SAFETY AND EFFICACY OF THORACOSCOPIC LOBECTOMY IN PATIENTS WITH STAGE I NON-SMALL CELL LUNG CANCER

Aim: to analyze short-and long-term treatment outcomes of thoracoscopic lobectomy in patients with stage
I NSCLC .

Material and Methods. A total of 479 NSCLC patients with clinical stage I NSCLC were treated at the Department of Thoracic Surgery of Hertzen Research Cancer Center from 2010 to 2019.

Results. Conversion to thoracotomy was required in 62 (12.9 %) of patients. Postoperative complications occurred in 19.9 % of patients in the thoracoscopic group and in 25.8 % of patients in the conversion group: the mortality rates were 0.4 % and 1.6 % respectively. The most common complication was prolonged air-leak (>5 days), which was diagnosed in 11.9 % and 8.0 % of patients respectively. In patients aged >70 years, the rate of complications was 35.8 % in the thoracoscopic group and 41.2 % in the conversion group. Thoracoscopic lobectomy had advantages over thoracotomy in terms of less postoperative pain syndrome and much less decrease in FEV1 during the first postoperative days and months. In patients with pT1-2aN0M0, stage I NSCLC , the overall and disease-free 5-year survival rates were respectively 92.2 % and 86.6 % after thoracoscopic lobectomy and 87.5 % и 81.2 % after conversion.

Conclusion. Thoracoscopic lobectomy is relatively safe procedure for patients with stage I NSCLC . To perform this type of surgery safely, the surgeon should pass the learning curve. Long-term outcomes were similar between patients undergoing thoracoscopic lobectomy and patients undergoing thoracotomy.

1. Landreneau R.J., Mack M.J., Hazelrigg S.R., Dowling R.D., Acuff T.E., Magee M.J., Ferson P.F. Video-assisted thoracic surgery: basic technical concepts and intercostal approach strategies. Ann Thorac Surg. 1992 Oct; 54(4): 800–7. doi: 10.1016/0003-4975(92)91040-g.

2. McKenna R.J.Jr. Thoracoscopic lobectomy with mediastinal sampling in 80-year-old patients. Chest. 1994; 106(6): 1902–4. doi: 10.1378/chest.106.6.1902.

3. Sigal E.I. The first experience of thoracoscopic surgery. Kazan Medical Journal. 1994; 75(6): 74–81. (in Russian).

4. Decaluwe H., Petersen R.H., Hansen H., Piwkowski C., Augustin F., Brunelli A., Schmid T., Papagiannopoulos K., Moons J., Gossot D.; ESTS Minimally Invasive Thoracic Surgery Interest Group (MITIG). Major intraoperative complications during video-assisted thoracoscopic anatomical lung resections: an intention-to-treat analysis. Eur J Cardiothorac Surg. 2015; 48(4): 588–98. doi: 10.1093/ejcts/ezv287.

5. Blasberg J.D., Seder C.W., Leverson G., Shan Y., Maloney J.D., Macke R.A. Video-Assisted Thoracoscopic Lobectomy for Lung Cancer: Current Practice Patterns and Predictors of Adoption. Ann Thorac Surg. 2016 Dec; 102(6): 1854–1862. doi: 10.1016/j.athoracsur.2016.06.030.

6. Bagrov V.A., Ryabov A.B., Pikin O.V., Kolbanov K.I., Glushko V.A.,Vursol D.A., Amiraliev A.M., Rudakov R.V., Barmin V.B. Causes and consequences of conversions in thoracoscopic anatomical lung resections. Oncology. P.A. Herzen Journal. 2017; 6(3): 11–16. (in Russian). doi: 10.17116/onkolog20176311-16.

7. Hawker G.A., Mian S., Kendzerska T., French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011 Nov; 63 Suppl 11: S24052. doi: 10.1002/acr.20543.

8. Boffa D.J., Kosinski A.S., Furnary A.P., Kim S., Onaitis M.W., Tong B.C., Cowper P.A., Hoag J.R., Jacobs J.P., Wright C.D., Putnam J.B.Jr., Fernandez F.G. Minimally Invasive Lung Cancer Surgery Performed by Thoracic Surgeons as Effective as Thoracotomy. J Clin Oncol. 2018 Aug 10; 36(23): 2378–2385. doi: 10.1200/JCO.2018.77.8977.

9. Cao C., Zhu Z.H., Yan T.D., Wang Q., Jiang G., Liu L., Liu D., Wang Z., Shao W., Black D., Zhao Q., He J. Video-assisted thoracic surgery versus open thoracotomy for non-small-cell lung cancer: a propensity score analysis based on a multi-institutional registry. Eur J Cardiothorac Surg. 2013 Nov; 44(5): 849–54. doi: 10.1093/ejcts/ezt406.

10. Onaitis M.W., Petersen R.P., Balderson S.S., Toloza E., Burfeind W.R., Harpole D.H. Jr., D’Amico T.A. Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg. 2006; 244(3): 420.

11. Samson P., Guitron J., Reed M.F., Hanseman D.J., Starnes S.L. Predictors of conversion to thoracotomy for video-assisted thoracoscopic lobectomy: a retrospective analysis and the influence of computed tomography-based calcification assessment. J Thorac Cardiovasc Surg. 2013 Jun; 145(6): 1512–8. doi: 10.1016/j.jtcvs.2012.05.028.

12. Pischik V.G., Zinchenko E.I., Maslak O.S., Kovalenko A.I., Obornev A.D., Shirinbekov N.R. The causes and consequences of conversion during video- assisted thoracoscopic anatomic pulmonary resections. The Hospital. 2016; 18(4): 6–13. (in Russian).

13. Divisi D., Barone M., Zaccagna G., De Palma A., Gabriele F., Crisci R. Video-assisted thoracoscopic surgery lobectomy learning curve: what program should be offered in a residency course? J Vis Surg. 2017 Oct 18; 3: 143. doi: 10.21037/jovs.2017.08.04.

14. Fourdrain A., De Dominicis F., Iquille J., Lafitte S., Merlusca G., Witte-Pfister A., Meynier J., Bagan P., Berna P. Intraoperative conversion during video-assisted thoracoscopy does not constitute a treatment failure†. Eur J Cardiothorac Surg. 2019 Apr 1; 55(4): 660–665. doi: 10.1093/ejcts/ezy343.

15. Pischik V.G., Zinchenko E.I., Obornev A.D., Kovalenko A.I. Video-assisted thoracoscopic anatomic lung resection: experience of 246 operations. Pirogov Russian Journal of Surgery. 2016; (1): 10–15. (in Russian). doi: hirurgia20161210-15.

16. Whitson B.A., Groth S.S., Duval S.J., Swanson S.J., Maddaus M.A. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg. 2008; 86(6): 2008–16. doi: 10.1016/j.athoracsur.2008.07.009.

17. Decaluwe H., Sokolow Y., Deryck F., Stanzi A., Depypere L., Moons J., Van Raemdonck D., De Leyn P. Thoracoscopic tunnel technique for anatomical lung resections: a ‘fissure first, hilum last’ approach with staplers in the fissureless patient. Interact Cardiovasc Thorac Surg. 2015 Jul; 21(1): 27. doi: 10.1093/icvts/ivv048.

18. Laursen L.Ø., Petersen R.H., Hansen H.J., Jensen T.K., Ravn J., Konge L. Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy. Eur J Cardiothorac Surg. 2016 Mar; 49(3): 870–5. doi: 10.1093/ejcts/ezv205.

19. Bagrov V.A., Ryabov A.B., Pikin O.V., Kolbanov K.I., Glushko V.A., Vursol D.A., Amiraliev A.M., Rudakov R.V., Barmin V.V. Complications after thoracoscopic lobectomy in patients with malignant lung tumors. Onkology. P.A. Gertsen Journal. 2018; 7(4): 26–33. (in Russian).

20. Nakata M., Saeki H., Yokoyama N., Kurita A., Takiyama W., Takashima S. Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 2000 Sep; 70(3): 938–41. doi: 10.1016/s0003-4975(00)01513-7.

21. Nagahiro I., Andou A., Aoe M., Sano Y., Date H., Shimizu N. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Ann Thorac Surg. 2001 Aug; 72(2): 362–5. doi: 10.1016/s0003-4975(01)02804-1.

22. Lardinois D., De Leyn P., Van Schil P., Porta R.R., Waller D., Passlick B., Zielinski M., Lerut T., Weder W. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg. 2006 Nov; 30(5): 787–92. doi: 10.1016/j.ejcts.2006.08.008.

23. Lee P.C., Kamel M., Nasar A., Ghaly G., Port J.L., Paul S., Stiles B.M., Andrews W.G., Altorki N.K. Lobectomy for Non-Small Cell Lung Cancer by Video-Assisted Thoracic Surgery: Effects of Cumulative Institutional Experience on Adequacy of Lymphadenectomy. Ann Thorac Surg. 2016 Mar; 101(3): 1116–22. doi: 10.1016/j.athoracsur.2015.09.073.

24. Berry M.F., D’Amico T.A., Onaitis M.W., Kelsey C.R. Thoracoscopic approach to lobectomy for lung cancer does not compromise oncologic efficacy. Ann Thorac Surg. 2014; 98(1): 197–202. doi: 10.1016/j.athoracsur.2014.03.018.

25. Mei J., Guo C., Xia L., Liao H., Pu Q., Ma L., Liu C., Zhu Y., Lin F., Yang Z., Zhao K., Che G., Liu L. Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stage I-II non-small cell lung cancer are more favorable than thoracotomy: a propensity score-matched analysis from a high-volume center in China. Transl Lung Cancer Res. 2019 Apr; 8(2): 155166. doi: 10.21037/tlcr.2018.12.04.