| Background and objectiveAccording to statistical study of World Health Organization (WHO) and theNational Patriotic Health Campaign Committee, lung cancer has become the top onecancer related to death in China. Thus far, operation is still the major method of lungcancer treatment. Surgical treatment is the prior treatment of early-stage non-small celllung cancer (NSCLC)..As per the lung cancer treatment guidelines (the nationalcomprehensive cancer network and American association of chest physicians,2006),VATS lobectomy had been adopted for the treatment of early-stage NSCLC. VATSlobectomy includes three operative approaches including single utility port (SUP),multiple port (MP) and video assisted mini-thoracotomy (VAMT). However, there is veryfew study in large sample size focusing on the comparison of perioperative, short-termand long-term outcomes following the abovementioned approaches. Herein, we studiedand evaluated the perioperative outcomes of the three approaches in early–stage NSCLC.MethodsFrom October2010to June2013，this study prospectively included188early–stageNSCLC cases who underwent VATS lobectomy. All the cases were divided randomlyinto three groups, i.e., VAMT (n=64), VATS-MP (n=66) and VATS-SUP (n=58). Weexcluded33cases without statistical analysis. We compared the clinical outcomes amongthe three groups, including surgery incision，operation time，intraoperative blood loss，postoperative drainage, duration of chest drainage，number of removed lymph node andcomplications.ResultThere was no perioperative death suggesting all the approaches are safety. (1) Surgery incision. VAMT group:12.34±2.59cm; MP-VATS group：4.08±0.68cm;SP-VATS group：4.19±0.67cm.(2) Operation time. VAMT group:219.64±58.96min; MP-VATS group：200.63±61.27min：SP-VATS group：197.50±38.58min.(3) Intraoperative blood loss. VAMT group:287.14±199.73ml; MP-VATS group：166.84±114.25ml;SP-VATS group：167.60±105.53ml.(4) Postoperative total drainage volume. VAMT group:1283.84±826.66ml;MP-VATS group：1083.61±1142.91ml;SP-VATS group：936.90±684.03ml.(5) Chest drainage duration. VAMT group:7.73±3.74d; MP-VATS group：7.45±4.84d; SP-VATS group：5.92±2.98d.(6) LN number of removed lymph node. VAMT group:10.61±3.91; MP-VATSgroup：11.47±3.82; SP-VATS group：10.26±3.33.(7) After surgery Pathological type：VAMT group: lung adenocarcinoma42cases，Squamous cell carcinoma of the lung13cases，other1case；；MP-VATS group：lungadenocarcinoma46cases，Squamous cell carcinoma of the lung2cases，other1caseSP-VATS group: lung adenocarcinoma44cases，Squamous cell carcinoma of the lung6cases.There were no significant differences regarding operation time，postoperative totaldrainage volume, number of removed lymph node and postoperative complicationsbetween groups VAMT and SP-VATS (P>0.05). However，SP-VATS group had smallersurgery incision, fewer intraoperative blood loss and shorter duration of chest drainage,compared with VAMT group (P <0.05). There were no significant differences regardingoperation time，postoperative total drainage volume, chest drainage duration,number ofremoved lymph node and postoperative complications between groups VAMT andMP-VATS(P>0.05). However，MP-VATS group had smaller surgery incision and fewerintraoperative blood loss, compared with VAMT group(P <0.05). There were nosignificant difference regarding surgery incision，operation time, intraoperative bloodloss，chest drainage duration,postoperative total drainage volume, number of removedlymph node and postoperative complications between groups SP-VATS andMP-VATS(P>0.05). Conclusion1. The three approaches are safety, reliable and radical for ontological treatment inearly-stage NSCLC.2. SP-VATS and VATS-MP lobectomy for NSCLC are less invasion, less bleeding,faster recovery and better cosmetic results compared with VAMT.3. Compared with MP-VATS and VAMT, SP-VATS has less invasion and smallincision. However, the postoperative pain, upper limb function and rehabilitation warrantfurther study... |
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