tailieunhanh - Difficult Decisions in Thoracic Surgery - part 4

Sự khác biệt về chỉ định, kỹ thuật, và mức độ bóc tách hạch bạch huyết làm cho so sánh giữa các nghiên cứu khó khăn. Nếu người ta có thể thực hiện các hoạt động tương tự về bóc tách giải phẫu và loại bỏ các hạch bạch huyết như thực hiện thông qua mở ngực | 16. Video-Assisted Thorascopic Surgery Major Lung Resections 145 require a total of 385 patients to demonstrate superiority. Differences in indications technique and extents of lymph node dissection make comparing across studies difficult. If one can perform the same operation in terms of anatomical dissection and lymph node removal as done through thoracotomy then it would seem reasonable to use VATS as long as sound oncologic principles were practiced. Our practice has been to offer VATS lobectomy to patients with clinical stage I disease by computed tomography CT and positron emission tomography PET scan. Our technique uses a 4-cm utility incision with no rib spreading two 2-cm thoracoscopic ports and dissection performed totally under thoracoscopic Dissection involves the individual ligation of hilar structures an anatomical lobectomy and a mediastinal node dissection or sampling. If there is any indication of oncologic compromise a thoracotomy is performed. Lobectomy remains the standard of care for all early lung cancers. The use of simultaneous stapling techniques is probably not warranted. In light of the increased number of bilobectomies performed by one center due to the inadequacy of their lymph node removals it would seem that this is not the same operation as an open lobectomy. Therefore our recommendation is that the simultaneous stapled technique not be considered a VATS lobectomy. . Future Studies There is certainly a need for further study. A large multicenter randomized trial comparing open lobectomy to VATS lobectomy should be performed. However the myriad of techniques employed by different surgeons would require a standardization of the VATS lobectomy technique and probably standardization in the thoracotomy arm as well. Quality-of-life studies with validated instruments need to be performed to ascertain the impact of VATS. Another interesting avenue of investigation that has been embarked on but requires further study is .