[A retrospective comparative study of the safety, completeness and efficacy of video-assisted thoracoscopic lobectomy versus open lobectomy for non-small-cell lung cancer patients whose tumor size was greater than 5 cm].


OBJECTIVE To discuss the feasibility of the completely video-assisted thoracoscopic lobectomy for non-small-cell lung cancer (NSCLC) patients whose tumor size was greater than 5 cm. METHODS From May 2001 to May 2010, 564 patients with NSCLC received lobectomy in our center, of whom, 114 had tumors whose diameters were larger than 5 centimeters (79 males and 35 females, their median age was 63.6 years, ranging from 29 to 81 years). We divided all the patients into two groups, group V (video-assisted thoracoscopic surgery) and group T (Thoracotomy). We compared all the factors, such as age, gender, tumor size, pathological type, location, operation time, blood loss, lymph node dissection, pathological stage, time of drainage, hospitalization, complications, overall survival and recurrence between the two groups. RESULTS There were 72 cases of lobectomy, 18 cases of composite lobectomy and 24 cases of pneumectomy in all the patients. All of the procedures were carried out safely with no serious complications except for two prioperative deaths resulting from respiratory failure (in group T). There were 34 cases in group V and 80 cases in group T. Age, gender, tumor size, tumor location, pathological type and stage were similar between the two groups. The operation time of group V was significantly shorter than that of group T [(208.2±57.0) min vs. (256.4±70.3) min, P=0.001]. The blood loss of group V was much less than that of group T[(269.1±176.2) mL vs. (591.9±169.7) mL, P<0.001].There were no differences between the two groups, such as complications (13.3% vs. 21.3%, P=0.232), lymph node dissection stages (5.0±2.2 vs. 5.1±1.1, P=0.885) and numbers (18.5±9.6 vs. 19.2±9.1, P=0.714), time of drainage[(8.6± 3.9 d) vs. (9.0±5.0) d,P=0.693] and hospitalization (11.7±6.8) d vs. (12.8±7.1) d,P=0.431].The local recurrence between the two groups was equivalent(3.5% vs. 4.2%, P=0.857).The estimated overall survival at the end of 1, 2 and 3 years was 90.0%, 76.9% and 65.9% for group V and 80.3%, 62.9% and 55.3% for group T, respectively. Kaplan-Meier survival curves showed that there was no significant difference between the two groups (P=0.163). CONCLUSION Completely video-assisted thoracoscopic lobectomy is a safe and feasible procedure for a part of non-small-cell lung cancer patients whose tumor size is greater than 5 cm.


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