To Compare Efficacy Of Completely Video-assisted Thoracoscopic Lobectomy And The Thoracotomy

Objective:To compare efficacy of completely video-assisted thoracoscopic lobectomy and the thoracotomy.Method:Between April.2009 and Dec.2009,25 consecutive patients underwent completely thoracoscopic lobectomy, which were either peripheral pulmonary nodules suspected of lung cancer in early stage (diameter<5cm) or benign lesions localized within single lobe.33 patients who were identified adenocarcinoma after surgery or benign lesions localized within single lobe who needed operation received conventional thoracotomy lobectomy. All patients suffering cancer of these two groups underwent systemic mediastinal and hilar lymph node sampling. The operative duration, chest drainage time, postoperative hospital stay and the number of dissected lymph node were analyzed.Results:All were treated conservatively without re-operation. No operative mortality or serious complications occurred in this group. VATS group consisted of 17 patients with primary lung cancer and 7 patients with benign lesion,which localized right upper lobe (n=3), right middle lobe (n=4), right lower lobe (n=4), left upper lobe (n=10), and left lower lobe (n=4).there are 4 cases of Pleural adhesion.however, the other group consisted of 31 primary lung cancer patients and 2 patients with benign lesion, which localized right upper lobe (n=3), right middle lobe (n=3) right lower lobe (n=9), left upper lobe (n=10), and left lower lobe (n= 9). There are 3 cases of Pleural adhesion. The median operative duration of VATS group was longer than conventional thoracotomy group,191.4 min (from 100 min to 410 min) versus 156.06 min (from 90-230min), which is statistically significant(P<0.05) excluding 4 cases of Pleural adhesion in VATS group. Postoperative hospital stay in VATS group was 8.28 days versus 11.39 days in conventional thoracotomy group (P<0.05). Chest drainage time was 4.7 days which is shorter than conventional thoracotomy group (6.9 days). Systemic lymph node dissection (including NO.2-11 lymph node) was carried out in all cases in malignancies. The total number of lymph node dissected in VATS was 131 (9.57 for each patient) versus 381 in conventional thoracotomy group,12.33 for each patient (p>0.05).Conclusion:Lobectomy for pulmonary diseases by complete VATS can shorten the chest drainage time and postoperative hospital stay with less complications and fast rehabilitation. VATS could accomplish the same therapeutic efficacy in lymph node dissection without elongating the incision. The indication of VATS should be normalized to enhance the quality of the surgery and avoid changing to conventional thoracotomy. Anyway, lobectomy for pulmonary diseases by complete VATS is techni-cally feasible, safe, minimally invasive operative duration.