The document discusses the surgical treatment of lung cancer, highlighting the benefits of minimally invasive techniques like video-assisted thoracoscopic surgery (VATS) and bronchoplastic operations. It presents data on survival rates and outcomes, showing VATS lobectomy offers advantages over traditional thoracotomy, with improved recovery and reduced costs. Additionally, it emphasizes the importance of patient health factors in predicting surgical outcomes, citing mortality and complication rates based on preoperative assessments.

1. Lung Cancer: an overview & discussion of minimally invasive surgical therapy Conrad Massimo Vial, MD Director of Cardiothoracic Surgery Mills Peninsula Health System

8. Tumor T1 T2 T3 T4 Nodes N0 N1 N2 N3 IA IB IIB IIIB Stage IV = M1 Stage IIIB and IV generally unresectable Lung Cancer IIIB IIIB IIIB IIIB IIIA IIIA IIIA IIIB IIA IIB IIIA IIIB

9. 5-yr survival for treated NSCLC according to surg-path state: Stage I: ≈ 70% Stage II: ≈ 50% Stage III: ≈ 20%

10. Minimally Invasive Lung Cancer Operations Video Assisted Thoracoscopic (VATS) Lobectomy & Lung Sparing Operations

11. The Traditional Approach Open Thoracotomy

12. Video Assisted Thoracoscopy (VATS)

13. VATS Lobectomy

16. Results in the Literature Advantages of VATS Approach . . . Less postoperative pain Shorter length of stay Reduced air leaks/length of chest tube placement Reduced overall hospital cost Faster recovery/return to normal activities Better postoperative pulmonary function More likely to complete postoperative chemotherapy

17. Literature Summary VATS lobectomy offers advantages over conventional thoracotomy without compromise of short term or long term outcome VATS lobectomy can become a cost effective alternative to open lobectomy in the treatment of operable NSCLC

18. Lung Sparing Operations Bronchoplasties & Sleeve Resections

19. Definition of Bronchoplastic Techniques Sleeve Lobectomy vs Bronchial Sleeve Resection A A

22. Results in the Literature 30 day mortality for all bronchoplastic procedures is 8% Mortality for sleeve lobectomy is 5% Mortality for sleeve pneumonectomy is 20 – 25% Mortality rates double or triple in the presence of; Poor pulmonary function (FEV 1 < 50% predicted) Pulmonary hypertension Severe coronary artery disease

23. What are we doing? What are our results? Conrad M Vial, MD Tomomi Oka, MD

24. Program in CT Surgery Overall Volume & Outcomes 2008-2010 TOTAL CASES = 1216 MORTALITY = 0.7% MAJOR MORBIDITY = 3.9% CARDIAC CASES = 529 MORTALITY = 1.5% MAJOR MORBIDITY = 6.2% THORACIC CASES = 687 MORTALITY = 0.4% MAJOR MORBIDITY = 2.8%

25. Diversity & Complexity of Major Thoracic Operations

26. Diversity & Complexity of Major Thoracic Lung Operations Bronchoplasty and/or Sleeve Resection n=15 Thoracoscopic Lobectomy n=107

27. STS NATIONAL DATABASE Influence of Functional Score in Resections for Lung Cancer ZUBROD SCORE MORTALITY LOS > 14 DAYS COMPLICATIONS 0 1.3% 4.8% 32% 1 1.8% 6.8% 35% 2 3.5% 12% 41% 3 7% 14% 46% 4 16% 21% 51%

28. STS NATIONAL DATABASE Influence of FEV 1 in Resections for Lung Cancer Preop FEV 1 MORTALITY LOS > 14 DAYS COMPLICATIONS > 80% pred 1.1% 4% 30% 61-79% pred 2% 8% 39% < 60% pred 2% 9% 41%

29. Diversity & Complexity of Major Thoracic Operations for Lung Ca Bronchoplasty and/or Sleeve Resection n=15 Thoracoscopic Lobectomy n=107

30. CRUDE Benchmarking “Best Case” vs Non-risk adjusted Best Case Lung Ca Resection STS Scenario Mortality LOS > 14 days Complications Preop FEV 1 > 80% pred & Zubrod Score 0 ~1.2% ~4% ~30%

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