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Feasibility of Video-assisted Thoracoscopic Anatomic Pulmonary Resection in Patients with Central Lung Cancer
Hyeong Ryul Kim1, Yong Jik Lee2, Geun Dong Lee1, Yong-Hee Kim1, Dong Kwan Kim1, Seung-il Park1.
1Seoul Asan Medical Center, University of Ulsan Medical College, Seoul, Korea, Republic of, 2University of Ulsan Medical college, Ulsan, Korea, Republic of.

Objective
To evaluate the feasibility and efficacy of video-assisted thoracoscopic (VATS) anatomical pulmonary resection in patients with central lung cancer.
Methods
Between July 2004 to December 2011, 1123 patients underwent VATS anatomical pulmonary resection and systematic mediastinal lymph node sampling or dissection (MLND) for lung cancer. A subsegmental, segmental or lobar endobronchial tumor was found in 80 patients and confirmed as cancer by bronchoscopic biopsy or brushing. 80 patients was followed-up until Jun, 2012 and medical records of were reviewed retrospectively.
Results
Median age of 80 patietns (64 Men) was 61 years (range 24, 80). A VATS lobectomy was attempted in 55 patients, a bilobectomy in 22 patients and a segmentectomy in 3 patients. Additional VATS bronchoplasty was completed in 2 patients. Conversion to thoracotomy(5%) was occurred in 3 patients for lobectomy with bronchoplasty and in one patient for bilobectomy with bronchoplasty. Complete resection (R0) was not possible in 5 patients (6.3%). Among theses, 4 had positive bronchial resection margin and 1 had remnant tumor around paratracheal tissue with extranodal invasion. Of 4 patients with positive RM, 3 were intraoperative R1 resection and 1 was intraopeartive R0 resection. Pathologic stage IA was reported in 31 patients (38.8%), IB in 18(22.5%), IIA in 15(18.8%), IIB in 3, IIIA in 7 and IV in 6 patients. There was one operative mortality due to small bowel infarction. Prolonged air-leakge (> 1 week) was occurred in 5 patients, pneumonia in 4, vocal cord palsy in 2, chylothorax in 2, atrial fibrillation in 1 and bleeding requiring reoperation in 1 patient. Median hospital stay after operation was 6 days (range 2, 26). Median follow-up duration was 28.8 months (range 0.1, 93.8). Recurrence after complete resection was observed in 13 patients (disease-free survival time 79.1±3.8 months). Among total 9 observed deaths, cancer-related death was occurred in 5 patients (overall survival time 82.9±3.4 months).
Conclusions
VATS anatomical pulmonary resection is a safe procedure providing a low operative mortality and a low probability for conversion to open thoracotomy. VATS anatomical pulmonary resection is feasible for central lung cancer providing comparable outcomes. More experiences and long-term data are needed.


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