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Video-Assisted Thoracoscopic Lung Resection Following Video-Assisted Mediastinoscopic Lymphadenectomy in the Cure of Non-Small Cell Lung Cancer

Ahmed Abdelaziz Abdellatif*, Akram Allam, Samir Keshk, Abdelmaguid Ramadan, Walid Abuarab, Rita Daniela Marasco, Aniello Della Morte, Gabriella Giudice, Cosimo Lequaglie

Aim: The aim of this study was to evaluate the technical feasibility and limitations of video-assisted mediastinoscopic lymphadenectomy (VAMLA) followed by video-assisted thoracoscopic surgery (VATS) lobectomy and video-assisted thoracoscopic surgery (VATS) lobectomy alone in treating patients with non-small cell lung cancer.
VATS lobectomy alone or following VAMLA is feasible and can be done with an acceptable safety profile under the hands of specialized, highly trained and cooperating team working in a high volume center treating patients with lung cancer. VAMLA followed by VATS lobectomy allowed the excision of more lymph nodes compared to the VATS approach alone, suggesting that VAMLA is a good adjuvant to VATS lobectomy for complete radical mediastinal lymphadenectomy for the surgical cure of non-small cell lung cancer patients.
Over the last decade we witnessed significant change of practice in many thoracic units within the hands of a new generation of young minimally invasive thoracic Surgeons. The goal of our research was to evaluate the technical feasibility and limitations of video-assisted mediastinoscopic lymphadenectomy (VAMLA) followed by video-assisted thoracoscopic surgery (VATS) lobectomy and video-assisted thoracoscopic surgery (VATS) lobectomy alone in treating patients with non-small cell lung cancer. A prospective study from September 2015 to September 2016 involving 22 non-small cell lung cancer patients admitted to the Department of Thoracic Surgery of the Referral Oncologic Center of Basilicata (IRCCS-CROB), Italy, was done. Six patients underwent a combination of subsequent VAMLA and VATS lobectomy (Group A), whereas sixteen patients underwent lobectomy and mediastinal lymphadenectomy using thoracoscopy only (Group B). Comparison between the two studied groups was done regarding the baseline characteristics, operative profiles and complications. Males were more than females (17 patients vs. 5 patients) respectively. The most common tumour was T1 (18 patients). And, the most common encountered tumour was adenocarcinoma (17 Patients). Our results highlighted that the lobectomy operative time was shorter in (Group A), (117 minutes) compared to (Group B), (157.5 minutes). The total number of mediastinal lymph nodes excised in (Group A), (18 lymph nodes) was more than (Group B), (12.5 lymph nodes). VATS lobectomy alone or following VAMLA is feasible and can be done safely under the hands of specialized, highly trained and cooperating team working in a high volume center treating lung cancer patients.