Abstract

To provide a less invasive procedure in video-assisted thoracic surgery (VATS), it is necessary to evaluate two types of VATS approaches in terms of clinical outcome, especially cancer recurrence.

We conducted a prospective feasibility study of two strictly defined types of VATS lobectomy by prospective cohort. Based on a patients’ decision after a similar preoperative explanation, cancer recurrence and long-term-prognosis were evaluated by comparing among assisted VATS and complete VATS groups.

One-hundred-four consecutive patients with clinical T1N0M0 non-small cell lung cancer (NSCLC) were analyzed. Twenty-six cases (ASSIST group) chose lobectomy performed through an anterolateral small thoracotomy with the use of a rib spreader in combination with a thoracoscopic view and direct view. Seventy-eight cases (PURE group) chose complete VATS in which only a monitor was used during smaller access thoracotomy without a rib spreader. Patients in the PURE group exhibited early recovery from surgery. The recurrence rate was equivalent (both 19.2%). At 2,039 days of a median follow-up period, the recurrence pattern was also similar between the two groups; however, two cases (2.6%) of pleural dissemination appeared only in the PURE group. Specific clinicopathological characteristics were not confirmed in the recurrent cases. Recurrence-free and overall 5-year survival rates were equivalent between the two groups.

Both PURE and ASSIST are feasible in terms of cancer recurrence and long-term prognosis.