[Totally endoscopic major pulmonary resection for stage I bronchial carcinoma: initial results]

Several series of video-assisted (VATS) major pulmonary resection (MPR) for non small cell bronchial carcinoma (NSCBC) have been published recently. However, totally endoscopic MPR is still very uncommon. We report the initial results of a recent series of 71 patients.

From 2007 to 2009, 635 patients had a major pulmonary resection (pneumonectomy, lobectomy or segmentectomy) for NSCBC. Seventy-one out of these patients (11%) in whom a clinical stage I NSCBC was strongly suspected were operated on via a totally endoscopic approach, without mini-thoracotomy or utility incision. Sixty-three had a lobectomy and 8 a segmentectomy. There were 2 conversions to thoracotomy (2.8%), for a fused fissure (1 patient) and for tight pleural adhesions (1 patient). The resection was completed by a radical lymphadenectomy in all patients.

For the 69 patients who had a totally endoscopic procedure, there was no mortality. No intraoperative complications occurred. The mean duration of operation was 226 minutes + or - 38 (range: 137-307 minutes). The mean intraoperative blood loss was 111 cc + or - 93 (range: 0-450 cc). Final pathological examination confirmed stage I NSCBC in 52 patients while 9 NSCBC were upstaged pN1 (n = 6) or pN2 (n = 3). In 8 cases, another type of malignant tumour was found. The mean number of lymph nodes collected was 21 + or - 8 after right-side lymphadenectomy and 23 + or - 8 after left-side lymphadenectomy and the mean number of dissected lymph node stations was 3 (range:2-5). Postoperative morbidity was 23%. The mean postoperative stay was 6.9 days + or - 2 (range: 3-12 days).

MPR via a totally endoscopic approach is safe and fulfils the criteria for an oncological resection.