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Vol.48 No.1 contents | Japanese/English |
 | Full Text of PDF (324K) Article in Japanese |
- Review Article -
Reduction of Surgical Invasion for Lung Cancer
Noriaki Tsubota11Department of Thoracic Oncology, Hyogo College of Medicine, Japan
Current surgical therapy for solid malignant tumors has changed remarkably. There are three common subjects, regardless of the kind of tumor. The changes regarding lung tumor operation were reviewed. I) Reduction in amount of resected tissue: The Lung Cancer Study Group first reported a randomized study showing that limited resection was inferior to lobectomy, producing a large impact on the subject, although one can find several questionable points in the report. However, many studies on segmentectomy for small peripheral tumors continued to be published from Japan and finally, some positive data began to appear from America. II) Shortening of the incision length: Development of video assisted thoracic surgery (VATS) and the increasing number of early cancer cases dramatically changed common knowledge of surgery, that is "The golden rule in surgery is a large incision and a wide view". Moreover surgeons must remember that VATS is only a means to enter the thoracic cavity, i.e., just an approach. What comes first is the quality of the operation. VATS with direct vision, known as hybrid VATS, or without direct vision, referred to as complete VATS, is not a point to be discussed. What patients are concerned about is the quality of the operation, not the kind of vision. Thus, minimal invasiveness comes second. When sufficient reduction of burden on the patient is obtained using a new technique without losing quality, which is correctly judged by the surgeon, one can define it as VATS. If a second learning curve is required by a trained surgeon, the curve should be reasonably short and sharp. III) Reduction in mediastinal lymph node dissection (MLND): The purpose of MLND is changing. Enormous amount of clinical data concerning the behavior of lymph node metastasis have disclosed the following: 1) a tumor with complete ground glass opacity (GGO) and high tumor disappearance rate (TDR) on CT does not require MLND, not even N1 node sampling, 2) the significance of both subcarinal lymph node dissection in cases of an upper lobe tumor and upper MLND in middle or lower lobe tumors is limited. A marked change of stage ratio in operative cases must have resulted from three factors: a) the increasing number of early cancers detected by new diagnostic equipment, b) development of operative tools and video technique, and c) advances in chemo-radiotherapy. One more hidden reason seems to be the lack of satisfaction on the part of both surgeons and patients regarding extended resection. This trend has probably accelerated due to avoidance of more risky operations which may lead to lawsuits. The general thoracic surgeon of the 21 century must be prepared with new techniques using video apparatus and tools, and conservative procedures to face both the increased number of patients in whom early lung cancer is detected and the unchanged number of those with advanced lung cancer.
key words: Surgery for lung cancer, Video assisted thoracic surgery (VATS), Lymph node dissection, Limited resection, Extended segmentectomy
JJLC 48 (1): 20-25, 2008
