Gavin M Wright1. 1. Director of Surgical Oncology, St Vincent's Hospital, Melbourne, Australia; ; Clinical Associate Professor, University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, Australia; ; Thoracic Surgical Lead, Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
Abstract
BACKGROUND: Despite its privileged economic and educational place in the world, Melbourne was relatively slow to embrace video-assisted thoracic surgery (VATS) for lobectomy. The initial driver of this was Professor C Peter Clarke at the Austin Hospital at the beginning of the new millennium. His legacy was carried on by his apprentice, but at St Vincent's Hospital. After a period of slow development, it became the procedure of choice from 2005, and began to filter sporadically to other hospitals from 2010. METHODS: This paper details the historical development, techniques and results of 343 VATS pulmonary resections (including lobectomies, sub-lobar anatomical resections, sleeve resections, bi-lobectomies and pneumonectomies). RESULTS: In-hospital and 30-day mortality was 2.0% and 5-year survival for all stages of NSCLC was 70%. Over 36% of patients were stage II-III using the new 7(th) revision TNM staging system. The conversion to thoracotomy rate was 4.7%. The estimated learning curve for this experience VATS lobectomy appears to be in the range of 15-20 cases. In this series, the same lymph node dissection or sampling was attempted and usually achieved as would have occurred at thoracotomy. CONCLUSIONS: The results confirm the findings of other large case series that the benefits of a minimally invasive approach are achieved without compromising the long-term survival.
BACKGROUND: Despite its privileged economic and educational place in the world, Melbourne was relatively slow to embrace video-assisted thoracic surgery (VATS) for lobectomy. The initial driver of this was Professor C Peter Clarke at the Austin Hospital at the beginning of the new millennium. His legacy was carried on by his apprentice, but at St Vincent's Hospital. After a period of slow development, it became the procedure of choice from 2005, and began to filter sporadically to other hospitals from 2010. METHODS: This paper details the historical development, techniques and results of 343 VATS pulmonary resections (including lobectomies, sub-lobar anatomical resections, sleeve resections, bi-lobectomies and pneumonectomies). RESULTS: In-hospital and 30-day mortality was 2.0% and 5-year survival for all stages of NSCLC was 70%. Over 36% of patients were stage II-III using the new 7(th) revision TNM staging system. The conversion to thoracotomy rate was 4.7%. The estimated learning curve for this experience VATS lobectomy appears to be in the range of 15-20 cases. In this series, the same lymph node dissection or sampling was attempted and usually achieved as would have occurred at thoracotomy. CONCLUSIONS: The results confirm the findings of other large case series that the benefits of a minimally invasive approach are achieved without compromising the long-term survival.
Authors: Giulia Veronesi; Bernardo G Agoglia; Franca Melfi; Patrick Maisonneuve; Raffaella Bertolotti; Paolo P Bianchi; Bernardo Rocco; Alessandro Borri; Roberto Gasparri; Lorenzo Spaggiari Journal: Innovations (Phila) Date: 2011-11
Authors: Farhood Farjah; Douglas E Wood; Michael S Mulligan; Bahirathan Krishnadasan; Patrick J Heagerty; Rebecca Gaston Symons; David R Flum Journal: J Thorac Cardiovasc Surg Date: 2009-03-09 Impact factor: 5.209