P3. Therapeutic efficacy of single incision thoracoscopic surgery (SITS) for stage I lung cancer

Objective: Whether thoracoscopic surgical treatment is acceptable for thymoma, one of main anterior mediastinal tumor remains to be still controversial. However, we performed the video-assisted thoracoscopic surgery (VATS) for Masaoka stage III thymoma invaded to adjacent organs after acquisition of the patient permission. We examined the feasibility of video-assisted thoracoscopic thymectomy (VAT-T) with lateral thoracotomy for Masaoka stage III thymoma. We introduce our representative thoracoscopic operations.

Methods: We evaluated the short-term outcomes of eight cases undergoing surgery for stage III thymomas without myasthenia gravis between January 2007 and June 2014. A part of stage III thymomas occurred in lower pole of the thymus, which locally invaded the lung, the pericardium and the left brachiocephalic vein was selected for this technique. Of these, five cases were operated via right thoracic cavity, and three cases were operated via left thoracic cavity. Lateral thoracotomy was done at fourth or fifth intercostal space. One or two thoracoscopic ports were inserted at sixth or seventh intercostal space on the anterior axillary line. We inserted unilateral hand into thoracic cavity adequately and touched the tumor directly under thoracoscopic vision. As for resection of upper pole of thymus, some cases were carried out using chest wall lifting method by the kirchner wires inserted under the skin on the sternum.

Results: The pathological examination showed that type AB was seen in two cases, type B1 in three cases, and type B2 in three cases. In all cases, tumor cells were seen at surgical margin. Postoperative radiation was carried out in one case. At a median follow-up of 2.9±0.6 (range, 0.6-6.2) years, lung in five cases and pericardium in four cases, only one case had pleural disseminations, and chemotherapy was carried out. No patient in this group underwent conversion to median sternotomy. No surgical complications and postoperative complications were detected.

Conclusions: The operative wound and postoperative ADL was very satisfactory to all patients. These results suggest that VAT-T for a part of stage III thymomas is safe and may confer some advantages over conventional methods of standard median sternotomy.

Keywords: Non-small cell lung cancer (NSCLC); stage I; thoracoscopic surgery; thymoma