Author of

• 10643

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  P1.07 - Poster Session 1 - Surgery (ID 184)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10656

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    P1.07-013 - "Minimally invasive small incision, muscle- and rib-sparing thoracotomy, minimally invasive lung cancer radical surgery", cures "aging, cardiopulmonary dysfunction patients with lung cancer" (ID 1300)

    09:30 - 09:30  |  Author(s): H. Li
    • Abstract

    Background
    Developing "minimally invasive small incision, muscle- and rib-sparing thoracotomy (miMRST), minimally invasive lung cancer radical surgery", to cure aging, cardiopulmonary dysfunction patients with lung cancer, who could not tolerate traditional large-incision posterolateral thoracotomy. Typical cases will be discussed here.

    Methods
    Man, aged 64, left lower lobe lesions 1.0cm, localized in central, deep part, not suitable for needle-biopsy, nor for wedge resection; smoking for 44 years, with serious chronic bronchitis 15 years, asthma episodes per year; coronary heart disease 13 years, coronary stenting 10 years; anticoagulation 10 years; serious gastric ulcers, colorectal polyps 2 years. Consulted in hospitals in Shenyang and Beijing for months, advised for follow-up considering his current cardiopulmonary condition and no malignant evidence. Then referral to China Medical University Lung Cancer Center in Dec 26, 2012. Surgical resection was advised at once. Preoperative examination: pulmonary function test revealed airway dysfunction, low blood oxygen. Anti-inflammatory, antispasmodic strategy and preoperative pulmonary function exercise did not improve lung function as expected. The patient was discussed not suitable for regular thoracotomy, unable to tolerate the damage from traditional large-incision posterolateral thoracotomy. “miMRST, minimally invasive lung cancer radical surgery” was scheduled.

    Results
    About 10cm lateral chest incision was enough for most lung cancer resection and mediastinal lymph nodes dissection. Latissimus dorsi and serratus anterior muscles were protected, chest cavity entered through intercostals space, no rib cut. Widespread intrathoracic adhesions, localized severe adhesions, and undifferentiated lung fissures were confirmed. The lesion was found in left lower lobe, adjacent to pulmonary vessels not suitable for wedge resection; swollen lymph nodes adhered around pulmonary vessels were confirmed. Left lower lobe resection, and No.3A,4,5,6,7,8,9,10,11,12,12u,13,14 group regional and mediastinal lymph nodes and surrounding adipose tissue were dissected. When awake after surgery, operative lateral upper limb recovered freedom of movement; the patient got out of bed in the 2nd postoperative day with catheter unplugged in the same day; the chest tube pull out in the 3rd postoperative day; no complications happened. Pathological examination reported lung squamous cell carcinoma, no lymph nodes metastasis. The patient recovered much better and quickly than other patients who received lung cancer resection via traditional standard posterolateral thoracotomy.

    Conclusion
    "miMRST", "minimally invasive small incision, muscle- and rib-sparing thoracotomy, minimally invasive lung cancer radical surgery", shows advantage of small incision, less pain; less damage; quick recovery, better recovery; operative side upper extremity activities early, pulling out catheter early, get out of bed early, being out of ICU early, chest tube pulled out early; stopping antibiotics early, discharge early; no need using expensive rib nails because of no-rib-cut; no need using expensive thoracoscopic vessel staples; almost no complications; significantly less cost. "miMRST ", is minimally invasive thoracic surgery, very suitable for aging, cardiopulmonary dysfunction patients with lung cancer, who could not tolerate traditional large-incision posterolateral thoracotomy. "miMRST ", is also economical, no need using expensive thoracoscopic devices, to some degree, very suitable for lung cancer surgery in developing countries. (This study was partly supported by the Fund for Scientific Research of The First Hospital of China Medical University, No.FSFH1210).