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Outcomes of Pulmonary Resection and Mediastinal Node Dissection by Video-Assisted Thoracoscopic Surgery Following Neoadjuvant Chemoradiation Therapy for Stage IIIA N2 Non-Small Cell Lung Cancer

대한흉부외과학회지
2018년 51권 1호 p.29 ~ p.34
 ( Jeon Yeong-Jeong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Thoracic and Cardiovascular Surgery

최용수 ( Choi Yong-Soo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Thoracic and Cardiovascular Surgery
이경종 ( Lee Kyung-Jong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Division of Pulmonary and Critical Care Medicine
이세훈 ( Lee Se-Hoon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine Division of Hematology-Oncology
표홍렬 ( Pyo Hong-Ryull ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
최준영 ( Choi Joon-Young ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Nuclear Medicine

Abstract

Background
We evaluated the feasibility and outcomes of pulmonary resection and mediastinal node dissection (MND) by video-assisted thoracoscopic surgery (VATS) following neoadjuvant therapy for stage IIIA N2 non-small cell lung cancer (NSCLC).

Methods: From November 2009 to December 2013, a total of 35 consecutive patients with pathologically or radiologically confirmed stage IIIA N2 lung cancer underwent pulmonary resection and MND, performed by a single surgeon, following neoadjuvant chemoradiation. Preoperative patient characteristics, surgical outcomes, postoperative drainage, postoperative complications, and mortality were retrospectively analyzed.

Results: VATS was completed in 17 patients. Thoracotomy was performed in 18 patients, with 13 planned thoracotomies and 5 conversions from the VATS approach. The median age was 62.7±7.9 years in the VATS group and 60±8.7 years in the thoracotomy group. The patients in the VATS group tended to have a lower diffusing capacity for carbon monoxide (p=0.077). There were no differences between the 2 groups in the method of diagnosing the N stage, tumor response and size after induction, tumor location, or histologic type. Complete resection was achieved in all patients. More total and mediastinal nodes were dissected in the VATS group than in the thoracotomy group (p<0.05). The median chest tube duration was 5.3 days (range, 1 to 33 days) for the VATS group and 7.2 days (range, 2 to 28 days) for the thoracotomy group. The median follow-up duration was 36.3 months. The 5-year survival rates were 76% in the VATS group and 57.8% in the thoracotomy group (p=0.39). The 5-year disease-free survival rates were 40.3% and 38.9% in the VATS and thoracotomy groups, respectively (p=0.8).

Conclusion: The VATS approach following neoadjuvant treatment was safe and feasible in selected patients for the treatment of stage IIIA N2 NSCLC, with no compromise of oncologic efficacy.

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