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

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 2
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

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    P1.07-047 - Could video-assisted thoracoscopic lobectomy plus mediastinal lymph node dissection be performed for non-small cell lung cancer in a low-volume hospital? (ID 3332)

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

    Background
    Video-assisted thoracoscopic lobectomy plus mediastinal lymph node dissection has been regularly performed for the treatment of patients with non-small cell lung cancer (NSCLC) in high-volume hospitals, owing to its advantage of less trauma and faster recovery. However, it is questioned whether it could be popularized more widely with worry about the technically difficulty and perioperative management. Up to date, no study has discussed the technical and clinical differences based on the number of this minimally invasive surgery performed per year. This study aimed to compare the clinical outcomes of video-assisted thoracoscopic lobectomy plus mediastinal lymph node dissection between a low-volume center (LVC) and a high-volume center (HVC).

    Methods
    This prospective study was conducted from January 2012 to December 2012 in a LVC and a HVC in the same city. Clinical features and operation characteristics of all patients were collected and compared to determine the differences between the 2 groups.

    Results
    A total of 511 cases with NSCLC were enrolled in this study. And 469 cases (91.8%) were performed in HVC, while 42 cases（8.2%）in LVC. There was no significant difference found between the two groups in age, gender, body mass index, ASA score, tumor location, histological type and clinical stage. LVC group has longer operation time (131.7±32.4min vs 89.2±39.4min, p=0.000) and more blood loss (125.7±97.1ml vs 82.7±52.6ml, p=0.000), compared with HVC group. However, the other clinical outcomes between LVC and HVC were similar, including the rate of conversion to thoracotomy (4.8% vs 1.9%, p=0.226), number of lymph nodes harvested (12.9±3.7vs 14.1±6.3, p=0.484), postoperative hospital stay (7.6±3.9d vs 6.8±2.7d, p=0.224), total complications (16.7% vs 12.8% , p=0.476) and 30-day mortality (0.0% vs 0.2% , p=1.000).

    Conclusion
    The study shows that video-assisted thoracoscopic lobectomy plus mediastinal lymph node dissection could also be performed feasibly and safely in LVC with similar clinical outcome, though the long term survival are still necessary to be confirmed with follow up.

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    P1.07-048 - Learning curve for video-assisted thoracoscopic Surgery lobectomy plus mediastinal lymph node dissection for non-small cell lung cancer: How many cases are needed to reach competence with guidance of consultant surgeon? (ID 3383)

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

    Background
    Video-assisted thoracoscopic surgery (VATS) lobectomy plus mediastinal lymph node dissection is an innovative technique shown to be minimally invasive and oncologically adequate for the treatment of non-small cell lung cancer (NSCLC), though it is technically difficulty. This study aimed to describe the learning curve for this minimally invasive surgery with guidance by consultant surgeon.

    Methods
    From September 2011 to March 2013, a total of 46 patients with NSCLC underwent VATS lobectomy plus mediastinal lymph node dissection in our low-volume center. The procedures were guided by experienced consultant surgeons. The patients were divided into three groups. Group A included the first 15 cases. Group B comprised cases No. 16 to 30, and group C included the final 16 cases. The demographic characteristics and the intra- and postoperative variables were collected retrospectively and analyzed.

    Results
    There was no significant difference found among the three groups in age, gender, body mass index, ASA score, tumor location, histological type and clinical stage. No postoperative death occurred. Two patients required conversion (1 in Group A, 1 in Group B). Compared with group A, a significant decrease in intrathoracic operative time (132±30 vs 185±29 min; P = 0.000), blood loss (128±64 vs 209±117ml; P =0.003), but more retrieved nodes (12.2±3.1 vs 9.3±2.5; P =0.014) was observed in group B, while the postoperative hospital stay was similar (9.9±3.3 vs 11.8±7.0 days; P =0.572). And compared with group B, the last 16 patients (group C) involved significantly less intrathoracic operative time (119±20 vs 132±30 min; P =0.091), less blood loss (92±43 vs 128±6ml; P =0.021), more retrieved nodes (14.3±3.4 vs 12.2±3.1; p=0.040) as well as a shorter postoperative hospital stay (6.8±2.5 vs 9.9±3.3 days; P =0.003). A decline in the overall morbidity from group A to group C (46.7%, 33.3%, 12.5, P = 0.098) was also observed.

    Conclusion
    This study suggests that at least 30 cases were needed to reach the plateau of VATS lobectomy plus mediastinal lymph node dissection for NSCLC. The guidance of experiened consultant surgeons might be meaningful to reduce the learning curve.