초록접수 현황
| 14F-117 | 포럼 발표 |
Video-assisted Mediastinoscopic Lymphadenectomy (VAMLA) Combined with Video-assisted Thoracic Surgery (VATS) for Left-sided Lung Cancer: Asan Medical Center Experience
Ho Jin Kim, Yong-Hee Kim, Se Hoon Choi, Hyeong Ryul Kim, Dong Kwan Kim, Seung-Il Park
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Background : Video-assisted mediastinoscopic lymphadenectomy (VAMLA) has immensely increased the diagnostic accuracy of mediastinal staging for the treatment of resectable lung cancer. However, controversy still remains as to whether its safety and accuracy can be consistently replicable, which limits the widespread adoption of this technique. We report the consecutive 225 cases of VAMLA combined with VATS lobectomy in patients with left-sided lung cancer.
Methods : From July 2002 to June 2013, a total of 1,685 patients underwent VATS lobectomy due to lung cancer at the Asan Medical Center. Among them, we identified the 225 patients with left-sided lung cancer who underwent concomitant VAMLA. Procedural time, sampled nodal stations, number of biopsies, and procedural complications related to VAMLA were evaluated.
Results : There was no early death, and recurrent laryngeal nerve palsy occurred in 10 patients (4.4%). The lymph nodal dissection of station 2R, 2L, 4R, and 4L was performed in 15.1%, 12.4%, 42.7%, and 87.6% of the total patients, respectively. The lymph nodal dissection of station 7, whereas, was performed in 100% of the patients. The mean number of biopsies and sampled nodal stations was 29.7 and 2.6, respectively. The mean procedural time was 38.1±12.3 minutes. The operative time for VATS lobectomy, compared with the patients (n=424) undergoing left-sided VATS lobectomy without VAMLA in the same study period, was significantly shorter in the VAMLA group (116.8±39.8 versus 159.6±4.0 minutes; P<0.01). Compared to the VATS-only group, there was no significant difference in other complications; A-fib (1.8% vs. 1.9%, P=0.92), chylothorax (0.4% vs. 0.5%, P=0.96), prolonged air leakage (1.3% vs. 1.2%, P=0.87), and postoperative pneumonia (2.7% vs. 1.2%, P=0.17)
Conclusion : Given our experience, VAMLA appears to be a safe and effective supplementary technique which allows more accurate mediastinal staging and shorter single-lung ventilation time in patients with left-sided lung cancer undergoing minimally-invasive pulmonary resection.
Methods : From July 2002 to June 2013, a total of 1,685 patients underwent VATS lobectomy due to lung cancer at the Asan Medical Center. Among them, we identified the 225 patients with left-sided lung cancer who underwent concomitant VAMLA. Procedural time, sampled nodal stations, number of biopsies, and procedural complications related to VAMLA were evaluated.
Results : There was no early death, and recurrent laryngeal nerve palsy occurred in 10 patients (4.4%). The lymph nodal dissection of station 2R, 2L, 4R, and 4L was performed in 15.1%, 12.4%, 42.7%, and 87.6% of the total patients, respectively. The lymph nodal dissection of station 7, whereas, was performed in 100% of the patients. The mean number of biopsies and sampled nodal stations was 29.7 and 2.6, respectively. The mean procedural time was 38.1±12.3 minutes. The operative time for VATS lobectomy, compared with the patients (n=424) undergoing left-sided VATS lobectomy without VAMLA in the same study period, was significantly shorter in the VAMLA group (116.8±39.8 versus 159.6±4.0 minutes; P<0.01). Compared to the VATS-only group, there was no significant difference in other complications; A-fib (1.8% vs. 1.9%, P=0.92), chylothorax (0.4% vs. 0.5%, P=0.96), prolonged air leakage (1.3% vs. 1.2%, P=0.87), and postoperative pneumonia (2.7% vs. 1.2%, P=0.17)
Conclusion : Given our experience, VAMLA appears to be a safe and effective supplementary technique which allows more accurate mediastinal staging and shorter single-lung ventilation time in patients with left-sided lung cancer undergoing minimally-invasive pulmonary resection.
책임저자: Yong-Hee Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
연락처 : 김호진, Tel: 02-3010-3580 , E-mail : rhonin.hojin@gmail.com
