| BACKGROUND: Lung cancer is the most rapidly developed cancer in terms of morbidity and fatality rate. Every year there are more than one million people die from lung cancer. The morbidity of lung cancer is the first of other kinds of malignant tumour , Lung cancer is also a part of the transfer, and high degree malignant tumour, otherwise the prognosis was poor, Surgical removal of the lung cancer is early treatment usually, Pneumonectomy and lobectomy, Mediastinal lymph nodes clean were used by VATS to treat early lung cancer was first to reported by Mck en na in 19 94,It means that VATS is the possibility of the treatment of lung cancer. In the last few years,for the use of Endo-GIA, A lot of it via VATS of the operation was successfully,such as Pneumonectomy and lobectomy, Also support with the incision (a - vamt) could be used as a necessary complement .[1] The concept of a lung cancer surgeries is Ia indication and part of the lung cancerIb, For the removal of the patient can reach the same effect ,[2]. At present there are reports of the same effect of small cell carcinoma in vats treatment for five year with traditional treatment. IT is an valuable of the operation method.[3]. Lobectomy , in particular of two nether leaves wsa tinked of the most suitable.An retrospective study of the 56 cases of a small cell lung cancer that tv assist the operation of the outcome of the VATS by sh ige mura[4], Over the corresponding period of five cases of Major Pulmonary Resection,The five years Overall survival with VATS is 96. 7%,in open thoracotomy is 97 . 2%( P >0. 05 ), They concluded that it is the first way for that period. For the operation of malignant tumour in VATS treatment must be met with general surgical removal of the same effect can be accepted,It must follow two principles during the operation ,one is security ,another is curative,[5] Surgical treatment of value still remains controversial for a period of more patients in N,[6] The focus of the differences mainly VATS operation is caused by incision with pleural the sexual transfer And whether you can follow the principle of treatment and the thorough cleaning nodes to the cure for the purpose of your mind, This difference will be solved by the strict large group of patients and clinical research and data validation of the follow-up, Overall, the Clinical treatment effect need to further observation.[7]OBJECTIVE: To evaluate the long-term outcome of video-assisted thoracoscopic surgery (VATS) major pulmonary resection in patients with clinically resectable non-small cell lung cancer (NSCLC).METHODS: Between January 2000 and December 2007, 1139 patients with NSCLC underwent VATS major pulmonary resection together with a systematic nodal dissection at a single institute. Complete VATS (c-VATS) consisted of purely endoscopic techniques with 100% monitor vision and without rib-spreading minithoracotomy. Assisted VATS (a-VATS) involved performing the primary procedures via rib-spreading minithoracotomy (<10 cm long) with a monitor and/or direct visualization.RESULTS: After postoperative staging, 463 (40.6%) patients were determined to be in stage I, 301 (26.4%) in stage II, 348 (30.6%) in stage III, and 27 (2.4%) in stage IV. Fifty-seven (5.0%) patients required conversion of the intended procedure to an alternate procedure (c-VATS to a-VATS, n=52; c-VATS to open, n=1; a-VATS to open, n=4). The overall one-year, three-year, and five-year survival for patients in stage I were 94.0% (95% confidence interval [CI], 91.8-96.2), 81.8% (95% CI, 78.1-85.5%), and 72.2% (95% CI, 67.1-77.3%), respectively. The overall five-year survival for stage IA, IB, IIA, IIB, IIIA, IIIB, and IV were 77.9% (95% CI, 71.4-84.4%), 65.8% (95% CI, 58.0-73.6%), 54.9% (95% CI, 45.5-64.3%), 37.0% (95% CI, 26.4-47.6%), 30.3% (95% CI, 23.6-37.0%), 22.2% (95% CI, 11.6-44.9%), and 28.6% (95% CI, 6.6-50.6%), respectively. There were no intraoperative deaths and five postoperative deaths (0.4%). The overall morbidity rate was 9.6%. Univariate analysis by log-rank test revealed that gender, tumor-node-metastasis (TNM) stage, pT status, pN status, status of lymphovascular invasion, and type of resection were statistically significant factors affecting overall survival (OS). Kaplan-Meier survival at five years was 55.7% (95% CI, 51.2-60.2%) for those who underwent c-VATS and 48.4% (95% CI, 42.3-54.5%) for those who underwent a-VATS (P=0.39). Female gender, less acute TNM stage, smaller pT status, and less extensive resection were significantly predictive for longer OS by multivariate analysis as well (P=0.01, P=0.01, P<0.001, and P=0.04, respectively).CONCLUSION: c- or a-VATS can be considered as an alternative to traditional incision in patients with clinically resectable NSCLC. These procedures may be used in more clinical settings in the near future due to their encouraging perioperative and long-term outcomes. Multivariate analysis confirmed that gender, TNM stage, pT status, and type of resection were significant predictive factors for OS. |
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