Objective: To evaluate the outcomes from a new surgical
technique for lobectomy.
Patients: Two hundred fifty
consecutive patients with an average age of 67.3 years underwent
simultaneously stapled lobectomy.
Video-assisted thoracic surgical non-rib spreading lobectomy
(VNSSL) is a new technique that has been evolving for
approximately 6.5 years. During 1990, we began using video-assisted
thoracic surgery (VATS) for simple, benign diseases. Throughout 1991,
VATS was applied to malignant problems, ie, mediastinal
masses, staging of lymph nodes, malignant effusions, and coin lesions.
As experience was acquired, more complex procedures were attempted,
such as lobectomy. On September 9, 1991, our first VATS lobectomy,
using anatomic hilar dissection and lymph node sampling, was performed
for primary carcinoma of the lung. One year later, we performed our
first VNSSL using simultaneous stapling.
Results: Currently, 400 VNSSLs have been performed. In this
entire series, there have been no surgical mortality, bronchopleural
fistulas, port implantations, or transfusions. Bronchial stumps have
averaged 4 mm in length, and all have been microscopically negative for
neoplasm. In order to evaluate long-term survival for primary carcinoma
of the lung in patients with an adequate duration of follow-up, the
first 250 consecutive VNSSLs have been reviewed. There were 120 male
and 130 female patients ranging in age from 20 to 92 years old who had
62 right upper lobe, 20 right middle lobe, 58 right lower lobe, 63 left
upper lobe, and 33 left lower lobe lobectomies, and 14
bilobectomies. The lesions consisted of 214 primary carcinomas,
8 metastatic lesions, and 28 benign problems. Seven to 18 lymph nodes
could be resected during staging of the primary neoplasms. The tumors
ranged in size from 1 to 9 cm, and operating times averaged 78.6 min.
Hospitalization averaged 2.83 days. No patient was admitted to the ICU.
Intensive monitoring or narcotic analgesia were not needed. No epidural
or intercostal anesthesia was used. Complications were infrequent and
minor. Most patients returned to preoperative levels of physical
activity within 7 to 10 days. Overall survival at a mean of 34 months,
when all stages of neoplasms were combined, is 83%. For stage I,
overall survival is 92%. The cost of VNSSL is approximately 50% less
than the traditional open thoracotomy.
Conclusion: VNSSL is an oncologic technique that has been
clinically rewarding and economically beneficial for patients with
malignant lesions. Long-term survival for primary carcinoma currently
exceeds reports being published for the traditional open thoracotomy.
Scientific reasons for this extraordinary survival are emerging.
Complications, surgical mortality, pain, and length of stay have all
been reduced. Patient recovery, comfort, and satisfaction have been