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Combined videothoracoscopic and videomediastinoscopic approach improves radicality of minimally invasive mediastinal lymphadenectomy for early stage lung carcinoma

^a Lungenzentrum Koblenz, Department of Thoracic Surgery, Katholisches Klinikum Koblenz, Germany
^b Lungenzentrum Koblenz, Department of Pneumology, Katholisches Klinikum Koblenz, Germany

Received 17 June 2008; received in revised form 16 September 2008; accepted 23 September 2008.

^_* Corresponding author. Address: Katholisches Klinikum Koblenz, Department of Thoracic Surgery, Kardinal-Krementz-Street 1-5, 56073 Koblenz, Germany. Tel.: +49 261 496 9027; fax: +49 261 496 6469. (Email: b.witte{at}kk.koblenz.de).

Objectives: To assess the feasibility and radicality of a combined thoracoscopic and mediastinoscopic approach to mediastinal lymphadenectomy compared to thoracoscopy only for minimally invasive management of early stage lung carcinoma. Methods: Prospective observational study of patients undergoing anatomical thoracoscopic lung resection for lung carcinoma in our department in 2007. Mediastinal lymphadenectomy was performed either thoracoscopically (VATS group) or by a combination of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and thoracoscopy (VAMLA + VATS group). Inclusion criteria for the study were: stage Ia on CT scan, no central tumor at bronchoscopy, and no contraindications against lobectomy or segmentectomy. Results: Eighteen VAMLA + VATS and fourteen VATS patients were studied. For histology, pTNM stage, type of resection, semiquantitative assessment of the fissure and vascular dissection plane, conversions, blood loss, operation time, adverse events and drainage time, no differences between the two groups were observed. In the VATS group, there was a slight preponderance of women, and right-sided tumors. In the VAMLA + VATS group, both the number of dissected mediastinal lymph node stations (mean, 6.4 stations vs 3.6 stations) and the weight of the mediastinal specimen (median, 11.2 groups vs 5.5 groups), were significantly higher than in the VATS group (p < 0.05). Conclusions: A combined approach by VATS and VAMLA improves radicality of minimally invasive mediastinal lymphadenectomy without increase in operation time, morbidity, and drainage time.

Key Words: Lung carcinoma • Lymphadenectomy • Mediastinum • Mediastinoscopy • Minimally invasive surgery • VAMLA • VATS lobectomy