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

TLDR

The study assessed the technical feasibility and safety of video‑assisted thoracic surgery lobectomy for small non‑small‑cell lung cancers. A prospective, multi‑institutional trial enrolled 128 patients with peripheral lung nodules ≤3 cm, performing VATS lobectomy with a standardized approach (single 4–8 cm access and two 0.5 cm ports, videoscopic guidance, no rib spreading) and recorded operative details such as a median 130‑minute duration and 3‑day chest‑tube stay. Of 111 stage‑I patients, 96 (86.5 %) underwent successful VATS lobectomies, with a 2.7 % 30‑day mortality and 7.4 % rate of grade 3 or higher complications, confirming feasibility of the standardized VATS approach.

Abstract

To evaluate the technical feasibility and safety of video-assisted thoracic surgery (VATS) lobectomy for small lung cancers.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 < or = 3 cm in size with suspected NSCLC were prospectively registered for VATS lobectomy.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.A standardized approach to VATS lobectomy as specifically defined with avoidance of rib spreading is feasible.