Technical difficulties and extending the indications for VATS lobectomy.

• DOI: 10.3978/j.issn.2072-1439.2014.10.11
• Publication Date: 2014-10-01
• Authors: Vadim Pischik
• Keywords: VATS lobectomy; Cardiothoracic surgery

Data on advantages of video-assisted thoracoscopic surgery (VATS) lobectomies has been accumulated during the last 10 years then number anatomic pulmonary resections rapidly increased. But still there is no agreement about limitations method. The most popular "technical contraindications" for VATS are: dense pleural adhesions, incompleteness interlobar fissure, previous chemo- or/and radiotherapy, perivascular peribronchial fibrosis, tumor larger than 5 cm, chest wall involvement, centrally located tumor, severe comorbidity, advanced age, COPD and emphysema. Extending indications resection its influence immediate outcomes was investigated.Ninety two consecutive cases performed by single surgeon from January 2012 till December 2013 at Federal University Hospital #122 in Saint Petersburg, Russia were retrospectively analyzed. Forty three males 49 females age 21 to 87 old (mean 59±7.2). comprised lung cancer I-III stage together with bronchiectasis tuberculomas. Conversion rate 3.2% mostly due calcification and/or fibrosis. There 30-days mortality readmission. All those patients divided into groups: standard extended lobectomy. Inclusion "extended" group made if had one or more technical challenges among following: size lesion cm more; strong adhesions "bad fissure"; adjacent structures involvement; hilar mediastinal lymph nodes enlargement tumors; chemoradiotherapy thoracic surgery.According these criteria, 45 (S) 47 (E) pair-matched statistically significant differences between groups common patients' characteristics. Postoperative comparison "standard" "expanded" revealed some average operation time (152 vs. 189 min), resected (10.2 13.1), mean before removal tube (3.9 5.2 days). blood loss, morbidity length hospital stay almost same groups.Extension lobectomy does not compromise short-term results. Incompleteness fissures, preoperative chemotherapy, big lesion, tumors are supposed be contraindications Peribronchial node may complicate even preclude VATS.