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Two-year Outcomes after Single Port VATS Lobectomy with Mediastinal Lymph Node Dissection in Non-Small Cell Lung Cancer
Yong Soo Choi, Seok Kim, Hong Kyu Lee, Jong Ho Cho.
Sungkyunkwan University School of Medicine Samsung Medical Center, Seoul, Korea, Republic of.

OBJECTIVE: Several institutions have recently begun performing single-port video-assisted thoracoscopic surgery(VATS) lobectomy for lung cancer. However, data on recurrence and survival after this surgery are scarce. We evaluated mid-term survival after single-port VATS lobectomy in non-small cell lung cancer patients.
METHODS: Single-port VATS lobectomy involved a single 4-cm incision at the fifth intercostal space without rib spreading followed by lobectomy and lymph node(LN) dissection. From February 2013 to February 2014, 54 cases of single-port VATS lobectomy and LN dissection were performed by a single surgeon (RUL, 16 cases; RML, 6 cases; RLL, 9 cases; LUL, 9 cases; and LLL, 14 cases). We retrospectively analyzed the survival and recurrence of 54 patients who underwent successful single-port VATS lobectomy without conversion. Twenty-five patients (46.3%) were male and the mean age was 61 years (36-78 years).
RESULTS: There was no postoperative mortality; minor postoperative complications occurred in 3 patients (5.6%). Clinical stage was IA in 40 patients (74.1%), IB in 8 patients (14.8%), IIA in 2 patients (3.7%), IIB in 2 patients (3.7%), and IIIA in 2 patients (3.7%). Pathologic stage was IA in 32 patients (59.3%), IB in 6 patients (11.1%), IIA in 6 patients (11.1%), and IIIA in 10 patients (18.5%). The median follow-up period was 25 months (range 16-28 months). Recurrence was observed in 6 patients (11.1%): regional LN recurrence in 1 patient (1.9%) and distant metastasis in 5 patients (9.3%). Recurrence was not seen in any stage IA or IB patients, while 2 stage IIA patients exhibited distant metastasis, and 4 stage IIIA patients demonstrated regional LN recurrence (1 case) or distant metastases (3 cases). Among these patients, 5 underwent additional treatment (chemotherapy in 3, radiation therapy in 1, gamma knife surgery in 1). The overall 2-year recurrence-free survival rate was 88.5% (pathologic stage I, 100%; II, 66.7%; IIIA, 60%).
CONCLUSIONS: In non-small cell lung cancer patients, single-port VATS lobectomy with LN dissection leads to satisfactory mid-term survival.

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