Thoracoscopic Lobectomy is a Broadly-Applicable and Safe Procedure for Patients with Suspected Stage I Lung Cancer
Mark Onaitis, MD*, Rebecca Petersen, MD, MSc*, Stafford S. Balderson, PA-C*, Eric Toloza, MD, PhD*, William R. Burfeind, MD*, David Harpole, MD, Thomas A. D'Amico, MD*
Duke University, Durham, NC
OBJECTIVE(S): Advantages of thoracoscopic lobectomy for early stage non-small cell lung cancer (NSCLC), as compared to lobectomy by conventional thoracotomy, include less postoperative pain and shorter length of hospitalization. The outcomes after thoracoscopic lobectomy in patients with more complex pulmonary conditions are analyzed to determine safety and efficacy.
METHODS: A prospective database of 470 consecutive thoracoscopic lobectomies between June 1999 and June 2005 was queried. Demographic, histopathologic, perioperative and outcome variables including overall survival were analyzed. Standard descriptive statistics and Kaplan-Meier survival analyses were used.
RESULTS: Thoracoscopic lobectomy was successfully performed in 462 (98%) patients (8 conversions). Mean preoperative FEV1 was 74 ± 22% predicted (range 21-138%). Pathologic analysis included stage I NSCLC (64%), stage II or greater NSCLC (17%), secondary pulmonary malignancy (10%), and granulomatous lung diseases (9%). The operative and perioperative mortality was 0% and 1%, respectively. Postoperative complications included pneumonia (5%), prolonged air leak (2%), postoperative bleeding requiring reoperation (0.2%) and atrial fibrillation (9%). The median chest tube duration was 3 days, and the median length of hospitalization was 3 days. The overall 2-year survival rate for the entire cohort was 80%, and the 2-year overall survival rates for stage I NSCLC, stage II or greater NSCLC, secondary pulmonary malignancy, and granulomatous disease patients were 85%, 77%, 73%, and 89%, respectively (Figure).
CONCLUSIONS: Thoracoscopic lobectomy is applicable to a spectrum of malignant and benign pulmonary disease and is associated with a low perioperative morbidity and mortality rate. Survival rates are comparable to those for thoracotomy.
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