Primary outcome of completely thoracoscopic lobectomy for clinical NO and postoperatively pathological N2 non-small cell lung cancer

Abstract

Objective To evaluate the feasibility of the completely thoracoscopic lobectomy for clinical NO and postoperatively pathological N2 non-small-cell lung cancer（NSCLC）. Methods From Sep. 2006 to Jan. 2010, 216 patients with NSCLC received completely thoracoscopic lobectomy in our center. Two hundred and six patients were clinical NO preoperatively（ 103 males and 103 females, median age of 62.3 years, rang 29 to 85 years）. They were divided into two groups based on postoperatively pathological staging, pNO group and pN2 group. Some perioperative factors including age, gender, tumor size, tumor location, pathological type, pathological differentiation, rate of conversion to thoractomy, operation time, blood loss,lymph node dissection,time of drainge,hospitalization and complications were studied and compared between two groups. Results There were 203 cases of lobectomy, 2 cases of composite lobectomy and 1 case of pneumonectomy. All procedures were carried out safely without serious complication except for one operative death result from respiratory failure. There were 168 cases in pN0 group and 38 cases in pN2 group. Age and gender were similar between two groups. The tumor size in pN0 group was smaller than that in pN2 group [ （2.6 ±1.6 ） cm vs （ 3.7 ± 1.9 ） cm, P = 0. 001 ]. The tumors in pN0 group were lesser appearance in the bilateral lower lobes（31.0% vs 50.0%, P =0. 026）. There was a approximate proportion of adenocarcinoma in two groups（ 82.7% vs 73.7%, P=0. 181 ）, but the proportion of poorly differentiated carcinoma in pNO group was significantly lower than that in pN2 group（ 19.0% vs 42.1%, P = 0. 002 ）. There were no differences in the rate of conversion to thoractomy （ 7.1% vs 7.9%, P = 1. 000）, operation time [ （ 196.1 ± 53.7 ） rain vs （ 208.6 ±56.8 ） min, P = 0. 202 ], blood loss[ （253.2 ± 247.9） ml vs（279.0 ± 183.3 ） ml, P = 0. 475 ], time of drainage[ （7.7 ± 3.2 ） days vs （9.7 ± 6.3 ） days, P = 0. 066 ], hospitalization [ （ 10.6 ±4.6 ） days vs （ 13.0 ± 7.6 ） days, P = 0.063 ] and complications （ 12.5 % vs 21.1%, P = 0.171 ）. The stations of mediastinal lymph node dissection were equivalent in two groups （ 3.1 ± 1.2 vs 3.3 ±1.1, P = 0. 237） , but there were fewer numbers of mediastinal lymph node dissection in pN0 greup（9.9 ±6.8 vs 12.7 ±8.4, P = 0. 038）. Conclusion Completely thoracoscopic lobectomy is a feasible surgical therapy for cN0-pN2 non-small-cell lung cancer without loss of curability. Key words: Carcinoma, non-small cell Thoracoscopy Neoplasm staging