LOBECTOMY WITH EXTENDED LYMPH-NODE DISSECTION BY VIDEO-ASSISTED THORACIC-SURGERY FOR LUNG-CANCER

Background: Between September 1992 and September 1996, we performed 88 VATS (video-assisted thoracic surgery) lobectomies and two VATS pneum onectomies. Methods: The indications for surgery were 68 cases of lung cancer, nine cases of bronchiectasis, six cases of tuberculosis, and seven cases of benign lesions. Of the 68 cases of lung cancer, 36 were treated by VATS lobectomy with extended lymph node dissection for cli nical stage I lung cancer, making full use of recently developed devic es for thoracoscopic surgery, such as reticulating endoscissors, minir etractors, endoclips, and harmonic scalpels. Results: Twenty-four lymp h nodes were resected on average (range, 10 to 51) by VATS. This numbe r was comparable to lymph nodes resected in open thoracotomy during th e same period. Among the 36 patients who underwent extended lymph node dissection, 20 showed no lymph node metastasis postoperatively (stage I): while 16 had N1 or N2 cancer. All patients with stage I cancer ha ve survived 4 to 36 months (median: 17 months) with no signs of recurr ence. Conclusions: This survival of stage I lung cancer after VATS is comparable to that of open thoracotomy. We thus believe that VATS lobe ctomy with extended lymph node dissection can be an alternative to sta ndard posterolateral thoracotomy for stage I lung cancer, results comp arable to open thoracotomy [3]. We accomplished this by using newly de veloped thoracoscopic instrumentation such as reticulating endoscissor s, miniretractors, endoclips, and harmonic scalpels, in addition to in struments for conventional surgery and endostapler devices. In this pa per, we report on the method and results of our VATS lobectomy and ext ended lymph node dissection for lung cancer.