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Zentralbl Chir 2012; 137(3): 228-233
DOI: 10.1055/s-0031-1283949
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

VATS-Lobektomie beim Stadium-I-Lungenkarzinom: Standard oder Experiment

VATS Lobectomy in Stage I Lung Cancer: Standard or Experimental Procedure
H. Dienemann
1   Thoraxklinik am Universitätsklinikum, Chirurgie, Heidelberg, Deutschland
,
H. Hoffmann
1   Thoraxklinik am Universitätsklinikum, Chirurgie, Heidelberg, Deutschland
› Author Affiliations
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Publication History

Publication Date:
18 June 2012 (online)

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Zusammenfassung

Die VATS-Lobektomie im Stadium I des nicht-kleinzelligen Lungenkarzinoms wird seit 1991 praktiziert, hat jedoch über einen langen Zeitraum erhebliche Zweifel an der Sicherheit und onkologischen Zulässigkeit des Verfahrens aufkommen lassen. Nur wenige randomisiert-kontrollierte Studien an kleinen Kollektiven sind durchgeführt worden, welche zeigen konnten, dass die VATS-Lobektomie dem offenen Verfahren im Hinblick auf technische Durchführbarkeit, Patientenkomfort und Langzeitprognose nicht unterlegen ist. Die zunehmende Akzeptanz der VATS-Lobektomie beruht jedoch überwiegend auf Fall-Kontroll-Studien und Fallserien mit Kollektiven von bis zu 1100 Patienten sowie Metaanalysen, die die Vorteile des Verfahrens belegen. Nach entsprechendem Training kann der Eingriff in adäquater Zeit und mit gleicher Sicherheit sowie onkologischer Radikalität ausgeführt werden. Patienten profitieren von einem geringeren Trauma und kürzerer Rekonvaleszenz. Die 5-Jahres-Überlebensraten unterscheiden sich nicht von jenen nach offenem Eingriff. Insofern darf die VATS-Lobektomie bei entsprechenden Patienten-seitigen und infrastrukturellen Voraussetzungen heute als Standardverfahren gelten.

Abstract

Video-assisted thoracoscopic surgery (VATS) for lobectomy in stage I non-small cell lung cancer (NSCLC) was introduced in 1991 and has been accompanied by concerns in terms of safety and oncological adequacy over a long period. Only few randomised controlled trials including a small number of patients have been performed, demonstrating non-inferiority of the technical feasibility, patient comfort and long-term prognosis compared with the open technique. The evolving acceptance of VATS lobectomy, however, is based on case-control series and case series including up to 1100 patients as well as reviews and metaanalyses demonstrating its overall advantages. Presuming appropiate training the VATS procedure can be accomplished rapidly, safely and without violation of oncological principles. Patients experience a less traumatic procedure and a shorter recovery. The 5-year survival is not different from that after open thoracotomy. In conclusion, VATS lobectomy may be regarded as standard in stage I NSCLC as long as the preconditions in terms of surgical training, patient selection and infrastructure are fulfilled.

Schlüsselwörter

Lungenkarzinom - VATS - Thorakotomie

Key words

lung cancer - VATS - thoracotomy
 

  • Literatur

  • 1 Grogan EL, Jones DR. VATS lobectomy is better than open thoracotomy: What is the evidence for short-term outcomes?. Thorac Surg Clin 2008; 18: 249-258
    CrossrefPubMedGoogle Scholar
  • 2 Flores RJ, Alam N. Video-assisted thoracic surgery lobectomy (VATS), open thoracotomy, and the robot for lung cancer. Ann Thorac Surg 2008; 85: 710-715
    CrossrefPubMedGoogle Scholar
  • 3 Whitson BA, Groth SS, Duval SJ et al. Surgery for early-stage non-small cell lung cancer: A systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg 2008; 86: 2008-2018
    CrossrefPubMedGoogle Scholar
  • 4 Yan TD, Black D, Bannon PG et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 2009; 27 (15) 2553-2562
    CrossrefPubMedGoogle Scholar
  • 5 Rocco G, Internullo E, Cassivi SD et al. The variability of practice in minimally invasive thoracic surgery for pulmonary resections. Thorac Surg Clin 2008; 18: 235-247
    CrossrefPubMedGoogle Scholar
  • 6 McKenna RJ. Complications and learning curves for video-assisted thoracic surgery lobectomy. Thorac Surg Clin 2008; 18: 275-280
    CrossrefPubMedGoogle Scholar
  • 7 Swanson SJ, Herndon JE, D’Amico TA et al. Video-assisted thoracic surgery lobectomy: Report of CALGB 39802 – A prospective, multi- institution feasibility study. J Clin Oncol 2007; 25: 4993-4997
    CrossrefPubMedGoogle Scholar
  • 8 Kirby T, Mack M, Landreneau J et al. Lobectomy: video-assisted thoracic surgery versus muscle-sparing thoracotomy – A randomized trial. J Thorac Cardiovasc Surg 1995; 109: 997-1001
    PubMedGoogle Scholar
  • 9 Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg 2000; 24: 27-30
    CrossrefPubMedGoogle Scholar
  • 10 Craig SR, Leaver HA, Yap PL et al. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg 2001; 20: 455-463
    CrossrefPubMedGoogle Scholar
  • 11 Koizumi K, Haraguchi S, Hirata T et al. Lobectomy by video-assisted thoracic surgery for lung cancer patients aged 80 years or more. Ann Thorac Cardiovasc Surg 2003; 9: 14-21
    PubMedGoogle Scholar
  • 12 Demmy TL, Curtis JJ. Minimally invasive lobectomy directed toward frail and high-risk patients: A case-control study. Ann Thorac Surg 1999; 68: 194-200
    CrossrefPubMedGoogle Scholar
  • 13 Nagahiro I, Andou A, Aoe M et al. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: A comparison of VATS and conventional procedure. Ann Thorac Surg 2001; 72: 362-365
    CrossrefPubMedGoogle Scholar
  • 14 Yim AP, Wan S, Lee TW et al. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg 2000; 70: 243-247
    CrossrefPubMedGoogle Scholar
  • 15 Nakata M, Saeki H, Yokoyama N et al. Pulmonary function after lobectomy: Video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg 2000; 70: 938-941
    CrossrefPubMedGoogle Scholar
  • 16 Balduyck B, Hendriks J, Lauwers P et al. Quality of life evolution after lung cancer surgery: A prospective study in 100 patients. Lung Cancer 2007; 56: 423-431
    CrossrefPubMedGoogle Scholar
  • 17 Roviaro G, Varoli F, Vergani C et al. Long term survival after video-assisted thoracoscopic surgery lobectomy for stage I lung cancer. Ann Thorac Surg 2003; 9 (01) 14-21
    PubMedGoogle Scholar
  • 18 Iwasaki A, Shirakusa T, Shiraishi T et al. Results of video-assisted thoracic surgery for stage I / II non-small cell lung cancer. Eur J Cardiothorac Surg 2004; 26: 158-164
    CrossrefPubMedGoogle Scholar
  • 19 Yim AP, Izzat MB, Liu HP et al. Thoracoscopic major lung resection: An Asian perspective. Semin Thorac Cardiovasc Surg 1998; 10: 326-331
    PubMedGoogle Scholar
  • 20 Lewis RJ, Caccavale RJ, Bocage JP et al. Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy. Chest 1999; 116: 1119-1124
    CrossrefPubMedGoogle Scholar
  • 21 He J, Shao W, Cao C et al. Long-term outcome and cost-effectiveness of complete versus assisted video-assisted thoracic surgery for non-small cell lung cancer. J Surg Oncol 2011; 104 (02) 162-168
    CrossrefPubMedGoogle Scholar
  • 22 Sagawa M, Sato M, Sakurada A et al. A prospective trial of systematic nodal dissection for lung cancer by video assisted thoracic surgery: can it be perfect?. Ann Thorac Surg 2002; 73: 900-904
    CrossrefPubMedGoogle Scholar
  • 23 Watanabe A, Koyanagi T, Ohsawa H et al. Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study. Surgery 2005; 138: 510-517
    CrossrefPubMedGoogle Scholar
  • 24 Swanson SJ, Batirel HF. Video-assisted thoracic surgery (VATS) resection for lung cancer. Surg Clin North Am 2002; 82 (03) 541-559
    CrossrefPubMedGoogle Scholar
  • 25 Demmy TL, Plante AJ, Nwogu CE et al. Discharge independence with minimally invasive lobectomy. Am J Surg 2004; 188 (06) 698-702
    CrossrefPubMedGoogle Scholar
  • 26 Demmy TL, Nwogu CE. Is video-assisted thoracic lobectomy better? Quality of life considerations. Ann Thorac Surg 2008; 85 (02) 719-728
    CrossrefPubMedGoogle Scholar
  • 27 Tajiri M, Maehara T, Nakayama H et al. Decreased invasiveness via two methods of thoracoscopic lobectomy for lung cancer, compared with open thoracotomy. Respirology 2007; 12: 207-211
    CrossrefPubMedGoogle Scholar
  • 28 Nomori H, Horio H, Naruke T et al. What is the advantage of a thoracoscopic lobectomy over a limited thoracotomy procedure for lung cancer surgery?. Ann Thorac Surg 2001; 72: 879-884
    CrossrefPubMedGoogle Scholar
  • 29 Kaseda S, Aoki T, Hangai N et al. Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg 2000; 70: 1644-1646
    CrossrefPubMedGoogle Scholar
  • 30 Whitson BA, Andrade RS, Boettcher A et al. Video-assisted thoracoscopic surgery is more favourable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg 2007; 83 (06) 1965-1970
    CrossrefPubMedGoogle Scholar
  • 31 Cattaneo SM, Park BJ, Wilton AS et al. Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications. Ann Thorac Surg 2008; 85 (01) 231-235
    CrossrefPubMedGoogle Scholar
  • 32 Garzon JC, Ng CSH, Sihoe ADL et al. Video- assisted thoracic surgery pulmonary resection for lung cancer in patients with poor lung function. Ann Thorac Surg 2006; 81: 1996-2003
    CrossrefPubMedGoogle Scholar
  • 33 Li WW, Lee TW, Lam SS et al. Quality of life following lung cancer resection: Video-assisted thoracic surgery vs thoracotomy. Chest 2002; 122: 584-589
    CrossrefPubMedGoogle Scholar
  • 34 Sugiura H, Morikawa T, Kaji M et al. Long-term benefits for the quality of life after video-assisted thoracoscopic lobectomy in patients with lung cancer. Surg Laparosc Endosc Percutan Tech 1999; 9: 403-408
    PubMedGoogle Scholar
  • 35 Petersen RP, Pham D, Burfeind WR et al. Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg 2007; 83: 1245-1249
    CrossrefPubMedGoogle Scholar
  • 36 Nakajima J, Downey RJ, Cheng D et al. Video assisted thoracic surgery in lung cancer resection: a consensus statement of the Int. Society of Minimally Invasive Cardiothoracic Surgery. Innovations 2007; 2 (06) 293-302
    CrossrefPubMedGoogle Scholar
  • 37 S3-Leitlinie zur Prävention, Diagnostik. Therapie und Nachsorge des Lungenkarzinoms. Pneumologie 2010; 64 (02) 23-155
    PubMedGoogle Scholar
  • 38 Scott WJ, Howington J, Feigenberg S et al. Treatment of Non-small Cell Lung Cancer Stage I and Stage II, ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition). CHEST 2007; 132: 234-242
    CrossrefPubMedGoogle Scholar
  • 39 Lim E, Baldwin D, Beckles M et al. Guidelines on the radical management of patients with lung cancer. Thorax 2010; 65 (Suppl. 03) 1-27
    CrossrefPubMedGoogle Scholar