Thoracoscopic anatomic pulmonary resection for locally advanced non-small cell lung cancer.

BACKGROUND: The safety and feasibility of thoracoscopic lobectomy for locally advanced lung cancer remain controversial.

METHODS: Between April 2002 and April 2011, we retrospectively reviewed 100 consecutive patients who underwent anatomic pulmonary resection for preoperative stage II or greater non-small cell lung cancer at a single institution. After excluding 16 patients undergoing planned thoracotomy and 8 patients with preoperative stage IV disease, the remaining 76 patients who underwent thoracoscopic surgery were divided chronologically into three groups and analyzed.

RESULTS: Thoracoscopic anatomic pulmonary resection was successfully performed in 74 patients (97.4%). There were 32 complications in 27 patients (35.5%), and 2 patients (2.6%) had grade 3 or higher complications. The operative, perioperative (30-day), and hospital mortality were 0%, 0%, and 2.6%, respectively. A significantly decreased operation time, a lower amount of blood loss, and increased numbers of bronchoplasty and bronchial coverage were seen, although there were no significant differences in the patient characteristics or other outcomes among the three groups. At a mean follow-up time of 40 months, the overall 3-year survival rates for pathologic stages I (n = 12), II (n = 27), III (n = 33), and IV (n = 4) were 100%, 64.2%, 36.2%, and 25.0%, respectively.

CONCLUSIONS: Thoracoscopic anatomic pulmonary resection is feasible, with acceptable morbidity and mortality rates, as well as favorable oncologic outcomes, in selected patients with locally advanced non-small cell lung cancer. The learning curve for this procedure appears to be overcome after 25 consecutive patients.