Multimedia article. Entirely thoracoscopic pneumonectomy using the prone position: a new technique

The role of thoracoscopic pneumonectomy in the management of non-small cell lung cancer: A multicenter study

OBJECTIVE

The objective of this study was to evaluate the impact of the video-assisted thoracoscopic (VATS) approach on the outcomes of patients who underwent pneumonectomy.

METHODS

The effect of the surgical approach on perioperative complications and survival in patients who underwent pneumonectomy for nonmetastatic non-small cell lung cancer across 3 institutions (2000-2016) was assessed using multivariable logistic regression, Cox proportional hazards analysis, and propensity-score matching. Completion pneumonectomies were excluded from this study, and an "intent-to-treat" analysis was performed.

RESULTS

During the study period, 359 patients met inclusion criteria and underwent pneumonectomy for nonmetastatic non-small cell lung cancer; 124 (35%) underwent pneumonectomy via VATS and 235 (65%) via thoracotomy. Perioperative mortality (VATS, 7% [n = 9] vs open, 8% [n = 19]; P = .75) and morbidity (VATS, 28% [n = 35] vs open, 28% [n = 65]; P = .91) were similar between the groups, even after multivariable adjustment. VATS showed similar 5-year survival when compared with thoracotomy in unadjusted analysis (47% [95% confidence interval (CI), 36-56] vs 33% [95% CI, 27-40]; P = .19), even after multivariable adjustment (hazard ratio, 0.76 [95% CI, 0.50-1.18]; P = .23). In a propensity score-matched analysis that balanced patient characteristics, there were no significant differences found in overall survival between the 2 groups (P = .69).

CONCLUSIONS

Although the role of VATS pneumonectomy will likely become clearer as more surgeons report results, this multicenter study suggests that the VATS approach for pneumonectomy can be performed safely, with at least equivalent oncologic outcomes when compared with thoracotomy.

Complex thoracoscopic pulmonary resections for the treatment of lung cancer-a review

Minimally invasive surgery is increasingly being used in cancer resections. Benefits attributed to minimally invasive surgery include improved functional and oncological outcomes. In keeping with this trend, thoracoscopic lung resections are gaining acceptance amongst thoracic oncologic surgeons. As surgeons become more comfortable with these approaches, more complex resections are being performed through these techniques. This review article summarizes the current state of the art with respect to complex thoracoscopic resections.