Thoracoscopic pneumonectomy for lung cancer

The advantages of thoracoscopic surgery are confirmed by the results of numerous studies. The main ones are: a reduced period of inpatient stay, less surgical trauma, blood loss, the need for narcotic analgesics, early recovery, accelerated rehabilitation and a high quality of life. In addition, if necessary, an earlier beginning of adjuvant treatment is possible. The accumulated experience of endoscopic surgery makes it possible to significantly expand the indications for performing thoracoscopic procedures. At the same time, the tendency toward a lung preserving surgery, namely, a reduction in the frequency of pneumonectomies, limits the use of minimally invasive technologies in this category of patients. Today the main indication for thoracoscopic approach is I–II stage of lung cancer, when it is possible to perform lob- and bilobectomy. Nevertheless, there is a small group of patients who, due to the impossibility of performing a sleeve resection, need to remove the entire lung, often with resection of surrounding structures or bronchoplasty. The article describes the main technical steps for performing thoracoscopic left pneumonectomy. 

2. Whitson B., Groth S., Duval S., Swanson S. 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 (6): 2008-16.

3. Whitson B., Andrade R., Boettcher A., Bardales R., et al. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg. 2007; 83 (6): 1965-70.

4. Villamizar N., Darrabie M., Burfeind W. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg. 2009; 138: 419-25.

5. Murakawa T., Ichinose J., Hino H., Kitano K., et al. Long-term outcomes of open and video-assisted thoracoscopic lung lobectomy for the treatment of early stage non-small cell lung cancer are similar: a propensity-matched study. World J Surg. 2015; 39 (5): 1084-91.

6. Agostini P., Lugg S., Adams K., Vartsaba N., et al. Postoperative pulmonary complications and rehabilitation requirements following lobectomy: a propensity score matched study of patients undergoing video-assisted thoracoscopic surgery versus thoracotomy. Interact Cardiovasc Thorac Surg. 2017 Mar 8. doi: 10.1093/icvts/ivx002.

7. Detterbeck F., Egan T. Thoracoscopy using a substernal hand-port for palpation. Ann Thorac Surg. 2004; 78: 1031-6.

8. Walker W., Carnochan F., Mattar S. Video-assisted thoracoscopic pneumonectomy. Br J Surg. 1994; 81: 81-2.

9. McKenna R.Jr, Fischel R., Wolf R., Wurnig P. Video-assisted thoracic surgery (VATS) lobectomy for bronchogenic carcinoma. Semin Thorac Cardiovasc Surg. 1998; 10: 321-5.

11. Liu H., Chang C., Lin P., Chang J., et al. Thoracoscopic assisted lobectomy. Preliminary experience and results. Chest. 1995; 107: 853-5.

12. Podbielski F., Marquez G., Nelson D., Diettrich N., et al. Thoracoscopic assisted pneumonectomy. JSLS. 1997; 1: 75-7.

13. Yim A. VATS major pulmonary resection revisited controversies, techniques, and results. Ann Thorac Surg. 2002; 74: 615-23.

14. Craig S., Walker W. Initial experience of video assisted thoracoscopic pneumonectomy. Thorax. 1995; 50: 392-5.

15. Roviaro G., Varoli F., Vergani C. Techniques of pneumonectomy: video-assisted thoracic surgery pneumonectomy. Chest Surg Clin N Am. 1999; 9: 419-36.

16. Nwogu C., Glinianski M., Demmy T. Minimally invasive pneumonectomy. Ann Thorac Surg. 2006; 82: e3-e4.

17. Conlan A., Sandor A. Total thoracoscopic pneumonectomy: indications and technical considerations. J Thorac Cardiovasc Surg. 2003; 126 (6): 2083-5.

18. Sagawa M., Sato M., Sakurada A. A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg. 2002; 73: 900-4.

19. Nwogu C., Yendamuri S., Demmy T. Does thoracoscopic pneumonectomy for lung cancer affect survival? Ann Thorac Surg. 2010; 89: 2102-6.

20. Hung W., Liao H., Cheng Y., Cen J. Nonintubated thoracoscopic pneumonectomy for bullous emphysema. Ann Thorac Surg. 2016; 102 (4): 353-5.

21. Kara H., Javidfar J., Hirji S., Balderson S., et al. Thoracoscopic pneumonectomy in management of histoplasmosis and fibrosing mediastinitis. Ann Thorac Surg. 2014; 98 (4):95-6.

22. Kim A., Fonseca A., Boffa D., Detterbeck F. Experience with thoracoscopic pneumonectomies at a single institution. Innovations. 2014; 9: 82-6.