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Ann Thorac Surg 2002;74:860-864
© 2002 The Society of Thoracic Surgeons

Original article: general thoracic

Thoracoscopic lobectomy: a safe and effective strategy for patients with stage i lung cancer

Larkin J. Daniels, MDa, Stafford S. Balderson, PA-Ca, Mark W. Onaitis, MDa, Thomas A. D’Amico, MD*a

a Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA

* Address reprint requests to Dr D’Amico, Department of Surgery, Duke University Medical Center, Box 3496, 3589 Clin Res II, Durham, NC 27710 USA
e-mail: damic001{at}mc.duke.edu

Presented at the Video Session of the Forty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 8–10, 2001.

Background. Thoracoscopic lobectomy is emerging as a potential alternative to thoracotomy for early stage lung cancer. The issues of safety and oncologic efficacy should be analyzed before recommending this procedure for widespread use.

Methods. Thoracoscopic lobectomy was attempted in 110 consecutive patients (age, 35 to 81years) with tumors that were judged to be amenable to lobectomy over a 26-month period. Exclusion criteria included tumors greater than 5 cm in diameter, T3 tumors, endobronchial tumors visible at bronchoscopy, the use of induction therapy, extensive N1 disease on computed tomographic scan, and N2 disease at mediastinoscopy. The procedures were performed without rib spreading using two ports and included anatomic hilar dissection and individual vessel stapling.

Results. Thoracoscopic lobectomy and mediastinal lymph dissection was successfully performed in 108 patients (98.2%); 2 patients required conversion to thoracotomy to control bleeding in the setting of dense hilar adenopathy. There were no intraoperative deaths and 4 perioperative deaths (3.6%) caused by pneumonia and associated adult respiratory distress syndrome (3 patients) and stroke (1 patient). Major complications included pneumonia (5 patients), stroke (1 patient), and return to the operating room to revise the bronchial closure (1 patient). Minor complications included prolonged air leak (6 patients), atrial fibrillation (4 patients), blood transfusion (2 patients) and ileus (1 patient). Median time to chest tube removal was 3 days, and median length of stay was 3 days.

Conclusions. Thoracoscopic lobectomy is a safe and effective strategy for patients with early stage lung cancer. Long-term follow-up is required to determine if recurrence rate and 5-year survival are comparable with thoracotomy for lobectomy.




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