Immediate results of video-assisted thoracoscopic lobectomies with routine mediastinal lymph node dissection in the surgical treatment of comorbid patients with non-small cell lung cancer

Background. Lung cancer (LC) is a leading oncological pathology and is characterized by a high mortality rate. Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancer cases. Surgical treatment of NSCLC is the main method of local treatment. Comorbidity and patient age are limiting factors for surgical treatment. The article presents our own results of treatment of somatically burdened patients with NSCLC who underwent video-assisted thoracoscopic radical anatomical lung resection. Material and methods. The results of surgical treatment of 11 patients who underwent video-assisted thoracoscopic lobectomy with routine mediastinal lymph node dissection for early and locally advanced NSCLC, having a high Charlson comorbidity index (CCI), were studied. The follow-up period was more than 12 months. Results. The average age of patients is 64 years. In 73% of cases, concomitant cardiovascular diseases were diagnosed (in 45% — two or more pathologies), digestive tract pathology was present in 91% of cases, bronchopulmonary diseases — in 54.5% of cases, chronic kidney disease — in 9% of cases, diseases endocrine system with metabolic disorders — in 36.4% of cases. The radicality of R0 resection was achieved in 100% of cases. Average CCI value is 6.6. Median duration of the operation was 158.2 minutes; all patients were extubated in the operating room and transferred to a specialized department. Long average duration of postoperative hospital treatment (13.2 days) was due to long-term leakage of the pulmonary parenchyma in 4 patients (re-drainage was required in 2 cases). These were patients with the highest comorbidity index, having both cardiovascular, bronchopulmonary and metabolic diseases, three patients aged 69 years and older. There were no cases of 90-day mortality reported. On average, 6.4 lymph nodes were removed. According to the results of pathomorphological examination, stages IA3 and IIB predominated. The leading histotype is adenocarcinoma (54.5%). No progression, recurrence or mortality were noted within 12 months after surgery. Conclusion. The good results we obtained from minimally invasive surgical treatment of comorbid patients with NSCLC are associated with the use of minimally invasive surgery and rational perioperative treatment in 100% of cases. Particular attention must be paid to the preoperative preparation of patients, which consists not only of examination in accordance with clinical recommendations for the treatment of lung cancer, but also of concomitant diseases. Particular attention after surgery in this category of patients requires ensuring adequate drainage of the pleural cavity. In this category of patients, it is advisable to place two pleural drainages according to the «classical» scheme.