Recurrence Pattern and Long-Term Survival After Two Types of VATS Lobectomy for Clinical T1N0 Lung Cancer
Pp. 53-65 (13)
Yoshinori Yamashita and Hiroaki Harada
To provide a less invasive procedure in video-assisted thoracic surgery
(VATS), it is necessary to evaluate two types of VATS approaches in terms of clinical
outcome, especially cancer recurrence.
We conducted a prospective feasibility study of two strictly defined types of VATS
lobectomy by prospective cohort. Based on a patients’ decision after a similar
preoperative explanation, cancer recurrence and long-term-prognosis were evaluated by
comparing among assisted VATS and complete VATS groups.
One-hundred-four consecutive patients with clinical T1N0M0 non-small cell lung
cancer (NSCLC) were analyzed. Twenty-six cases (ASSIST group) chose lobectomy
performed through an anterolateral small thoracotomy with the use of a rib spreader in
combination with a thoracoscopic view and direct view. Seventy-eight cases (PURE
group) chose complete VATS in which only a monitor was used during smaller access
thoracotomy without a rib spreader. Patients in the PURE group exhibited early
recovery from surgery. The recurrence rate was equivalent (both 19.2%). At 2,039 days
of a median follow-up period, the recurrence pattern was also similar between the two
groups; however, two cases (2.6%) of pleural dissemination appeared only in the PURE
group. Specific clinicopathological characteristics were not confirmed in the recurrent
cases. Recurrence-free and overall 5-year survival rates were equivalent between the
Both PURE and ASSIST are feasible in terms of cancer recurrence and long-term
Lobectomy, Minimally invasive surgery, Non-small cell lung cancer,
Recurrence rate, Video-assisted thoracic surgery.
Department of General Thoracic Surgery, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure 737-0023, Japan.