Clinical Assessment of the Two Windows Method in Video-assisted Thoracoscopic Surgery for Lung Cancer.

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Objectives: In January 1993, we developed a two-windows, video-assisted thoracoscopic surgery (VATS) method for treating lung cancer. Access to the pleural cavity was achieved by making two skin incisions: for right thoracotomies, 2-cm and 3-cm incisions were made anterior and posterior, respectively, to the inferior angle of the scapula in the fourth intercostal space. For left thoracotomies, the incisions were 3 cm and 2 cm, respectively. The two-windows method can thus be regarded as the least invasive current VATS procedure for lung cancer. Methods: Using this procedure, we performed pulmonary lobectomies and mediastinal lymph node dissections in 50 lung cancer patients (Stage IA, T1NOMO according to pre-and post-operative histological classifications). Various features of these operations were compared to those of 50 other Stage IA, T1NOMO lung cancer patients who received standard thoracotomies (posterolateral open chest surgery) in the same period. Results: The mean operation time using the two-windows VATS method was 2 hours and 35 minutes; the mean blood loss was 45.6ml; and an average of 28 mediastinal lymph nodes were dissected. The four-year cumulative survival rates were 94.6% by this method and 78.7% for the standard thoracotomy. Conclusion: We believe that the two-windows VATS method will become the standard surgical procedure for Stage IA lung cancer.
特定非営利活動法人日本肺癌学会の論文