Long-term Comparison Of VATS Sub-pulmonary Lobectomy To VATS Pulmonary Lobectomy For The Treatment Of Ia NSLC

Objective:VATS sub-pulmonary lobectomy is considered to be a less invasive treatment of stage la non-small cell lung cancer (NSLC) method. Early clinical studies show that patients receiving VATS lobectomy is undergoing open-heart operation and accept VATS pulmonary lobectomy, The early life quality has been improved significantly,the peri-operation period higher survival rate and less complications occurred.VATS sub-pulmonary lobectomy has become a widely established treatment for a variety of la NSLC despite limited long-term data to support its use. We compared the long-term outcomes of VATS sub-pulmonary lobectomy to results in control subjects undergoing VATS pulmonary lobectomy.Methods:Demographic, clinical parameters were collected prospectively on patients enrolled in trials assessing the VATS sub-pulmonary lobectomy (45) and VATS pulmonary lobectomy (45).Detailed clinical information was available for analysis. Survival and regression methods were used.Results:During the study period (2004～2008),45patients were enrolled in VATS sub-pulmonary lobectomy trials and there were45pulmonary controls. VATS sub-pulmonary lobectomy patients were older and had significantly more comorbidities including COPD、diabetes and coronary heart disease. Mortality (0%VATS sub-pulmonary lobectomy,0%VATS pulmonary lobectomy), Postoperative atelectasis (2.2%VATS sub-pulmonary lobectomy,17.8%VATS pulmonary lobectomy; P=0.01), and prolonged intubation more than48hours (8.9%VATS sub-pulmonary lobectomy,26.7%VATS pulmonary lobectomy; P=0.02) tended to be more common in the VATS pulmonary lobectomy. Overall survival at5years was similar between groups (log rank P=0.75). Multivariate predictors of late mortality included age, chronic obstructive pulmonary disease, diabetes, and smoking history. Use of VATS sub-pulmonary lobectomy versus VATS pulmonary lobectomy did not influence mortality (hazard ratio,0.9;95%confidence interval,0.4-1.6). Over5years of radiographic follow-up in the VATS sub-pulmonary lobectomy group, mean freedom from reintervention on the treated segment was88.9%in VATS sub-pulmonary lobectomy. However over5years of radiographic follow-up in the VATS pulmonary lobectomy group, mean freedom from reintervention on the treated segment was88.9%in VATS sub-pulmonary lobectomy.Conclusions:VATS sub-pulmonary lobectomy is a safe and effective procedure to treat la NSLC with improved perioperative and similar long-term results as VATS pulmonary lobectomy.