Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve.
J Cardiothorac Surg
; 11(1): 130, 2016 Aug 05.
Article
em En
| MEDLINE
| ID: mdl-27496022
ABSTRACT
BACKGROUND:
The development of a video assisted thoracic surgery lobectomy (VATS-L) program provides a dedicated surgical team with a recognized learning curve (LC) of 50 procedures. We analyse the results of our program, comparing the LC with subsequent cases.METHODS:
From June 2012 to March 2015, we performed n = 146 VATS major pulmonary resections n = 50 (Group A LC); n = 96 (Group B). Pre-operative mediastinal staging followed the National Comprehensive Cancer Network guidelines. All procedures were performed using a standard anterior approach to the hilum; lymphadenectomy followed the NCCN recommendations. During the LC, VATS-L indication was reserved to clinical stages I, therefore evaluated case by case.RESULTS:
Mean operative time was 191 min (120-290) in Group A and 162 min (85-360) in Group B (p <0,01). Pathological T status was similar between two Groups. Lymphadenectomy included a mean of 5.8 stations in Group A and 6.6 in Group B resulting in pN0 disease Group A n = 44 (88 %), Group B n = 80 (83.4 %); pN1 Group A n = 3 (6 %), Group B n = 8 (8.3 %); pN2 Group A n = 3 (6 %), Group B n = 8 (8.3 %). Conversion rate was 8 % in group A (n = 4 vascular injuries); 1.1 % in Group B (n = 1 hilar lymph node disease). We registered n = 6 (12 %) complications in Group A, n = 10 (10.6 %) in Group B. One case (1.1 %) of late post-operative mortality (90 days) was registered in Group B for liver failure. Mean hospital stay was 6.5 days in Group A and 5.9 days in Group B.CONCLUSIONS:
We confirm the effectiveness of a VATS-L program with a learning curve of 50 cases performed by a dedicated surgical team. Besides the LC, conversion rate falls down, lymphadenectomy become more efficient, indications can be extended to upper stages.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pneumonectomia
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Cirurgia Torácica Vídeoassistida
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Curva de Aprendizado
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Neoplasias Pulmonares
/
Excisão de Linfonodo
Tipo de estudo:
Guideline
/
Observational_studies
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
J Cardiothorac Surg
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Itália