VATS-Lobektomie beim Stadium-I-Lungenkarzinom: Standard oder Experiment

Zusammenfassung

Die VATS-Lobektomie im Stadium I des nicht-kleinzelligen Lungenkarzinoms wird seit 1991 praktiziert, hat jedoch über einen langen Zeitraum erhebliche Zweifel an der Sicherheit und onkologischen Zulässigkeit des Verfahrens aufkommen lassen. Nur wenige randomisiert-kontrollierte Studien an kleinen Kollektiven sind durchgeführt worden, welche zeigen konnten, dass die VATS-Lobektomie dem offenen Verfahren im Hinblick auf technische Durchführbarkeit, Patientenkomfort und Langzeitprognose nicht unterlegen ist. Die zunehmende Akzeptanz der VATS-Lobektomie beruht jedoch überwiegend auf Fall-Kontroll-Studien und Fallserien mit Kollektiven von bis zu 1100 Patienten sowie Metaanalysen, die die Vorteile des Verfahrens belegen. Nach entsprechendem Training kann der Eingriff in adäquater Zeit und mit gleicher Sicherheit sowie onkologischer Radikalität ausgeführt werden. Patienten profitieren von einem geringeren Trauma und kürzerer Rekonvaleszenz. Die 5-Jahres-Überlebensraten unterscheiden sich nicht von jenen nach offenem Eingriff. Insofern darf die VATS-Lobektomie bei entsprechenden Patienten-seitigen und infrastrukturellen Voraussetzungen heute als Standardverfahren gelten.

Abstract

Video-assisted thoracoscopic surgery (VATS) for lobectomy in stage I non-small cell lung cancer (NSCLC) was introduced in 1991 and has been accompanied by concerns in terms of safety and oncological adequacy over a long period. Only few randomised controlled trials including a small number of patients have been performed, demonstrating non-inferiority of the technical feasibility, patient comfort and long-term prognosis compared with the open technique. The evolving acceptance of VATS lobectomy, however, is based on case-control series and case series including up to 1100 patients as well as reviews and metaanalyses demonstrating its overall advantages. Presuming appropiate training the VATS procedure can be accomplished rapidly, safely and without violation of oncological principles. Patients experience a less traumatic procedure and a shorter recovery. The 5-year survival is not different from that after open thoracotomy. In conclusion, VATS lobectomy may be regarded as standard in stage I NSCLC as long as the preconditions in terms of surgical training, patient selection and infrastructure are fulfilled.

Schlüsselwörter

Lungenkarzinom - VATS - Thorakotomie

Key words

lung cancer - VATS - thoracotomy

• Literatur

• 1 Grogan EL, Jones DR. VATS lobectomy is better than open thoracotomy: What is the evidence for short-term outcomes?. Thorac Surg Clin 2008; 18: 249-258
• 2 Flores RJ, Alam N. Video-assisted thoracic surgery lobectomy (VATS), open thoracotomy, and the robot for lung cancer. Ann Thorac Surg 2008; 85: 710-715
• 3 Whitson BA, Groth SS, Duval SJ et al. Surgery for early-stage non-small cell lung cancer: A systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg 2008; 86: 2008-2018
• 4 Yan TD, Black D, Bannon PG et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 2009; 27 (15) 2553-2562
• 5 Rocco G, Internullo E, Cassivi SD et al. The variability of practice in minimally invasive thoracic surgery for pulmonary resections. Thorac Surg Clin 2008; 18: 235-247
• 6 McKenna RJ. Complications and learning curves for video-assisted thoracic surgery lobectomy. Thorac Surg Clin 2008; 18: 275-280
• 7 Swanson SJ, Herndon JE, D’Amico TA et al. Video-assisted thoracic surgery lobectomy: Report of CALGB 39802 – A prospective, multi- institution feasibility study. J Clin Oncol 2007; 25: 4993-4997
• 8 Kirby T, Mack M, Landreneau J et al. Lobectomy: video-assisted thoracic surgery versus muscle-sparing thoracotomy – A randomized trial. J Thorac Cardiovasc Surg 1995; 109: 997-1001
• 9 Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg 2000; 24: 27-30
• 10 Craig SR, Leaver HA, Yap PL et al. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg 2001; 20: 455-463
• 11 Koizumi K, Haraguchi S, Hirata T et al. Lobectomy by video-assisted thoracic surgery for lung cancer patients aged 80 years or more. Ann Thorac Cardiovasc Surg 2003; 9: 14-21
• 12 Demmy TL, Curtis JJ. Minimally invasive lobectomy directed toward frail and high-risk patients: A case-control study. Ann Thorac Surg 1999; 68: 194-200
• 13 Nagahiro I, Andou A, Aoe M et al. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: A comparison of VATS and conventional procedure. Ann Thorac Surg 2001; 72: 362-365
• 14 Yim AP, Wan S, Lee TW et al. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg 2000; 70: 243-247
• 15 Nakata M, Saeki H, Yokoyama N et al. Pulmonary function after lobectomy: Video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg 2000; 70: 938-941
• 16 Balduyck B, Hendriks J, Lauwers P et al. Quality of life evolution after lung cancer surgery: A prospective study in 100 patients. Lung Cancer 2007; 56: 423-431
• 17 Roviaro G, Varoli F, Vergani C et al. Long term survival after video-assisted thoracoscopic surgery lobectomy for stage I lung cancer. Ann Thorac Surg 2003; 9 (01) 14-21
• 18 Iwasaki A, Shirakusa T, Shiraishi T et al. Results of video-assisted thoracic surgery for stage I / II non-small cell lung cancer. Eur J Cardiothorac Surg 2004; 26: 158-164
• 19 Yim AP, Izzat MB, Liu HP et al. Thoracoscopic major lung resection: An Asian perspective. Semin Thorac Cardiovasc Surg 1998; 10: 326-331
• 20 Lewis RJ, Caccavale RJ, Bocage JP et al. Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy. Chest 1999; 116: 1119-1124
• 21 He J, Shao W, Cao C et al. Long-term outcome and cost-effectiveness of complete versus assisted video-assisted thoracic surgery for non-small cell lung cancer. J Surg Oncol 2011; 104 (02) 162-168
• 22 Sagawa M, Sato M, Sakurada A et al. A prospective trial of systematic nodal dissection for lung cancer by video assisted thoracic surgery: can it be perfect?. Ann Thorac Surg 2002; 73: 900-904
• 23 Watanabe A, Koyanagi T, Ohsawa H et al. Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study. Surgery 2005; 138: 510-517
• 24 Swanson SJ, Batirel HF. Video-assisted thoracic surgery (VATS) resection for lung cancer. Surg Clin North Am 2002; 82 (03) 541-559
• 25 Demmy TL, Plante AJ, Nwogu CE et al. Discharge independence with minimally invasive lobectomy. Am J Surg 2004; 188 (06) 698-702
• 26 Demmy TL, Nwogu CE. Is video-assisted thoracic lobectomy better? Quality of life considerations. Ann Thorac Surg 2008; 85 (02) 719-728
• 27 Tajiri M, Maehara T, Nakayama H et al. Decreased invasiveness via two methods of thoracoscopic lobectomy for lung cancer, compared with open thoracotomy. Respirology 2007; 12: 207-211
• 28 Nomori H, Horio H, Naruke T et al. What is the advantage of a thoracoscopic lobectomy over a limited thoracotomy procedure for lung cancer surgery?. Ann Thorac Surg 2001; 72: 879-884
• 29 Kaseda S, Aoki T, Hangai N et al. Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg 2000; 70: 1644-1646
• 30 Whitson BA, Andrade RS, Boettcher A et al. Video-assisted thoracoscopic surgery is more favourable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg 2007; 83 (06) 1965-1970
• 31 Cattaneo SM, Park BJ, Wilton AS et al. Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications. Ann Thorac Surg 2008; 85 (01) 231-235
• 32 Garzon JC, Ng CSH, Sihoe ADL et al. Video- assisted thoracic surgery pulmonary resection for lung cancer in patients with poor lung function. Ann Thorac Surg 2006; 81: 1996-2003
• 33 Li WW, Lee TW, Lam SS et al. Quality of life following lung cancer resection: Video-assisted thoracic surgery vs thoracotomy. Chest 2002; 122: 584-589
• 34 Sugiura H, Morikawa T, Kaji M et al. Long-term benefits for the quality of life after video-assisted thoracoscopic lobectomy in patients with lung cancer. Surg Laparosc Endosc Percutan Tech 1999; 9: 403-408
• 35 Petersen RP, Pham D, Burfeind WR et al. Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg 2007; 83: 1245-1249
• 36 Nakajima J, Downey RJ, Cheng D et al. Video assisted thoracic surgery in lung cancer resection: a consensus statement of the Int. Society of Minimally Invasive Cardiothoracic Surgery. Innovations 2007; 2 (06) 293-302
• 37 S3-Leitlinie zur Prävention, Diagnostik. Therapie und Nachsorge des Lungenkarzinoms. Pneumologie 2010; 64 (02) 23-155
• 38 Scott WJ, Howington J, Feigenberg S et al. Treatment of Non-small Cell Lung Cancer Stage I and Stage II, ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition). CHEST 2007; 132: 234-242
• 39 Lim E, Baldwin D, Beckles M et al. Guidelines on the radical management of patients with lung cancer. Thorax 2010; 65 (Suppl. 03) 1-27