Comparison of Long-Term Outcomes Between Minimally Invasive Pulmonary Resection With and Without Video-Assisted Mediastinoscopic Lymphadenectomy for Left-Sided Lung Cancer.

Abstract

BACKGROUND:

This study aimed to assess the long-term outcomes of video-assisted mediastinoscopic lymphadenectomy (VAMLA) combined with video-assisted thoracic surgery (VATS) for left-sided lung cancer pulmonary resection.

PATIENTS AND METHODS:

We retrospectively reviewed 1194 consecutive patients who underwent VATS anatomical resection for left-sided lung cancer between January 2007 and December 2016. Using propensity score-based inverse probability of treatment weighting (IPTW), perioperative outcomes and long-term survival outcomes were compared.

RESULTS:

Among 1194 patients, 295 (24.7%) underwent additional VAMLA (VATS + VAMLA group) and 899 patients (75.3%) underwent VATS only (VATS group). The proportion of patients with advanced N stage were higher in the VATS + VAMLA group (24.7%) than in the VATS group (18.3%). After IPTW adjustment, all baseline profiles between the two groups became similar. The long-term overall survival (OS) and recurrence-free survival (RFS) rates were similar between the VATS + VAMLA group and the VATS group (5-year OS, 77.8% versus 79.3%, p = 0.957; 5-year RFS, 69.6% versus 70.1%, p = 0.498). However, among patients with borderline pulmonary function (FEV1 ≤ 60% or DLCO ≤ 60%), the VATS + VAMLA group (n = 23) had a better prognosis than the VATS group (n = 36) (5-year OS, 67.4% versus 46.7%, respectively; p = 0.047; 5-year RFS, 74.6% versus 53.5%, respectively; p = 0.027).

CONCLUSIONS:

VAMLA might be a good complement to VATS for left-sided lung cancer, wherein optimal mediastinal lymph node dissection is not feasible under one-lung ventilation, such as when patients have borderline pulmonary function.

• Authors: Jae Kwang Yun, Seungmo Yoo, Geun Dong Lee, Sehoon Choi, Hyeong Ryul Kim, Dong Kwan Kim, Seung-Il Park, Yong-Hee Kim
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 29 Issue 5 Pg. 2830-2839 (May 2022) ISSN: 1534-4681 [Electronic] United States
• PMID: 35022898 (Publication Type: Journal Article)
• Copyright: © 2021. Society of Surgical Oncology.

Topics

• Humans
• Lung Neoplasms (pathology, surgery)
• Lymph Node Excision
• Mediastinoscopy
• Neoplasm Staging
• Pneumonectomy
• Retrospective Studies
• Thoracic Surgery, Video-Assisted