Choi, Min-Suk
(Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
,
Park, Joon-Suk
(Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
,
Kim, Hong-Kwan
(Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
,
Choi, Yong-Soo
(Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
,
Kim, Jhin-Gook
(Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
,
Shim, Young-Mog
(Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
,
Kim, Kwhan-Mien
(Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Background: Video-assisted thoracic surgery (VATS) lobectomy has been performed with increasing frequency over the last decade. However, there is still controversy as to its indications, safety, and feasibility. Especially regarding lung cancer surgery, it is not certain whether it can reduce local ...
Background: Video-assisted thoracic surgery (VATS) lobectomy has been performed with increasing frequency over the last decade. However, there is still controversy as to its indications, safety, and feasibility. Especially regarding lung cancer surgery, it is not certain whether it can reduce local recurrences and improve overall survival. Materials and Methods: We retrospectively reviewed 1,067 cases of VATS lobectomy performed between 2003 and 2009, including the indications, postoperative morbidity, mortality, recurrence, and survival rate. Results: One thousand and sixty seven patients underwent VATS lobectomy for the following indications: non-small cell lung cancer (NSCLC) (n=832), carcinoid tumors (n=12), metastatic lung cancer (n=48), and benign or other diseases (n=175). There were 63 cases (5.9%) of conversion to open thoracotomy during VATS lobectomy. One hundred thirty one (15.7%) of the 832 NSCLC patients experienced pathologic upstaging postoperatively. The hospital mortality rate was 0.84% (9 patients), and all of them died of acute respiratory distress syndrome. One hundred forty-nine patients (14.0%) experienced postoperative complications. The median follow-up was 22.9 months for patients with NSCLC. During follow-up, 120 patients had a recurrence and 55 patients died. For patients with pathologic stage I, the overall survival rate and disease-free survival rate at 3 years was $92.2{\pm}1.5%$ and $86.2{\pm}1.9%$, respectively. For patients with pathologic stage II disease, the overall survival rate and disease-free survival rate at 3 years was $79.2{\pm}6.5%$ and $61.9{\pm}6.6%$, respectively. Conclusion: Our results suggest that VATS lobectomy is a technically feasible and safe operation, which can be applied to various lung diseases. In patients with early-stage lung cancer, excellent survival can be also achieved.
Background: Video-assisted thoracic surgery (VATS) lobectomy has been performed with increasing frequency over the last decade. However, there is still controversy as to its indications, safety, and feasibility. Especially regarding lung cancer surgery, it is not certain whether it can reduce local recurrences and improve overall survival. Materials and Methods: We retrospectively reviewed 1,067 cases of VATS lobectomy performed between 2003 and 2009, including the indications, postoperative morbidity, mortality, recurrence, and survival rate. Results: One thousand and sixty seven patients underwent VATS lobectomy for the following indications: non-small cell lung cancer (NSCLC) (n=832), carcinoid tumors (n=12), metastatic lung cancer (n=48), and benign or other diseases (n=175). There were 63 cases (5.9%) of conversion to open thoracotomy during VATS lobectomy. One hundred thirty one (15.7%) of the 832 NSCLC patients experienced pathologic upstaging postoperatively. The hospital mortality rate was 0.84% (9 patients), and all of them died of acute respiratory distress syndrome. One hundred forty-nine patients (14.0%) experienced postoperative complications. The median follow-up was 22.9 months for patients with NSCLC. During follow-up, 120 patients had a recurrence and 55 patients died. For patients with pathologic stage I, the overall survival rate and disease-free survival rate at 3 years was $92.2{\pm}1.5%$ and $86.2{\pm}1.9%$, respectively. For patients with pathologic stage II disease, the overall survival rate and disease-free survival rate at 3 years was $79.2{\pm}6.5%$ and $61.9{\pm}6.6%$, respectively. Conclusion: Our results suggest that VATS lobectomy is a technically feasible and safe operation, which can be applied to various lung diseases. In patients with early-stage lung cancer, excellent survival can be also achieved.
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제안 방법
Adjuvant chemotherapy or radiotherapy was done if the post-operative pathologic stage was more advanced when compared with the preoperative clinical stage. CT scans were done every 3 or 6 months for first 2 years after surgery to check for recurrence. After 2 years, CT scans were done every 6 months or more.
1,067 patients who had gone through thoracoscopic lobectomy from December 24, 2003, to December 31, 2009, were retrospectively analyzed based on their medical records. Data regarding age, sex, pre-surgical diagnosis, accompanying disease, date of surgery, name of surgery, conversion to thoracotomy, length of hospitalization, pathological diagnosis, presence of complications, adjuvant chemotherapy, follow-up observation period, recurrence, and survival was collected.
In addition, there was no difference in the 5-year survival rate when comparing the results of thoracoscopic lobectomy with the results of thoracotomic lobectomy. The authors of the present study retrospectively analyzed 1,067 cases of thoracoscopic lobectomy and their indications, conversion rate to thoracotomy during surgery, postsurgical complications, hospital mortality rate, and postsurgical recurrence and survival rate in order to suggest ways to widen the surgical application of the thoracoscopic lobectomy in the future.
The consistency of the research results from our clinic was maintained by using the same medical team to perform operations with identical indications and criteria (lymph node biopsy and mediastinal lymph node dissection under mediastinoscopy). Also, with a relatively abundant amount of data (1,067 cases), results such as low morbidity, low hospital mortality, and low conversion rate are acceptable.
데이터처리
, IBM, Chicago, Illinois). The log-rank test was used for comparing the survival rates.
이론/모형
In cases without relapse, the disease-free survival period was set from the date of surgery to the most recent visit or the date of death. The survival curve was calculated using the Kaplan-Meier method using PASW Statistics 18 (SPSS Inc., IBM, Chicago, Illinois). The log-rank test was used for comparing the survival rates.
성능/효과
The overall 1-year and 3-year survival rates for all non-small cell lung cancer patients were 96.6±7% and 89.5±1.6%, respectively.
Two hundred and forty-two patients in pathological stage IB showed overall 1-year and 3-year survival rates of 94.3±1.5%, and 89.1±2.5%, respectively.
참고문헌 (31)
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