Computed Tomography-guided Dye Localization Prior to Uniportal Thoracoscopic Surgery for Lung Cancer

Tung ming Tsai

National Taiwan University Hospital, Taipei, Taiwan

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–C

Abstract

Objectives: Uniportal video-assisted thoracoscopic surgery (VATS) has recently been reported as an alternative to conventional VATS. However, preoperative image-guided localization is usually required for small nodules. The present study evaluated the efficacy of preoperative computed tomography-guided dye localization prior to uniportal VATS for small nodules in patients with non-small cell lung cancer.

Methods: We retrospectively reviewed 234 consecutive patients who underwent uniportal VATS to treat early non-small cell lung cancer nodules (diameter, ≤1.5 cm). Of the patients enrolled, 198 received preoperative dye localization (localization group) and 36 did not (direct surgery group).

Results: The demographics and operative outcomes were comparable for both groups. The nodule size was significantly smaller in the localization group than in the direct surgery group (0.73 ± 0.26 cm vs 1.03 ± 0.34 cm, p < 0.001). The complication rates were low in both groups (2.8% and 3.0%, respectively). The uniportal to multi-portal VATS conversion rate was significantly higher in the direct surgery group than in the localization group (16.7% vs 2.5%, p = 0.007). Multiple logistic regression analysis revealed that smoking, past ipsilateral lung surgery, and nonintubated anesthesia were significantly associated with conversion, whereas preoperative dye localization significantly reduced the risk of conversion (odds ratio, 0.10; 95% confidence interval, 0.02–0.56; p = 0.009).

Conclusions: Uniportal VATS is a feasible, effective, and safe procedure for the treatment of non-small cell lung cancer. Combined with the use of preoperative computed tomography-guided dye localization, surgeons can treat small nodules with a low risk of conversion.