Thoracoscopic lobectomy with mediastinal lymph node dissection as a standard surgery for T1-2N0M0 non-small cell lung cancer (>300 surgeries experience)

BACKGROUND: A lot of clinics worldwide in recent years recommend the use of minimally invasive surgical procedures in the early stages of lung cancer claiming that this technique helps reduce the number of postoperative complications, shortens the period of social rehabilitation of patients, without significantly affecting the long-term results of treatment. In this study we evaluate immediate and long-term results of surgical treatment of patients with early stages of non-small cell lung cancer (NSCLC) after video-assisted thoracoscopic lobectomy (VATS) with mediastinal lymph node dissection. MATERIALS AND METHODS: Since 2008 317 patients with T1-2N0M0 NSCLC over 20 (median age was 65.3 ± 2.5) years underwent VATS with mediastinal lymphadenectomy. Total number of men was 186 (58.7%), women – 131 (41.3%). Histologically verified adenocarcinoma was in 278 (87, 7%), Squamous cell carcinoma in 39 (12.3%). A group of patients who underwent thoracotomy lobectomy (n = 189) was taken to compare immediate and long-term results. Median age in this group was 66.5 ± 1.7. Total number of men was 115, women – 74. Histologically verified adenocarcinoma was in 154 (82.4%), Squamous cell carcinoma in 35 (17.6%). RESULTS: Conversion to thoracotomy during VATS was in 14.3% of surgeries. There was no postoperative mortality in VATS group, whereas in open surgeries this happened in 2.6%. The 3 and 5-year overall survival (OS) rate was 94.0% and 94.0% in the VATS group respectively, 83.0% and 78.0% in the thoracotomy group for clinical stage T1N0M0 NSCLC (p = 0.04554). CONCLUSION: Considering the results of our research and the literature review we made sure that VATS lobectomy with mediastinal lymph node dissection is an alternative procedure to open approaches: it is much safer, reduce the frequency of post-operative complications and the rehabilitation period. We believe that complete VATS lobectomy with mediastinal lymph node dissection must be taken as a standard in surgical treatment of patients with early stages of non-small cell lung cancer.