Wide exposure in uniportal video-assisted thoracoscopic surgery for radical resection of lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

RAO Sunyin , HUANG Yunchao ,  YE Lianhua , RUAN Wenpeng , CHEN Ya , YANG Jichen

The First Department of Thoracic Surgery, Cancer Hospital, Kunming Medical University, Kunming, 650105, P.R.China;

Corresponding?author：

YE Lianhua, Email: Lhye1204@aliyun.com

Keywords：

Uniportal surgery; video-assisted thoracoscopic surgery; lung cancer; wide exposure; mediastinal lymphadenectomy

DOI：

10.7507/1007-4848.201806049

Video：

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Objective To investigate the advantage of the concept of wide exposure in uniportal video-assisted thoracoscopic surgery (uniportal-VATS) for radical resection of lung cancer and assess its safety and feasibility. Methods Clinical data of 255 patients (110 males and 145 females, a mean age of 54.3±7.9 years) with non-small cell lung cancer (NSCLC) who received wide exposure in uniportal-VATS or three portal VATS (3P-VATS) during August 2017 to March 2018 were retrospectively analyzed. There were 153 patients (67 males and 86 females, a mean age of 56.1±8.5 years) in the uniportal-VATS group and 102 patients (43 males and 59 femals, a mean age of 54.4±7.4 years) in the 3P-VATS group. The clinical effects were compared between the two groups. Results There was no statistical difference in the operation time between the uniportal-VATS and 3P-VATS (135.0±45.6 min vs. 142.0±39.5 min, P>0.05). The overall number of dissected stations (6.9±1.0) and LNs (14.5±3.0) in the uniportal-VATS group were similar with those in the 3P-VATS group (7.1±1.0, 15.1±1.7). The dissected stations of N2 LNs (uniportal-VATS: 4.1±1.7, 3P-VATS: 3.9±0.8) and number of dissected N2 LNs (uniportal-VATS: 8.0±0.9, 3P-VATS: 7.8±1.1) were both similar between the two groups. The duration of postoperative tube drainage and postoperative hospital stay of uniportal-VATS group (3.5±1.8 d and 7.2±0.9 d) were much shorter than those of 3P-VATS group (4.0±1.3 d and 8.8±2.0 d). No significant difference was found in incidence of postoperative complication between the two groups except that the incidence of subcutaneous emphysema in the uniportal-VATS group was much lower. There was no perioperative death in the two groups. Conclusion The concept of wide exposure in uniportal-VATS can meet the requirment of radical resection and it is a safe and valid method which can be used for radical resection of lung cancer.

Citation： RAO Sunyin, HUANG Yunchao, YE Lianhua, RUAN Wenpeng, CHEN Ya, YANG Jichen. Wide exposure in uniportal video-assisted thoracoscopic surgery for radical resection of lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(4): 374-378. doi: 10.7507/1007-4848.201806049 Copy

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11.	Kozian A, Schilling T, Fredén F, et al. One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung: an experimental study. Br J Anaesth, 2008, 100(4): 549-559.
12.	藍嵐. 單肺通氣時間對肺損傷的影響. 南方醫科大學, 2012.
13.	鄭鑫林, 夏學陽, 張金周, 等. 胸腔鏡下肺段切除與肺葉切除治療臨床Ⅰ期非小細胞肺癌療效對比的 Meta 分析. 中國癌癥雜志, 2016, 26(10): 854-860.
14.	Saito H, Konno H, Atari M, et al. Management of intersegmental plane on pulmonary segmentectomy concerning postoperative complications. Ann Thorac Surg, 2017, 103(6): 1773-1780.
15.	Okada M, Mimae T, Tsutani Y, et al. Segmentectomy versus lobectomy for clinical stage ⅠA lung adenocarcinoma. Ann Cardiothorac Surg, 2014, 3(2): 153-159.
16.	馬少華, 閆天生, 王可毅, 等. 完全胸腔鏡下解剖性肺段切除術治療早期肺癌的體會. 中國肺癌雜志, 2018, 21(2): 99-103.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. 周清華, 范亞光, 王穎, 等. 中國肺部結節分類、診斷與治療指南 (2016 年版). 中國肺癌雜志, 2016, 19(12): 793-798.
3. Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg, 2011, 12(3): 514-515.
4. Yang HC, Noh D. Single incision thoracoscopic lobectomy through a 2.5 cm skin incision. J Thorac Dis, 2015, 7(5): E122-E125.
5. Liu CY, Lin CS, Shih CH, et al. Single-port video-assisted thoracoscopic surgery for lung cancer. J Thorac Dis, 2014, 6(1): 14-21.
6. 趙光強, 黃云超, 陳小波, 等. 快速康復外科在肺癌手術中的應用研究. 中國肺癌雜志, 2010, 13(2): 102-106.
7. Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg, 2015, 15: 38.
8. 郝志鵬, 蔡奕欣, 付圣靈, 等. 縱隔淋巴結模塊化清掃在單孔胸腔鏡肺癌根治術中的應用. 中國胸心血管外科臨床雜志, 2017, 24(7): 527-532.
9. D’Amico TA, Niland J, Mamet R, et al. Efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy. Ann Thorac Surg, 2011, 92(1): 226-231.
10. 霍云奎, 張雍偲, 閆曉亮, 等. 胸腔鏡肺葉切除在Ⅰ/Ⅱa 期非小細胞肺癌治療中的臨床應用. 臨床醫學研究與實踐, 2017, 24(3): 116-117.
11. Kozian A, Schilling T, Fredén F, et al. One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung: an experimental study. Br J Anaesth, 2008, 100(4): 549-559.
12. 藍嵐. 單肺通氣時間對肺損傷的影響. 南方醫科大學, 2012.
13. 鄭鑫林, 夏學陽, 張金周, 等. 胸腔鏡下肺段切除與肺葉切除治療臨床Ⅰ期非小細胞肺癌療效對比的 Meta 分析. 中國癌癥雜志, 2016, 26(10): 854-860.
14. Saito H, Konno H, Atari M, et al. Management of intersegmental plane on pulmonary segmentectomy concerning postoperative complications. Ann Thorac Surg, 2017, 103(6): 1773-1780.
15. Okada M, Mimae T, Tsutani Y, et al. Segmentectomy versus lobectomy for clinical stage ⅠA lung adenocarcinoma. Ann Cardiothorac Surg, 2014, 3(2): 153-159.
16. 馬少華, 閆天生, 王可毅, 等. 完全胸腔鏡下解剖性肺段切除術治療早期肺癌的體會. 中國肺癌雜志, 2018, 21(2): 99-103.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Wide exposure in uniportal video-assisted thoracoscopic surgery for radical resection of lung cancer

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