Successful Application Of VATS To Treat The N2 Lung Cancer After Neoadjuvant Concurrent Chemoradiation Therapy
Byung Jo Park, Yong Soo Choi.
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of.
Background We have applied VATS approach for the patients with clinical N2 lung cancer after neoadjuvant concurrent chemoradiation therapy (CCRT) since 2008. The aim of this was to compare the operative outcomes between early and late period in these patients. Methods VATS lobectomy and mediastinal lymph node dissection following neoadjuvant CCRT was attempted in 50 patients with stage IIIA-N2 lung cancer from Oct 2008 to April 2018. Except for the learning period of initial 4 years, 40 patients who underwent surgery were enrolled. The study period was divided into early (23 patients, June 2012 to June 2016) and late period (17 patients, July 2016 to April 2018) since we have launched 3D VATS and energy device from July 2016. Results In the late period, operation time (mean 148.8min vs. 191.3min, p=0.010), operative blood loss (median 100ml vs. 200ml, p=0.001) and hospital stay after surgery (median 6 days vs. 9 days, p=0.017) were significantly reduced compared to those in the early period. Moreover, thoracotomy conversion rate was lower (0% vs. 30.4%, p=0.037) and port numbers were fewer (single or two port 70.6% vs. 30.4%, p=0.028) in the late period. There was no significant difference in operative complication (Clavien-Dindo classification Grade ≥ 2, 17.6% vs. 39.1%, p=0.264), the number of total resected lymph nodes (median 22 vs. 22, p=0.464) or the number of resected N2 nodes (median 15 vs. 11, p=0.551). Conclusion With technological advancements and accumulation of experiences, we could accomplish successful VATS lobectomy and complete mediastinal lymph node dissection for N2 lung cancer after neoadjuvant CCRT. 
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