Video-assisted thoracic surgery major pulmonary resections. Present experience

Objective: The purpose of this report is to review our experience of video- assisted thoracic surgery (VATS) major pulmonary resections. Methods: From January 1993 to December 1999 we proposed VATS, for major pulmonary resecti ons, with these indications: benign lesions and solitary metastases not rem ovable by wedge resection and stage I non-small cell lung cancer (NSCLC). T he maximum size of the lesion had to be less than 4 cm. Results: There were 125 patients, 87 men and 38 women with a mean age of 62. We successfully p erformed VATS procedure in 112 cases (one hamartoma, one tubercoloma, 12 ty pical carcinoids, 11 metastases and 87 lung cancers), while in another 13 ( 10.4%) a conversion to open surgery was required. There were 108 lobectomie s, three bilobectomies and one pneumonectomy. Out of the first three cases of NSCLC, in all patients mediastinal node sampling or lymphadenectomy was performed. We recorded 13 (11.6%) postoperative complications, one of which required re-operation (bleeding). In the 99 patients without complications , the mean postoperative stay was 5.8 days. In a mean follow-up period of 3 6 months with patients having lung cancer we achieved a 3-year survival rat e of 85 +/- 9 and 90 +/- 8% when only the patients in Stage I were consider ed. Conclusions: We believe that VATS, in performing pulmonary lobectomy, i s a safe and effective approach and it seems to give the same long-term res ults as open surgery. Now the main problems concern the indications that sh ould be strictly respected and the conversion to thoracotomy which should b e undertaken without hesitation when the anatomic or pathologic conditions are not favourable. (C) 2001 Elsevier Science B.V. All rights reserved.