Article Abstract

Video-assisted thoracic surgery double sleeve lobectomy for non- small cell lung cancer: a report of seven cases

Authors: Jiandong Mei, Chenglin Guo, Qiang Pu, Lin Ma, Chengwu Liu, Yunke Zhu, Hu Liao, Lunxu Liu


Background: Video-assisted thoracic surgery (VATS) double sleeve lobectomy has been rarely reported. We aimed to summarize the techniques and outcomes of this challenging procedure for non-small cell lung cancer (NSCLC) involving both the bronchus and pulmonary artery.
Methods:From May 2012 to December 2016, seven patients were selected for VATS double sleeve lobectomy at our center, including four cases of left upper lobectomy and three cases of right upper lobectomy. Surgical procedures were performed with four ports for the first patient and three ports for the other patients. The “hollow out” process was designed for hilum dissection. The main pulmonary artery and interlobar artery were then blocked using two releasable atraumatic endoscopic Bulldog Clamps. Bronchovascular reconstruction was accomplished by the “two-needle-holder suturing technique” through directly watching a video monitor. Low-molecular heparin was subcutaneously administered during the first week after surgery.
Results:The operations were uneventful. Surgical duration ranged from 250 to 480 min (median, 318 min) with blood loss between 30 to 200 mL (median, 200 mL). The average number of the dissected lymph nodes was 13 (range, 11–19). Two patients developed postoperative pneumonia with no mortalities. Prolonged air leak (>5 days) was observed in three patients. The median postoperative hospital stay was 15.5 days (range, 5–33 days). There were two cases of adenosquamous cell carcinoma and five cases of squamous cell carcinoma. One patient died of hemoptysis 50 days after surgery, and one died of metastatic lung cancer 2 years after surgery. The other five patients were alive without local recurrence at 4–58 months of follow-up.
Conclusions:VATS bronchovascular double sleeve lobectomy is technically difficult but feasible for skilled thoracoscopic surgeons in experienced centers. More data are encouraged to assess the long-term outcomes of this new procedure.