From November 2009 to December 2013, a total of 35 consecutive patients with pathologically or radiologically confirmed stage IIIA N2
lung cancer underwent pulmonary resection and MND, performed by a single surgeon, following
neoadjuvant chemoradiation. Preoperative patient characteristics, surgical outcomes, postoperative drainage, postoperative complications, and mortality were retrospectively analyzed.
RESULTS: VATS was completed in 17 patients.
Thoracotomy was performed in 18 patients, with 13 planned
thoracotomies and 5 conversions from the VATS approach. The median age was 62.7±7.9 years in the VATS group and 60±8.7 years in the
thoracotomy group. The patients in the VATS group tended to have a lower diffusing capacity for
carbon monoxide (p=0.077). There were no differences between the 2 groups in the method of diagnosing the N stage,
tumor response and size after induction,
tumor location, or histologic type. Complete resection was achieved in all patients. More total and mediastinal nodes were dissected in the VATS group than in the
thoracotomy group (p<0.05). The median
chest tube duration was 5.3 days (range, 1 to 33 days) for the VATS group and 7.2 days (range, 2 to 28 days) for the
thoracotomy group. The median follow-up duration was 36.3 months. The 5-year survival rates were 76% in the VATS group and 57.8% in the
thoracotomy group (p=0.39). The 5-year disease-free survival rates were 40.3% and 38.9% in the VATS and
thoracotomy groups, respectively (p=0.8).
CONCLUSION: The VATS approach following
neoadjuvant treatment was safe and feasible in selected patients for the treatment of stage IIIA N2 NSCLC, with no compromise of oncologic efficacy.