VATS patients also had the post-operative chest tube removed sooner than patients with open surgery," he says. Adjusted median chest tube duration was 5 days for open surgery versus 4 days for VATS (P<0.0001) The percentage of patients with any complication was 42 percent for open surgery versus 35 percent for VATS (P=0.516).
Scott says the new study shows VATS allows the same comprehensive approach to removing the cancer as open surgery. "Removing all of the cancer is always our main goal which includes the removal of lymph nodes." Adjusted mean lymph nodes stations (#/patient) was 4.6 (open) versus 4.2 (VATS), p=0.249. Adjusted mean number of lymph nodes per patient was 18.1 (open) versus 14.7 (VATS), p=0.145. (Walter, the last couple of sentences here are clunky and contain too much jargon. Can you help me out by translating this?)
"Minimally invasive surgical techniques have been used for many decades, but only recently have we applied the technology to patients with lung cancer," Scott says. "This study is important in demonstrating the effectiveness and the reduced impact it can have for our patients."
Scott's co-authors include T. Salewa Oseni, M.D., Philip Prest D.O., Brian L Egleston Ph.D., James Flaherty M.D. and Abraham Lebenthal, M.D. The authors report no disclosures.
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