gms | German Medical Science

Introduction: Thoracoscopic surgery has been widely applied to lung-cancer treatment in recent years, and its usefulness has been frequently reported. However, the surgical procedures in each institute are diverse, and the reports of comparison between open thoracic surgery and thoracoscopic surgery are very few. In this report, totally thoracoscopic lobectomy for lung cancer that has been standardized in our institute was shown, and its advantages over open thoracic surgery in the postoperative complications and the tolerability of chemotherapy after surgery were presented.

Material and methods: The patients who underwent lobectomy for lung cancer in our institute were divided in two groups (287 cases of totally thoracoscopic surgery: group A, the thoracotomy group (357 cases of open thoracotomy; group B), and incidence rate of postoperative complications and tolerability of adjuvant chemotherapy in two groups were compared.

Results: To delete the influence of cancer stage on comparison of between two groups, pathological stage I patients were extracted from each groups (209 cases of totally thoracoscopic surgery: group A-I, 223 cases of thoracotomy: group B-I). Average of Charlson comobidity index, indicating the comorbidity score was 1.1 in group A-I, and 1.0 in group B-1. Comparison of surgical time, amount of bleeding, and drainage period were 190 vursus176 minutes, 102 versus 247 ml, and 3.1 versus 4.2 days, respectively (A-I group versus B-I group). For post-operative complications (A-I group versus B-I group), postoperative atrial fibrillation was 3 cases (1.0%) versus 11 cases (3.1%), and pneumonia was complicated in 4 cases (1.4%) versus 11 casese (3.1%), respectively. Empyema and brain infarction was diagnosed only in group B-I (6 cases and 3 cases, respectively). In comparison of group A and group B, the platinum-based adjuvant chemotherapy was applied in 37 cases of group A and 79 cases of group B. Four courses of chemotherapy was completed without dose reduction in 30 cases (81%) of group A and 51 cases (64%) cases of group B (p = 0.06, group A versus B).

Conclusion: Totally thoracoscopic lobectomy for lung cancer had advantages in the incidence of postoperative complications and the tolerability of postoperative chemotherapy. These results indicated that totally thoracoscopic lobectomy was less invasive surgical procedure and superior to open thoracotomy in early-stage lung cancer.