Editorial
The minimally invasive thoracic surgery for lung cancer: A voice from China Jiao W, Qiu T Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China, 266003 Correspondence to: Wenjie Jiao, Email: [email protected]
The video assisted thoracoscopic surgery (VATS) was first introduced to thoracic surgeons of China in 1990s. In the past 20 years, the VATS technique has been extensively applied in treatment of lung cancer all over the land. By the end of 2014, more than 300 thousands thoracic surgeries per year are operated that nearly half of these are finished by VATS. As China has been one of the most important forces to fight against lung cancer in the world, it is essential and inevitable to understand the status and future of China’s VATS in the treatment of lung cancer during this historic period. Clinical Features of Lung Cancer Promote The VATS in China Nowadays, with the popularization of health examination and the application of thoracic computed tomography (CT), the appearance that lung cancer patient’s trend to earlier stage must be one of the most noteworthy clinical features in China, especially those with solitary pulmonary nodule or ground glass opacity. Although sometimes the localization of this lesion appears to be a challenge, assistive technology, such as methylene blue injection or CT guided puncture would help the surgeons solve this problem. Despite the opportunity of radical resection of lung cancer has been expected more than ever, lung cancer patients, especially those in early stage, also care about painless and cosmetic issues, which promotes the VATS technique more popular among the public. In the recent years, Data from different institutions shows that the VATS technique has lower incidence of postoperative compilations and more benefits to the patients. With the support of these evidences, there is no reason to resist a strong development of VATS in China. Meanwhile, more researches in China show that the lung cancer patients trend to younger age, which may have the equal significance in physic and sociology. Does lobectomy benefit the mid‑aged patients who are in early stage of lung cancer and suffering the social stress or economic pressure? With the raising of the quantity of VATS cases, the quality of VATS covered with sociology emerges as a new proposition to the thoracic surgeons. To keep the balance between prognosis and the social problems, more thoracic surgeons in China devote to the research whether reduced range of resection combining VATS could solve this question. The VATS sub‑lobectomy in early stage lung cancer has been discussed on recent national conferences. The establishment of an appropriate indication and an efficient VATS procedure, that gives consideration to both Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.151983
the oncology and the sociology, is the responsibility of the whole thoracic surgeons in China. The Harmonious Co‑Existence of Different VATS Technique In China To the consensus of major thoracic surgeons in China, the VATS techniques were developed at first in the city of Beijing, Shanghai and Guangzhou. Since then other cities joined in, like Chengdu’ level representing Southwest China, Jinan and Qingdao’s level representing Shandong province, etc. Video assisted thoracoscopic thoracotomy, complete VATS (cVATS), two‑port VATS, single port VATS and trans‑subxiphoid VATS were appeared and introduced on several national conferences. Whether the electronic hook or the Harmonic ACE was more “benefit” to the surgeon raised an intense discussion. As the three dimensional VATS (3D‑VATS) invented, the VATS image first came into a “real” world. In the recent years, the robotic surgery has been introduced into China, as someone called the revolution of VATS, which was applied rapidly in the treatment of lung cancer. There has been already more than one thousand operation of robotic lobectomy by the end of 2014 in China. Despite of the economic consideration, the robotic surgery for lung cancer has certain advantages in many aspects, such as elaborate operation and coordination control. But more evidences in long term for the patients of lung cancer should be presented. As we can see, the VATS technique progresses every day in China. Nevertheless, there are a thousand Hamlets in a thousand people’s eyes. Relying on more than over six thousands thoracic surgeons in China, each VATS technique has its suitable soil. In this great land, all the different VATS technique could exist peacefully and promote mutually. In addition, the training programs of VATS have been held in different centers since 1994s. With the development of the internet and computer technology, different VATS techniques have been exchanged rapidly, especially among the junior thoracic surgeons who were born in 1980s and had an amazing smoother VATS learning curve. As this historic generation begins to clinical practice in China, more ingenious surgical skills or ideas of VATS technique may appear. With a large population and relatively high incidence of lung cancer, the VATS has come into a “glory” period in China. But we should ask ourselves a question: Where is the road to VATS after the next 10 years? Well, maybe robotic surgery would occupy the territory of thoracic surgery, or even robotic surgery would have been replaced by other more technical surgeries. But there is one thing will not change: The spirit of minimally invasive surgery derived from VATS will imprint in the thoracic surgeons of the next generation. How to cite this article: Jiao W, Qiu T. The minimally invasive thoracic surgery for lung cancer: A voice from China. Indian J Cancer 2014;51:2 Source of Support: Nil. Conflict of Interest: None declared.
e2
Indian Journal of Cancer | Volume 51 | Special Issue 1-2014
Copyright of Indian Journal of Cancer is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
The minimally invasive thoracic surgery for lung cancer: A voice from China Jiao W, Qiu T Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China, 266003 Correspondence to: Wenjie Jiao, Email: [email protected]
The video assisted thoracoscopic surgery (VATS) was first introduced to thoracic surgeons of China in 1990s. In the past 20 years, the VATS technique has been extensively applied in treatment of lung cancer all over the land. By the end of 2014, more than 300 thousands thoracic surgeries per year are operated that nearly half of these are finished by VATS. As China has been one of the most important forces to fight against lung cancer in the world, it is essential and inevitable to understand the status and future of China’s VATS in the treatment of lung cancer during this historic period. Clinical Features of Lung Cancer Promote The VATS in China Nowadays, with the popularization of health examination and the application of thoracic computed tomography (CT), the appearance that lung cancer patient’s trend to earlier stage must be one of the most noteworthy clinical features in China, especially those with solitary pulmonary nodule or ground glass opacity. Although sometimes the localization of this lesion appears to be a challenge, assistive technology, such as methylene blue injection or CT guided puncture would help the surgeons solve this problem. Despite the opportunity of radical resection of lung cancer has been expected more than ever, lung cancer patients, especially those in early stage, also care about painless and cosmetic issues, which promotes the VATS technique more popular among the public. In the recent years, Data from different institutions shows that the VATS technique has lower incidence of postoperative compilations and more benefits to the patients. With the support of these evidences, there is no reason to resist a strong development of VATS in China. Meanwhile, more researches in China show that the lung cancer patients trend to younger age, which may have the equal significance in physic and sociology. Does lobectomy benefit the mid‑aged patients who are in early stage of lung cancer and suffering the social stress or economic pressure? With the raising of the quantity of VATS cases, the quality of VATS covered with sociology emerges as a new proposition to the thoracic surgeons. To keep the balance between prognosis and the social problems, more thoracic surgeons in China devote to the research whether reduced range of resection combining VATS could solve this question. The VATS sub‑lobectomy in early stage lung cancer has been discussed on recent national conferences. The establishment of an appropriate indication and an efficient VATS procedure, that gives consideration to both Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.151983
the oncology and the sociology, is the responsibility of the whole thoracic surgeons in China. The Harmonious Co‑Existence of Different VATS Technique In China To the consensus of major thoracic surgeons in China, the VATS techniques were developed at first in the city of Beijing, Shanghai and Guangzhou. Since then other cities joined in, like Chengdu’ level representing Southwest China, Jinan and Qingdao’s level representing Shandong province, etc. Video assisted thoracoscopic thoracotomy, complete VATS (cVATS), two‑port VATS, single port VATS and trans‑subxiphoid VATS were appeared and introduced on several national conferences. Whether the electronic hook or the Harmonic ACE was more “benefit” to the surgeon raised an intense discussion. As the three dimensional VATS (3D‑VATS) invented, the VATS image first came into a “real” world. In the recent years, the robotic surgery has been introduced into China, as someone called the revolution of VATS, which was applied rapidly in the treatment of lung cancer. There has been already more than one thousand operation of robotic lobectomy by the end of 2014 in China. Despite of the economic consideration, the robotic surgery for lung cancer has certain advantages in many aspects, such as elaborate operation and coordination control. But more evidences in long term for the patients of lung cancer should be presented. As we can see, the VATS technique progresses every day in China. Nevertheless, there are a thousand Hamlets in a thousand people’s eyes. Relying on more than over six thousands thoracic surgeons in China, each VATS technique has its suitable soil. In this great land, all the different VATS technique could exist peacefully and promote mutually. In addition, the training programs of VATS have been held in different centers since 1994s. With the development of the internet and computer technology, different VATS techniques have been exchanged rapidly, especially among the junior thoracic surgeons who were born in 1980s and had an amazing smoother VATS learning curve. As this historic generation begins to clinical practice in China, more ingenious surgical skills or ideas of VATS technique may appear. With a large population and relatively high incidence of lung cancer, the VATS has come into a “glory” period in China. But we should ask ourselves a question: Where is the road to VATS after the next 10 years? Well, maybe robotic surgery would occupy the territory of thoracic surgery, or even robotic surgery would have been replaced by other more technical surgeries. But there is one thing will not change: The spirit of minimally invasive surgery derived from VATS will imprint in the thoracic surgeons of the next generation. How to cite this article: Jiao W, Qiu T. The minimally invasive thoracic surgery for lung cancer: A voice from China. Indian J Cancer 2014;51:2 Source of Support: Nil. Conflict of Interest: None declared.
e2
Indian Journal of Cancer | Volume 51 | Special Issue 1-2014
Copyright of Indian Journal of Cancer is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
