[The first thousand of VATS anatomical lung resections at the Herzen Moscow Oncology Research Institute].

Abstract

Objective: To analyze the first thousand of anatomical resections at the Herzen Moscow Oncology Research Institute between 2009 and 2023.

Material and methods: A retrospective study included 1078 patients who underwent thoracoscopic anatomical lung resection: lobectomy (TL - group 1) or segmentectomy (TS - group 2) between 2009 and 2023. Perioperative parameters including gender, age, side of surgery, resected lobe, histological data, surgery time, blood loss, tumor size, duration of pleural drainage were assessed. Postoperative complications were classified according to the TM&M system. Statistical analysis was performed using the Student's t, Mann-Whitney U and Pearson's χ2 tests.

Results: There were 513 men (47.59%) and 565 women (52.41%). The median age was 61.3 and 59.7 years in both groups, respectively (p=0.672). Lung cancer patients predominated (70.6% and 43.5%, respectively). Stage I of disease was diagnosed in 70.36% of patients. Lymph nodes were affected in 160 patients (14.84%), including 100 (62.5%) ones with N1 and 60 (37.5%) ones with N2. TL was performed in 92% of N1 cases and 91.67% of N2 cases. The overall complication rate was 10.76% (n=116). Complications were less common after TS compared to TL (p=0.007). The conversion rate decreased from 35% in the first years to 1.8% over 10 years. In 2023, this parameter slightly increased to 6.3%.

Conclusion: Successful development of thoracoscopic anatomical lung resection program is based on standardization of technique and interchangeability of surgical team. This shortens the learning curve, increases safety of surgeries and reduces conversion rate.