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Date of Graduation

8-2004

Degree Type

Capstone Project (On-Campus Access Only)

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Keir Todd PA-C., M.Ed.

Abstract

Context. There is very little published data for patients who are status-post lobectomy by Video-Assisted Thoracoscopic Surgery (V ATS) for lung cancer, which includes a 5 year survival analysis with a corresponding 5 year follow-up time period. To the author's knowledge, there are no studies published to date that report a survival analysis for a time period greater than five years.

Objective. To investigate both short and long term survival rates for patients having undergone VATS lobectomy for clinical stage I lung cancer, as well as identify any independent prognostic factors for survival.

Design. Retrospective chart review; Period from 1992 to 2002; follow-up 18-143 months.

Setting. Patients were referred from the general community to this private, general surgery group practice, with operations performed by Robert Schauer :MD, at a regional acute care hospital.

Patients. One-hundred consecutive patients diagnosed with clinical stage I lung cancer and deemed eligible candidates for VATS lobectomy.

Intervention(s). Non-rib spreading VATS lobectomy, bilobectomy, or pneumonectomy.

Main Outcome Measure(s). Survival was calculated both directly and with the KaplanMeier method. Log-rank and Cox-proportional hazards regression were used for data analysis.

Results. Kaplan-Meier analysis demonstrated five and seven year survival rates of 51.5% (Cl 0.735 to 0.296) and 38.2% (Cl 0.683 to 0.081) respectively with a mean follow-up of 63.52 months for all standard non-small cell cancer patients (n=89). There was no significant difference between VATS and open lobectomy survival curves (p=0.0946). Cancer stage was an independent prognosticator (p=0.032) of survival.

Conclusion. VATS lobectomy is a comparatively safe surgical procedure with improved perioperative outcomes and survival rates at least equivalent to lobectomies by thoracotomy.

Comments

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