The results of a recent study published in the journal Chest indicate that video-assisted thoracic surgery may become a valid alternative to conventional surgery for patients with stage I lung cancer.[1]

Lung cancer is the leading cause of cancer-related deaths in the United States and Europe. The most common type of lung cancer, non-small cell lung cancer (NSCLC), is a malignancy that arises from the tissues of the lung. Non-small cell lung cancer is further defined by the “stage” of disease. For lung cancer, there are four possible stages and each stage describes how far the cancer has spread. This staging system is important because treatments are often based on the stage of the disease. Stage I lung cancer indicates that the cancer is localized to just one area of the lung and no lymph nodes are involved.

Current treatment for stage I lung cancer may include a surgical procedure called a lobectomy, during which the lobe of the lung containing the cancer is removed. A thoracotomy is the standard surgical procedure used to perform a lobectomy. A thoracotomy is a very invasive and serious surgery that is associated with significant side effects and often precludes older and more debilitated patients from receiving potentially curative treatment for their cancer. In order to reach the affected lobe, surgeons performing a thoracotomy have to break some of the patient’s ribs and create a long incision through large muscle layers on the patient’s side and back. Following surgery, patients undergoing a thoracotomy must be closely monitored in the hospital for approximately 2 weeks. Chest tubes (tubes placed in the chest which allow excess drainage to be collected outside the body) are needed temporarily and severe long-term pain is often a side effect from the surgery. These problems have led surgeons to develop less invasive surgical techniques to perform a lobectomy.

Recent advances in minimally invasive technology have allowed complex procedures to be performed with the aid of a video camera. A videothoracoscopic procedure has recently been shown to be effective for performing a lobectomy, while decreasing the undesirable side effects caused by a thoracotomy. The procedure works as follows: 4 one-centimeter incisions are made in the patient’s chest. A very small tube that holds a video camera can be inserted through the incisions, creating a live picture of the inside of the patient’s body. This picture is continually displayed on a television screen, so physicians can perform the entire surgery by watching the screen. Before the lobe containing the cancer is removed from the body, the incision through which it will be removed is enlarged to allow its passage with minimal contact. Previous studies have demonstrated similar effectiveness between a thoracotomy and a videothoracoscopic procedure for the surgery of lung cancer, with reduced side effects with a videothroacoscopic procedure.[2]

The recent study was conducted at the University of Milan and included 257 patients diagnosed with stage I lung cancer. Lobectomies using video-assisted thoracic surgery (VATS) were performed on 193 patients. After video thorascopic evaluation, 64 patients were found to be poor candidates for VATS and were then converted to conventional surgery. Results of the study found no intraoperative mortality and no recurrence. Overall survival was 77% at 3 years and 63% at 5 years. Patients with smaller tumors had an improved survival at 3 and 5 years at 83% and 70%, respectively, compared to patients with larger tumors, whose survival at 3 and 5 years was 71% and 56%, respectively. Patients under age 70 who underwent VATS had better 3 and 5-year survival rates (82% and 73%, respectively) than patients over the age of 70 (57% and 37%, respectively).

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Researchers found that the VATS study results match the best results reported following conventional surgery. In addition, the benefit of minimally invasive surgery includes reduced tissue damage and a shorter period of impaired immune function. VATS could become a valid alternative to conventional surgery for stage I lung cancer, provided that long-term surgical standards are followed. Patients are encouraged to speak to their physician regarding surgical options.

References:

[1] Roviaro G, Varoli F, Vergani C, et al. Long-term survival after videothorascopic lobectomy for stage I lung cancer. Chest . 2004; 126: 725-732.

[2] Luketich J, Meehan M, Landreneau R, et al. Total videothroacoscopic lobectomy versus open thoracotomy for early-stage non small-cell lung cancer. Clinical Lung Cancer. 2000;2:56-60.

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