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Video-Assisted Thoracic Surgery Lobectomy: Report of CALGB 39802—A Prospective, Multi-Institution Feasibility Study

Scott J. Swanson, James E. Herndon, II, Thomas A. D'Amico, Todd L. Demmy, Robert J. McKenna, Jr, Mark R. Green, David J. Sugarbaker

From the Surgery Committee of the Cancer and Leukemia Group B (CALGB), Statistics Office of CALGB, and Respiratory Committee of CALGB, Chicago, IL

Address reprint requests to Scott J. Swanson, MD, Division of Thoracic Surgery, Mt Sinai Medical Center, 1190 5th Ave, New York, NY 10029; e-mail: Scott.Swanson{at}mountsinai.org

Purpose To evaluate the technical feasibility and safety of video-assisted thoracic surgery (VATS) lobectomy for small lung cancers.

Patients and Methods The Cancer and Leukemia Group B 39802 trial was a prospective, multi-institutional study designed to elucidate the technical feasibility of VATS in early non–small-cell lung cancer (NSCLC) using a standard definition for VATS lobectomy (one 4- to 8-cm access and two 0.5-cm port incisions) that mandated videoscopic guidance and a traditional hilar dissection without rib spreading. Between 1998 and 2001, 128 patients with peripheral lung nodules 3 cm in size with suspected NSCLC were prospectively registered for VATS lobectomy.

Results One hundred twenty-seven patients (66 males and 61 females; median age, 66 years; range, 37 to 86 years), with a performance status of 0 (74%) or 1 (26%), underwent surgery. Patients with lymph nodes more than 1 cm by computed tomography scan underwent mediastinal lymph node sampling to rule out N2 disease. One hundred eleven patients (87%) had stage I lung cancer, and 96 (86.5%) of these 111 patients underwent successful VATS lobectomies. The median procedure length was 130 minutes (range, 47 to 428 minutes), and median chest tube duration was 3 days (range, 1 to 14 days). Fifty-eight (60%) of 97 patients underwent diagnostic biopsy at lobectomy. Within 30 days, three (2.7%) of 111 patient deaths occurred, none of which were directly related to VATS technique; seven (7.4%) of 95 patients had grade 3 or greater complications, with only one case of bleeding.

Conclusion A standardized approach to VATS lobectomy as specifically defined with avoidance of rib spreading is feasible.

Supported by the National Cancer Institute Grants No. UO1 CA65170 and U10 CA59594.

Presented at the 38th Annual Meeting of the American Society of Clinical Oncology, May 18-21, 2002, Orlando FL.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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