Minimally invasive approaches for en-bloc anatomical lung and chest wall resection

Abstract

Background: The aim of this study was to evaluate the feasibility of en-bloc anatomical lung and chest wall resection via minimally invasive surgery.Methods: Between January 2013 and December 2021, a total of 22 patients (18 males, 4 females; mean age: 63 & PLUSMN;6.9 years; range, 48 to 78 years) who underwent anatomical lung and chest wall resection using minimally invasive surgery for non-small cell lung cancer were retrospectively analyzed. Demographic, clinical, intra-and postoperative data of the patients, recurrence, metastasis, mortality, and overall survival rates were recorded.Results: The surgical technique was robot-assisted thoracic surgery in two, multiport video-assisted thoracoscopic surgery in 18, and uniport video-assisted thoracoscopic surgery in two patients. Upper lobectomy was performed in 17 (77.3%) patients, lower lobectomy in three (13.6%) patients, and upper lobe segmentectomy in two (9.1%) patients. Five different techniques were used for chest wall resection. Nine (40.9%) patients had one, eight (36.4%) patients had two, four (18.2%) patients had three, and one (4.5%) patient had four rib resections. Chest wall reconstruction was necessary for only one of the patients. The mean operation time was 114 & PLUSMN;36.8 min. Complete resection was achieved in all patients. Complications were observed in seven (31.8%) patients without mortality. The mean follow-up was 24.4 & PLUSMN;17.9 months. The five-year overall survival rate was 55.3%. Conclusion: Segmentectomy/lobectomy and chest wall resection with minimally invasive surgery are safe and feasible in patients with non -small cell lung cancer. In addition, the localization of the area where chest wall resection would be performed should be considered the most crucial criterion in selecting the ideal technique.