Objective To explore current view and application status of video-assisted thoracoscopic surgery （VATS） of thoracic surgeons in some municipal hospitals in China，and provide evidence for further VATS study and training.Methods We conducted a questionnaire study for thoracic surgeons in municipal hospitals who attended the 5th West China Forum on Mini-invasive Thoracic Surgery in 2012. The questionnaire content included general descriptions of the thoracic surgeons，the departments of thoracic surgery where they worked，and VATS application status in their hospitals. A total of 263 surgeons were investigated，and 183 （69.58%） valid questionnaires were collected for descriptive analysis.Results （1） Responders’ view of VATS：There were 89.62% （164/183） responders who believed that the advantages of VATS were mainly mini-invasive and fast postoperative recovery，while its disadvantage was high cost （76.50%，140/183）. There were 71.04% （130/183） responders who thought that VATS lobectomy could provide a higher postoperative quality of life for lung cancer patients，while only 12.57% （23/183） responders thought that the 5-year survival rate of VATS was higher than that of open thoracotomy. There were 60.11% （110/183） responders who believed that VATS was less widely performed in China than America，but VATS level of very few hospitals in China was superior or equal to American level. There were 52.46% （96/183） responders who agreed that VATS could be used for the treatment of locally advanced lung cancer. （2） Training situation of VATS lobectomy for lung cancer：Learning class or short-term training （32.24%，59/183） was the best way to learn VATS lobectomy. Their main learning process was from open thoracotomy to mini- thoracotomy then to VATS （60.66%，111/183）. Single-direction thoracoscopic lobectomy was the most popular VATS technique （54.64%，100/183），and its learning curve was at least 30 cases （26.78%，49/183）. （3） VATS application status：VATS was performed in all the hospitals investigated. Benign thoracic diseases were most commonly chosen by thoracic surgeons who started to perform VATS （81.42%，149/183）. The main initial hurdles of VATS lobectomy for lung cancer included poor operation theater conditions and surgical teamwork （39.34%，72/183） as well as unsatisfactory surgical techniques （36.07%，66/183）. Further improvement of VATS technique （118/183，64.48%） was the developmental trend of VATS. Conclusions Thoracic surgeons in China have reached the consensus on the application of VATS for surgical treatment of thoracic diseases including lung cancer. Single-direction thoracoscopic lobectomy is a widely accepted technique. Further trends of VATS training and development are equipment upgrade and better teamwork.
Objective To evaluate the safety，efficacy，short- and long-term clinical outcomes of complete video-assisted thoracoscopic surgery （VATS） lobectomy for non-small cell lung cancer （NSCLC）. Methods Clinical data of231 consecutive patients with NSCLC who underwent complete VATS lobectomy in the First Affiliated Hospital of NanjingMedical University between June 2006 and March 2011 were retrospective analyzed. There were 132 male and 99 femalepatients with their age of 15-81 （59.51±11.90） years. Preoperative cancer staging wasⅠa in 149 patients，Ⅰb in 50 patients，Ⅱa in 14 patients，Ⅱb in 13 patients and Ⅲa in 5 patients. There were 152 patients with adenocarcinoma，41 patients with squamous carcinoma，23 patients with bronchioalveolar carcinoma，5 patients with adenosquamous carcinoma，4 patients with large cell carcinoma，and 6 patients with other carcinoma. Follow-up data were statistically analyzed，and short-and long-term survival rates were calculated. Results No perioperative mortality was observed. Operation time was 60-370（199.14±51.04） minutes，and intraoperative blood loss was 10-2 300 （168.19±176.39） ml. Thirty-seven patients had postoperative complications including air leak，pulmonary infection，atelectasis，arrhythmia，subcutaneous emphysema andothers，who were all cured after conservative treatment. Mean number of dissected lymph nodes was 11.14±5.49，and meannumber of explored nodal stations was 3.66±1.52. There were 51 patients （22.08%） whose postoperative cancer staging wasmore advanced than preoperative cancer staging. Postoperative hospital stay was 3-36 （10.79±5.13） days. Primary causesof prolonged postoperative hospitalization included pulmonary air leak，pulmonary infection，preoperative concomitant chronic pulmonary diseases （COPD，asthma），and moderate to severe pulmonary dysfunction. A total of 228 patients werefollowed up for a mean duration of 40.83 months （22-82 months），and 3 patients were lost during follow-up. Overall 5-yearsurvival rates were 85.78%，52.54% and 32.70% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. Five-year cancerfreesurvival rates were 80.00%，45.37% and 20.99% for stageⅠ，stageⅡand stageⅢ-Ⅳpatients respectively. ConclusionThe advantages of VATS lobectomy include smaller surgical incision，less injury and postoperative pain，quicker postoperative recovery and shorter hospital stay. Long-term survival rate is comparable to previous international and Chinese studies. VATS lobectomy can anatomically achieve complete tumor resection and systematic lymph node dissection. VATS lobectomy will become a standard surgical procedure for NSCLC patients.
Abstract： Objective To evaluate video-assisted thoracic surgery（VATS）and minimal incision thoracotomy（MIT）lobectomy for early stage non-small cell lung cancer patients and the impact upon postoperative quality of life（QOL）. Methods A prospective randomized controlled trial was conducted. From January 1, 2008 to December 10, 2011, the qualified patients with early stage NSCLC were recruited and randomized to VATS group （57 patients）and MIT group（49 patients）, totally 106 patients，57 males and 49 females, aged 57.60 years. The quality of life was assessed using Lung Cancer Symptom Scale （LCSS） before operation and at 1,3,6,9,12 months after operation. Results There were no significant differences between the 2 groups in age, sex, the location of tumor, tumor pathologic stage, pathological types, postoperative complications, tumor size, operative time, operative bleeding and air leak days. There were no symptoms after operation at the VATS group worse than the leve before operation. Five major symptoms, including appetit（1.04±0.71 vs.2.00±0.83, F=6.357，P=0.021）, fatigue （4.55±1.17 vs.10.19±2.10, F=4.721，P=0.043）, dyspnea（2.18±0.86 vs.10.26±2.05, F=10.020，P=0.005）, normal activity（5.16±1.70 vs.17.60±3.17, F=12.319，P=0.002）at the MIT group were deteriorated significantly at 1 month after the operation （P＜0.05）. Conclusion The VATS will lead to better quality of life for the patients with early stage NSCLC after surgery and lead to a smooth postoperative recovery.