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Lung cancer is the leading cause of cancer death in the United
States, with approximately 180,000 new cases diagnosed each
year. Traditionally, open-chest surgical resection offers the
best chance of a cure for patients with a locally controlled
cancer. For early-stage lung cancer patients, new video-assisted
thoracic surgery reduces hospital stay and enables a rapid
recovery with less pain.
According to David Wyatt, MD, UF College of Medicine associate
professor of thoracic and cardiovascular surgery, video-assisted
thoracic surgery, or VATS, has been commonly performed in the
past for pleural diseases and biopsy purposes. In recent years
the use of this less-invasive technique for anatomic lobectomy
has slowly developed.
"For the past decade thoracic surgeons have studied VATS
lobectomy for clinical Stage I tumors with close observation
centered around safety, the adequacy of an oncology procedure
and whether or not it truly benefited the patient," Wyatt said.
After performing several surgeries of his own, Wyatt concludes
that patients do benefit from VATS lobectomy. His findings are
supported by multiple hospitals in the United States now
reporting studies that consistently demonstrate a three to
five-year survival rate, which equals that of traditional open
procedures. Survival at five years is reported by some centers
to be as high as 97 percent.
"It is now known that VATS offers a shorter average hospital
stay and lower complication and mortality rates. Patients are
shown to have better pulmonary function, less pain and higher
quality-of-life scores post operatively. These benefits also
have been shown to exist for high-risk and elderly patients,"
Wyatt said. "Most patients may return to normal activities
within two weeks."
In 2006, McKenna et. Al., reported in Annals of Thoracic Surgery
that in a single-institutional study of 1,100 VATS lobectomies,
0.8 percent resulted in mortality, and the mean length of
hospital stay post operatively was 4.78 days. Half of the
patients were discharged in three days or less.
During a VATS lobectomy, Wyatt makes three 1-inch incisions and
one 3-to-4-inch incision in the chest, providing access to the
chest cavity without the traditional muscle-splitting and
rib-spreading process. He inserts a thoracoscopic camera and
surgical instruments into the incisions, which project guided
images onto a flat-panel monitor. He removes the tumor or
affected tissue through the incisions. If an early-stage cancer
tumor is being removed, he typically removes or biopsies the
lymph nodes in the mid-chest area to ensure that the cancer has
not spread.
Early-stage lung cancers (tumors under 3 cm that have not spread
beyond the lungs) or undiagnosed solitary pulmonary nodules
suspicious for bronchogenic carcinoma, now are candidates for
VATS lobectomies.
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