(Created page with " ==Keywords== non-small cell lung cancer;surgery;VATS Minimizing surgical wound is major contribution of VATS. Reduced surgical injury could induce lesser surgical pain the...") |
m (Scipediacontent moved page Draft Content 534473709 to Yi et al 2016a) |
(No difference)
|
non-small cell lung cancer;surgery;VATS
Minimizing surgical wound is major contribution of VATS. Reduced surgical injury could induce lesser surgical pain thereby preventing catastrophic postoperative cytokine cascade, consequentially enhance functional recovery.1 The less invasiveness is likely to be the reason that VATS approaches have been expanding their territories continuously, and various novel techniques such as single port VATS or subxiphoid approaches have been developed.2
The three-port two instrument (TPTI) technique introduced in the attractive article by Cheng et al3 is part of efforts to improve the standard VATS approaches. The author had reported successful 60 cases of complete VATS lobectomy using three 1.2 cm ports. It was interesting that this technique could be applied for all stages of lung cancers accompanied by sufficient lymph node dissection, and the learning curve was shorter than standard VATS lobectomy techniques. The article reported that there had been no need to expand the port wound to extract resected specimen. The author insisted that he could remove 5 cm sized tumor with at least 1 cm of safety margin without destruction. This was surely feasible and may have advantages for cosmetic concern and reduction of pain.
However, the TPTI technique did not seemed to be attempted to complex VATS surgery like bronchoscopy or pneumonectomy, and the resected lung inevitably cut into several strip using surgical endo-staplers. Although the cutting of resected lung in thoracic cavity might be possible technically, it could increase medical expenses and the oncologic safety has not been demonstrated.
We had applied standard VATS approaches of two thoracoscopic port incision and one accessory 4 cm sized incision into advanced lung cancer which needed bronchoplasty or pneumonectomy. Between March 2012 and November 2014, we had experienced 12 cases of complex VATS surgery by a single experienced surgeon (K. Kim), consisting of 2 cases of simple and 3 cases of wedge bronchoplasty, 7 cases of pneumonectomy including 4 cases of completion pneumonectomy. One patient was suffered from postoperative bronchopleural fistula which could be repaired using VATS technique. No conversion and no postoperative mortality was observed. Unlikely the TPTI technique, we used 4 cm sized working port, instead, the resected lung could be preserved in all cases. Perioperative outcomes were described in Table 1.
Variables | Mean ± SD | Min | Max |
---|---|---|---|
Tumor size (mm) | 40.8 ± 17.06 | 20 | 75 |
Operation time (min) | 212.5 ± 102.86 | 80 | 475 |
Anesthesia time (min) | 265.8 ± 102.80 | 125 | 250 |
Blood loss during operation (ml) | 341.7 ± 347.61 | 0 | 1200 |
Duration of ICU care (day) | 0.67 ± 12.68 | 0 | 1 |
Hospital stay (day) | 10.5 ± 12.68 | 2 | 49 |
Duration of chest tube (day) | 1.1 ± 1.24 | 0 | 3 |
Which technique is better than others, standard VATS, TPTI, single port or robot? This seemed stupid question. Surgeon can choose the appropriate technique suitable for their patients considering their diverse medical environment. Although there still has no demonstrated evidence for oncologic comparability, VATS could be beneficial because they provide lesser surgical trauma, less impairment of immune response, thereby improved response to the chemotherapy and postoperative recovery.4 The endeavor to reduce surgical wound may lead to expanding the treatment role of minimally invasive surgical techniques.
Thank you for Dr. Kims comments and also for Editors' kindness to have me the responses. I sincerely make a commentary one by one in the following paragraphs, and also make some comments.
Abbreviation explanation:
There are no potential financial and non-financial conflicts of interest.
The authors declare no competing financial interest or funding of sources.
Published on 26/05/17
Submitted on 26/05/17
Licence: Other
Are you one of the authors of this document?