Video-Assisted Thoracoscopic Surgery Technique for Pneumonectomy Shown to Be Safe

“In the largest series of its kind to date, researchers at Roswell Park Cancer Institute (RPCI) have shown that performing thoracoscopic pneumonectomy, removal of the entire lung through a minimally invasive endoscopic approach, at a high-volume center appears to be safe and may provide pain and survival advantages in the long term.

“ ‘During the past 20 years, portions of the lungs have been removed for lung cancer through lobectomies, and that has been shown to be better done through small incisions or through thoracoscopic lobectomy compared with standard, open lobectomy,’ says Todd Demmy, MD, FACS, Clinical Chair of the Department of Thoracic Surgery and Professor of Oncology at RPCI. ‘We wanted to see if any of the benefits of the lobectomy — which typically involves removal of 20-50% of the organ — carry forward when you take the whole lung out in a pneumonectomy.’

“Dr. Demmy and his colleagues retrospectively reviewed all patients who underwent pneumonectomy at RPCI from 2002 through 2012. Of the 107 consecutive pneumonectomies performed during this time period, 40 cases were done through an open technique, 50 were done through successful video-assisted thoracoscopic surgery (VATS), and 17 were converted from VATS to an open procedure.

“ ‘We performed a relatively large number of pneumonectomies without a significant event in the operating room such as excessive bleeding, which has been one of the major concerns that have prevented other surgeons from trying this technique,’ Dr. Demmy says.”


Radiation and Chemotherapy before Surgery Best Option in Patients with Stage IIIA(N2) NSCLC

Disagreement persists about the best treatment for non-small cell lung cancer (NSCLC) patients with stage IIIA(N2) disease, that is, cancer that has spread to lymph nodes just outside the lung. A recent study compared the outcomes of different treatments. Patients who had received neoadjuvant chemoradiotherapy (chemotherapy and radiation administered before surgery) followed by lobectomy (removal of the lung subsection containing the cancer) had higher 5-year survival rates than patients treated with:

-neoadjuvant chemoradiotherapy and pneumonectomy (removal of the whole lung containing the cancer);

-either lobectomy or pneumonectomy plus adjuvant therapy (chemotherapy and/or radiation administered after surgery);

-concurrent chemoradiotherapy (chemotherapy and radiation delivered at the same time, without surgery).

These findings suggest that neoadjuvant chemoradiotherapy followed by lobectomy is the preferable treatment for stage IIIA(N2) NSCLC.