Complete Video-assisted Thoracoscopic Lobectomy Research Articles

Adenocarcinoma with fetal features invading the right superior sulcus treated with neoadjuvant chemoradiotherapy followed by complete video-assisted thoracoscopic right upper lobectomy: a case report

BackgroundFetal adenocarcinoma of the lung is a rare lung neoplasm that accounts for only 0.5% of all primary lung cancers. Because of its rarity, effective treatments for the management of the tumor are poorly understood. We herein report a case of adenocarcinoma with fetal features of the lung with invasion of the right superior sulcus that was treated with neoadjuvant chemoradiotherapy followed by surgical resection.Case presentationA 54-year-old man was referred to a medical institution due to right inner forearm pain. On computed tomography of the chest, a 56-mm mass with invasion of right superior sulcus was discovered. Bronchoscopic biopsy revealed non-small cell lung carcinoma. We performed concurrent chemotherapy (2 cycles of cisplatin and vinorelbine) and thoracic radiation therapy (40 Gy in 20 fractions). As the result of extreme tumor reduction after neoadjuvant chemoradiotherapy, we could perform right upper lobectomy by complete video-assisted thoracoscopic surgery. Since no viable cancer cells were detected from the pathological examination of the resected tissue, the specimen obtained by bronchoscopic biopsy was reexamined by immunohistochemistry. The analysis supported a pathologic diagnosis of adenocarcinoma with fetal features.ConclusionsWe experienced a case of adenocarcinoma with fetal features of the lung in which the patient showed a complete response to neoadjuvant chemoradiotherapy. In addition, the tumor invading the right superior sulcus was completely resected by video-assisted thoracoscopic lobectomy. Neoadjuvant chemoradiotherapy followed by surgery may be also an effective treatment for advanced-stage high-grade fetal adenocarcinoma of the lung, similarly to other subtypes of advanced-stage primary lung cancer.

EP1.17-03 New Approach to Complete Video-Assisted Thoracoscopic Lobectomy in T2 and T3 Non-Small Cell Lung Cancer

The advantages of complete video assisted thoracoscopic surgery(c-VATS) include less postoperative pain and early cosmetic benefit because of the small incision recured. If large tumors can be successfully removed without need for a long thoracic incision or extensive costal rib resection, c-VATS may be performed in patients with stage II or III NSCLC. We herein repot our experience with a novel c-VATS technique that involves removal of resected lung tissu from an abdominal incision in patinets with T2 and T3 NSCLC. Fifteen patients with T2 and T3 NSCLC who underwent surgical treatment. Five patients underwent c-VATS lobectomy, and 10 patients under went hybrid VATS(h-VATS), which is performed mainly by direct visualization using video assistance. The tumour large perpendicular was 60 to 140mm in the c-VATS group and 52mm to 82mm in the h-VATSgroup. Surgical procedure. For lobectomy, the ports were placed in the 3rd, 5fh, and 7th intercostal spaces on the anterior axillary line for the operator and camera pole and in the 6th and 8th intercostal spaces on the infrascapular line for the assistant. An abdominal skin incision of <5cm was then created just below the xiphoid in Fig1. A forceps was inserted through this incision into the intrapleural cavity through the preperitoneal space to remove the resected lung tissu by grabbing the endocatch bag. the resected lung tissue was remoed with the forceps through this route. Comparison between c-VATS and h-VATS groups. Significantly fewer patients in the c-VATS than h-VATS group developed severe pain in Table1.table 1View Large Image Figure ViewerDownload Hi-res image Download (PPT) The present study suggests that the indications for c-VATS lobectomy in patients with T2 and T3 NSCLC can be expanded by implementation of our approach, which involves removal of the free lobe through an abdoninal incision.

Complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection.

We describe herein a case of complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection. The patient was a 67-year-old man. A physical examination revealed a nodule in the left lower lobe that had been present for 7 years. According to the chest computed tomography (CT) report recently, a diagnosis of lung cancer was not excluded. Due to the surgical indications, he was underwent complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection. The frozen pathology report was consistent with adenocarcinoma. He recovered smoothly, without any perioperative complications.

RETRACTED: Lobectomy after three-dimensional computed tomography of the pulmonary artery

Our aim was to evaluate the efficacy of 3-dimensional imaging using multidetector row helical computed tomography for preoperative assessment of the branching pattern of the pulmonary artery before complete video-assisted thoracoscopic lobectomy for lung cancer. Forty-nine consecutive patients with clinical stage I lung cancer scheduled for complete video-assisted thoracoscopic lobectomy were evaluated for pulmonary artery branching patterns on 16-channel multidetector row helical computed tomography. Intraoperative finding were compared with the 3-dimensional computed tomography angiography. According to the intraoperative findings, 95.2% (139/146) of pulmonary artery branches were precisely identified on preoperative computed tomography angiography. All of the 7 undetected branches were less than 2 mm in diameter. No patient needed conversion to an open thoracotomy because of intraoperative bleeding. Three-dimensional computed tomography angiography clearly revealed individual anatomies of the pulmonary artery and could play an important role in safely facilitating complete video-assisted thoracoscopic lobectomy. However, we were unable to detect several thin branches with this technique.

Technique for delivering large tumors in video-assisted thoracoscopic lobectomy

The optimal technique for delivering large tumors during video-assisted thoracoscopic lobectomy remains uncertain. In 258 patients receiving video-assisted thoracoscopic lobectomy for lung cancer, techniques for delivering the resected lobe included complete video-assisted thoracoscopic lobectomy without rib spreading (n = 206, 80%), resection of a short rib segment (n = 9, 3%), brief rib spreading (n = 12, 5%), and conversion to a minithoracotomy (n = 21, 8%). In 10 (4%) patients, a novel anterior rib cutting technique was used: one rib at the utility port was cut near its anterior end to widen the intercostal space without forcible rib spreading for lobe delivery. There was no mortality or major morbidity using the anterior rib cutting technique, and it delivered tumors of a larger mean diameter than complete video-assisted thoracoscopic lobectomy (5.4 ± 3.4 vs. 2.3 ± 1.4 cm, p = 0.017) whilst yielding a similar mean operation time and blood loss to the other non-complete video-assisted thoracoscopic lobectomy techniques. The anterior rib cutting technique gave similar postoperative patient pain scores and analgesic use to complete video-assisted thoracoscopic lobectomy, and shorter mean hospital stay than the other non-complete video-assisted thoracoscopic lobectomy techniques (5.6 ± 2.8 vs. 10.0 ± 7.1 days, p = 0.003). In video-assisted thoracoscopic lobectomy, the anterior rib cutting technique is a safe and feasible procedure for delivering large tumors, causing no more pain than complete video-assisted thoracoscopic lobectomy, and allowing faster recovery than other non-complete video-assisted thoracoscopic lobectomy techniques.

Preoperative assessment of the pulmonary artery by three-dimensional computed tomography before video-assisted thoracic surgery lobectomy

Our aim was to evaluate the efficacy of 3D imaging using multidetector row helical computed tomography (MDCT) in the preoperative assessment of the branching pattern of pulmonary artery (PA) before complete video-assisted thoracoscopic lobectomy (complete VATS lobectomy) for lung cancer. Forty-nine consecutive patients with clinical stage I lung cancer scheduled for complete VATS lobectomy were evaluated about branching pattern of PA on 16-channel MDCT. Intraoperative finding of the PA branching pattern were compared with the 3D-CT angiography images obtained using MDCT. According to the intraoperative findings, 95.2% (139 of 146) of PA branches were precisely identified on preoperative 3D-CT angiography. All of the seven undetected branches were within 2mm in diameter. There was not a case that needed conversion to open thoracotomy because of intraoperative bleeding. A 3D-CT angiography using MDCT clearly revealed individual anatomies of pulmonary artery and could play an important role in safely facilitating complete VATS lobectomy procedure. However, we were unable to detect several thin branches with this technique. So, more care should be taken to avoid bleeding from these small vessels.