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Clinics in Oncology
2016 | Volume 1 | Article 1087 1
Introduction
Is widely accepted that VATS lobectomy is associated with decreased post operative pain,
shorten hospital stay, fewer post operative complications and therefore better compliance with
adjuvant chemotherapy than open lobectomy [1]. Tese data have prompt some thoracic surgeons
to use it routinely in early stage NSCLC.
On the other hand, many Authors still argue that VATS efcacy is uncertain in terms of
lymph node dissection and should be avoided particularly in N1 or N2 disease [2]. According to
the ESTS guidelines, it is common opinion that systemic nodal dissection (SND) is mandatory in
every pulmonary resection for NSCLC [3]. SND is recommended also in clinical N0 patients since
about 10% of them have been shown to have pathologic N2 at defnitive postoperative diagnosis [4].
Terefore, the possibility to obtain SND by VATS is the key topic to defnitively state the oncologic
efectiveness of thoracoscopy versus open thoracotomy.
Te aim of our study was to compare the number of nodes and stations dissected in patients who
underwent lobectomy by VATS or open thoracotomy at our thoracic surgery department and to
determine if there was a signifcant diference in the two groups as concerns the cN0-pN2 patient’s
percentage.
Patients and Methods
From June 2013 to December 2014, 30 patients with clinical stage I (T1-2aN0M0) lung cancer
submitted to lobectomy and SND at our thoracic surgery department were retrospectively reviewed.
All data concerning surgical approach, operative time, number of stations and nodes removed and
Video-Assisted Thoracic Surgery Effcacy in Systemic
Nodal Dissection: A Single Institution Experience
OPEN ACCESS
*Correspondence:
Alessandro Baisi, Department of
Thoracic Surgery, Azienda Ospedaliera
San Paolo, University of Milan,
Ospedale San Paolo Via Di Rudinì 8,
20142 Milano, Italy,
E-mail: Alessandro.baisi@unimi.it
Received Date: 05 Aug 2016
Accepted Date: 23 Aug 2016
Published Date: 12 Sep 2016
Citation:
Baisi A, Raveglia F, De Simone M, Cioff
U. Video-Assisted Thoracic Surgery
Effcacy in Systemic Nodal Dissection:
A Single Institution Experience. Clin
Oncol. 2016; 1: 1087.
Copyright © 2016 Baisi A. This is an
open access article distributed under
the Creative Commons Attribution
License, which permits unrestricted
use, distribution, and reproduction in
any medium, provided the original work
is properly cited.
Research Article
Published: 12 Sep, 2016
Abstract
Background: According to the European Society of Toracic Surgeons (ESTS) guidelines, systemic
nodal dissection (SND) is mandatory in pulmonary resection for non-small cell lung cancer
(NSCLC). Since VATS SND efcacy is still an uncertain issue, this is a key topic to defnitively state
the oncologic efectiveness of thoracoscopy. Our study compared the number of nodes and stations
dissected and cN0-pN2 cases in VATS versus open thoracotomy.
Material and Methods: From June 2013 to December 2014, 30 patients with clinical stage I (T1-
2aN0M0) lung cancer underwent lobectomy at our thoracic surgery department. Clinical staging
was always obtained by positron emission tomography (PET). All mediastinal nodes suspected were
studied by ultrasound-guided bronchoscopy with fne needle aspiration (EBUS-FNA). Patients
were referred to VATS or open thoracotomy based on clinical general conditions and tumor
characteristics. SND was performed in both the groups.
Results: Among 30 patients who underwent lobectomy, 21 underwent open thoracotomy and 9
VATS. Four (13.3%) showed to have pN2 at defnitive pathologic examination: 2 in VATS and 2
in open thoracotomy group. Mean operation time was longer in VATS than in open thoracotomy
(p=0.03).Tere was not signifcant diference between the two groups in terms of total nodes
dissected (p >0.05), mediastinal nodes dissected (p >0.05) and stations removed (p >0.05).
Conclusion: VATS SND is theoretically successful as open thoracotomy but it is technically more
demanding and more time-consuming.
Keywords: Vats; Lymphnode dissection; Non-small-cell lung cancer; Toracotomy; Lymphnode
staging
Alessandro Baisi
1
*, Federico Raveglia
2
, Matilde De Simone
2
and Ugo Cioff
2
1
Department of Thoracic Surgery, Azienda Ospedaliera San Paolo, University of Milan, Italy
2
Department of Surgery, University of Milan, Italy