VATS-Lobektomie - Ein Standardverfahren in der Therapie des nicht kleinzelligen Lungenkarzinoms im Stadium I?

Abstract

Even though VATS lobectomy has been practised since 1991 in stage I of non-small cell lung cancer (NSCLC), it was not being considered equivalent to conventional lobectomy due to considerable doubts in terms of safety and oncological permissibility. This study describes our experience and an evaluation of the systematic establishment of lobectomy by means of video-assisted thoracic surgery (VATS) as standard treatment of NSCLC in stage I, which serves as an alternative to conventional surgery. For this purpose, 42 NSCLC patients in stage I, undergoing a conventional lobectomy in 2010 (group I), were retrospectively compared to 30 patients in the same tumour stage (group II) who were treated in 2011 using VATS lobectomy. The comparison of these two groups was drawn regarding operation time, number of resected lymph nodes, required analgesics, duration of drainage, rate of postoperative complications and length of hospital stay. Although VATS lobectomy requires a longer operation time of approximately 30 minutes, it shows significant advantages in reference to postoperative need of analgesics, duration of drainage and complications after surgery. Furthermore, the amount of resected lymph nodes was comparable in both groups. Therefore, VATS lobectomy constitutes an essential extension for the operative management in a lung cancer centre. Our results show that this new method is not only of equal, but of superior value compared to conventional lobectomy. Our experience and recent data in the literature illustrate that VATS lobectomy will play a decisive role in therapy for NSCLC in stage I, potentially even in stages II and IIIA.