Jon A Lutz1,2, Agathe Seguin-Givelet1,3, Madalina Grigoroiu1, Emmanuel Brian1, Philippe Girard1, Dominique Gossot1. 1. Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France. 2. Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland. 3. Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France.
Abstract
OBJECTIVES: The full thoracoscopic approach to major pulmonary resections is considered challenging and controversial as it might compromise oncological outcomes. The aim of this work was to analyse the results of a full thoracoscopic technique in terms of nodal upstaging and survival in patients with non-small-cell lung carcinoma (NSCLC). METHODS: All patients who underwent a full thoracoscopic major pulmonary resection for NSCLC between 2007 and August 2016 were analysed from an 'intent-to-treat' prospective database. Overall survival and disease-free survival were estimated using the Kaplan-Meier curves and comparisons in survival using the log-rank test. RESULTS: A total of 648 patients met the inclusion criteria, of whom 621 patients had clinical Stage I and 27 had higher stages (16 oligometastatic patients were excluded from the analysis, 11 cT3 or cT4). The mean follow-up was 34.5 months. There were 40 conversions to thoracotomy (6.3%). Thirty-day or in-hospital mortality was 0.95%. Complications occurred in 29.3% of patients. On pathological examination, 22.5% of clinical Stage I patients were upstaged. Nodal upstaging to N1 or N2 was observed in 15.8% of clinical Stage I patients. Five-year overall survival of the whole cohort was 75% and was significantly different between clinical Stages IA (76%) and IB (70.9%). For tumours <2 cm, no significant difference in overall survival was found for the segmentectomy group compared to the lobectomy group: 74% versus 78.9% (P = 0.634). CONCLUSIONS: Long-term survival is not compromised by a full thoracoscopic approach. Our results compared favourably with those of video-assisted techniques.
OBJECTIVES: The full thoracoscopic approach to major pulmonary resections is considered challenging and controversial as it might compromise oncological outcomes. The aim of this work was to analyse the results of a full thoracoscopic technique in terms of nodal upstaging and survival in patients with non-small-cell lung carcinoma (NSCLC). METHODS: All patients who underwent a full thoracoscopic major pulmonary resection for NSCLC between 2007 and August 2016 were analysed from an 'intent-to-treat' prospective database. Overall survival and disease-free survival were estimated using the Kaplan-Meier curves and comparisons in survival using the log-rank test. RESULTS: A total of 648 patients met the inclusion criteria, of whom 621 patients had clinical Stage I and 27 had higher stages (16 oligometastatic patients were excluded from the analysis, 11 cT3 or cT4). The mean follow-up was 34.5 months. There were 40 conversions to thoracotomy (6.3%). Thirty-day or in-hospital mortality was 0.95%. Complications occurred in 29.3% of patients. On pathological examination, 22.5% of clinical Stage I patients were upstaged. Nodal upstaging to N1 or N2 was observed in 15.8% of clinical Stage I patients. Five-year overall survival of the whole cohort was 75% and was significantly different between clinical Stages IA (76%) and IB (70.9%). For tumours <2 cm, no significant difference in overall survival was found for the segmentectomy group compared to the lobectomy group: 74% versus 78.9% (P = 0.634). CONCLUSIONS: Long-term survival is not compromised by a full thoracoscopic approach. Our results compared favourably with those of video-assisted techniques.
Authors: Christopher Cao; David H Tian; Ben Fu; James Huang; Neel K Ranganath; Dominique Gossot Journal: J Thorac Dis Date: 2018-09 Impact factor: 2.895
Authors: Monica Casiraghi; Alessio Vincenzo Mariolo; Shehab Mohamed; Giulia Sedda; Patrick Maisonneuve; Antonio Mazzella; Giorgio Lo Iacono; Francesco Petrella; Lorenzo Spaggiari Journal: J Clin Med Date: 2022-06-11 Impact factor: 4.964