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Background: The present study evaluated the impact of the introduction of thoracoscopic lung lobectomy (TL) for non-small cell lung cancer at our institution. Methods: This study retrospectively compared surgical and oncological outcomes in the period before and after the introduction of TL for non-small cell lung cancer. Propensity score-matched analysis was performed with respect to baseline patient variables and tumor characteristics. Results: Patients were divided into two groups: those who underwent lung lobectomy in the period before (BI group, n=261) and after (AI group, n=261) the introduction of TL. The proportion of TLs at our institution increased from 1.3% in the BI group to 93% in the AI group. The AI group experienced a longer duration of surgery, lesser intraoperative blood loss, and a significantly shorter postoperative hospital stay (POHS). There were no significant differences in postoperative complications between the two groups. The median follow-up period was 50 months in both groups. No significant differences were observed between the BI and AI groups with respect to 5-year overall survival (OS) (76.1% and 71.7%, respectively; P=0.1973) and disease-free survival (DFS) (67.6% and 66.1%, respectively; P=0.4071). On multivariate analysis, pathological N1–2 status was an independent predictor of survival. AI group and TL showed no independent association with survival. Conclusions: The introduction of TL represented a positive change at our institution owing to decreased invasiveness and oncological equivalence of the surgical treatment for non-small cell lung cancer.

Background: We assessed how the severity of chronic obstructive pulmonary disease (COPD) and other comorbidities affect long-term survival after thoracoscopic lung resection for c-stage I non-small cell lung cancer (NSCLC). Methods: Patients with c-stage I NSCLC who underwent thoracoscopic lung resection at our hospital between 2006 to 2014 were retrospectively analyzed. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric grades were used to classify the severity of COPD, and comorbidity was classified according to the Charlson comorbidity index (CCI). Various outcomes were assessed and compared. Results: The cohort comprised 404 patients with NSCLC, of whom 133 were diagnosed with COPD (51 as GOLD 1, 79 as GOLD 2, and 3 as GOLD 3) and 271 were diagnosed without COPD. The 5-year overall survival (OS) rates were 86.0%, 80.2%, and 71.1% for the non-COPD, GOLD 1, and GOLD 2/3 groups, respectively (P=0.0221); the corresponding 5-year disease-specific survival (DSS) rates were 91.7%, 86.9%, and 85.1% (P=0.2136). Univariate analysis indicated that sex, smoking status, pathology, COPD severity, CCI, and pathological stage were associated with OS, and multivariate analysis confirmed the association with CCI and pathological stage. Postoperative complications were significantly more frequent in the GOLD 1 (21.5%) and GOLD 2/3 (26.8%) groups than in the non-COPD group (12.1%) (P=0.0040). Conclusions: Following thoracoscopic surgery (TS) for NSCLC, patients with COPD had a poorer OS than patients without COPD. However, the CCI and not the COPD severity was the independent prognostic factor for OS. Comorbidities adversely affected long-term survival of patients with stage I NSCLC and COPD after TS, and the same effect can be oncologically expected regardless of the COPD severity.

Precise imaging modalities are necessary during pulmonary resection to assess nodules that are otherwise difficult to diagnose. Studies have demonstrated that partial lung resection can completely cure adenocarcinoma in situ and minimally invasive adenocarcinoma. The important considerations for partial lung resection are: (I) to accurately identify the location of a small tumor intraoperatively and (II) to ensure a sufficient resection margin and preserve the remaining lung function. Hence, precise detection of hardly palpable or invisible tumors is essential. Although some reports describe methods for marking tumor locations, these processes are both invasive and complicated. Here, we describe a novel intraoperative navigation system that easily feeds image information to the operator on-site and evaluated its feasibility in three cases of partial lung resection. Implementing the software developed by Amin Inc. allowed three-dimensional scaling, rotation, transparency display, and calculation of tumor volumes in real time using a tablet computer (TC) interfaced with a hand tracking and voice control device. The surgeon, assistant, and digital imaging assistant can preoperatively verify the image using a TC by simulating the virtual resection line and insertion angle of the endoscopic stapler. During surgery, the tumor was assessed with a thoracoscope in comparison with the constructed three-dimensional image. Partial resection was successfully performed and pathological excision margins were negative in all cases. Other than prolonged air leakage in one case, no other complications were encountered. This novel navigation system appears to be safe and effective for less invasive partial lung resection.