P1.17-37 Minimally Invasive Open Surgery (MIOS) for Clinical Stage I Lung Cancer: Perioperative Outcomes in Recent 5 Years

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Many thoracic surgeons have tried to make lung cancer surgery less invasive. Although several minimally invasive procedures for lung cancer surgery have been proposed, it has been controversial which procedure is the most optimal. Since around 2010, minimally invasive open surgery (MIOS) has been adopted for lung cancer surgery at our institute. MIOS was performed with direct vision and thoracoscopic vision through a 2-cm port and a muscle-sparing mini-thoracotomy (incision, 6-8 cm in the fourth or fifth intercostal space at the anterior or posterior axillary line). The objective of this study was to evaluate MIOS in terms of perioperative outcomes in recent 5 years. Between 2013 and 2017, 2404 patients underwent pulmonary resection for lung cancer at National Cancer Center Hospital, Tokyo, Japan. Among them, 1930 patients with clinical stage I lung cancer were included in this study. We investigated several perioperative factors according to the type of pulmonary resection: lobectomy, segmentectomy and wedge resection. The patients consisted of 993 men (51.5%) and 937 women (48.5%) with a median age of 69 years (range: 32-90 years). Lobectomy was performed in 1288 patients (66.7%), segmentectomy in 397 (20.6%), and wide wedge resection in 245 (12.7%). Median blood loss was 32 ml (range: 1-1489 ml) for lobectomy, 20 ml (range: 1-435 ml) for segmentectomy, and 4 ml (range: 1-177 ml) for wedge resection. Median operative time was 122 min (range: 45-293 min) for lobectomy, 115 min (range: 69-211 min) for segmentectomy, and 66 min (range: 29-177 min) for wedge resection. Median length of post-operative hospital stay was 4 days (range: 1-57 days) for lobectomy, 4 days (range: 2-20 days) for segmentectomy, and 3 days (range: 2-24 days) for wedge resection. There were no operative deaths. The morbidity rate was 11.8% for lobectomy, 7.3% for segmentectomy, and 4.1% for wedge resection. The 30-day mortality rate was 0.16% for lobectomy, 0.25% for segmentectomy, and 0% for wedge resection. MIOS for clinical stage I lung cancer is a technically safe and feasible procedure with a low complication rate and a shorter hospital stay. The oncological outcomes with a longer follow-up need to be investigated.