การผ่าตัดรักษามะเร็งปอด ชนิดไม่ใช่เซลล์เล็กผ่านการส่องกล้อง

<h2>Understanding Lung Cancer</h2>
Lung cancer is broadly categorized into two major types:
<ul>
<li style="font-weight: 400;" aria-level="1">Small Cell Lung Cancer (SCLC)</li>
<li style="font-weight: 400;" aria-level="1">Non-Small Cell Lung Cancer (NSCLC) – accounting for approximately 85% of all lung cancer cases&nbsp;</li>
</ul>
Today, treatment for lung cancer includes both medication and surgery, with significant advancements in outcomes. Dr. Kittichai Luangthaweeboon, a thoracic surgeon at Phyathai 2 Hospital, shares insights into minimally invasive thoracoscopic surgery for NSCLC—including its advantages, limitations, and clinical considerations.
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<h2>Thoracoscopic Surgery for NSCLC: Benefits and Considerations</h2>
Video-Assisted Thoracoscopic Surgery (VATS) is a minimally invasive technique that aims to reduce the size of the surgical incision. In contrast to traditional open thoracotomy, where the surgeon must divide the latissimus dorsi and serratus anterior muscles and separate intercostal muscles, VATS minimizes trauma to the chest wall.
Open thoracotomy may cause pain with coughing or deep breathing, increasing the risk of lung collapse (atelectasis) and limiting shoulder mobility. While both surgical methods involve the same oncologic procedures—dissecting the blood vessels, bronchus, and lymph nodes—the key difference is that VATS does not allow direct palpation of lung tissue, making it necessary to use localization techniques such as wire placement or dye injection, particularly when nodules are located deeper than 1 cm from the lung surface.
Additionally, VATS requires the use of automated surgical staplers to divide and seal pulmonary vessels and bronchi. These staplers are significantly more expensive than traditional sutures, with each firing costing around 10,000 THB, and up to five devices may be used per patient.
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<h2>Clinical Outcomes and Recovery</h2>
For surgeons experienced in VATS, operative time is comparable to open surgery. The benefits of VATS include:
<ol>
<li>Less postoperative pain</li>
<li>Lower rate of early complications</li>
<li>Shorter hospital stay (by approximately one day)&nbsp;</li>
</ol>
However, long-term cancer control is similar to open surgery, especially in Stage I disease, where both approaches yield comparable cure rates.
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<h2>Postoperative Care and Recovery</h2>
<ul>
<li style="font-weight: 400;" aria-level="1">No long-term adverse effects are associated with chest wall muscle division</li>
<li style="font-weight: 400;" aria-level="1">Pain from rib spreading is minimal</li>
<li style="font-weight: 400;" aria-level="1">Some patients may experience tingling or numbness under the breast, which improves as absorbable sutures dissolve (typically within 2 months)&nbsp;</li>
</ul>
Early mobilization is essential to prevent complications like frozen shoulder, which is difficult to treat but easily prevented
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<h2>Definition of VATS Lobectomy (2012 Consensus)</h2>
<ul>
<li style="font-weight: 400;" aria-level="1">No use of rib-spreaders</li>
<li style="font-weight: 400;" aria-level="1">Incision length does not exceed 8 cm</li>
<li style="font-weight: 400;" aria-level="1">Separate dissection of vessels and bronchi using automated staplers</li>
<li style="font-weight: 400;" aria-level="1">Typically performed through 1–3 small incisions in the chest wall&nbsp;</li>
</ul>
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<h2>Indications for VATS Lobectomy</h2>
<ul>
<li style="font-weight: 400;" aria-level="1">Lung tumors less than 6 cm in size 
</li>
<li style="font-weight: 400;" aria-level="1">Stage I or II NSCLC 
</li>
<li style="font-weight: 400;" aria-level="1">No abnormalities in mediastinal lymph nodes&nbsp;</li>
</ul>
Patients unsuitable for single-lung ventilation (due to poor pulmonary function) may not tolerate VATS, as it relies on clear visualization using a thoracoscopic camera. In such cases, open surgery remains the preferred approach. Similarly, patients with extensive pleural adhesions—due to prior thoracic surgery or infection—may pose challenges for VATS and be better candidates for open thoracotomy.
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VATS lobectomy offers an effective, minimally invasive alternative for select patients with early-stage NSCLC. When performed by an experienced surgical team, it provides comparable oncologic outcomes with enhanced recovery and fewer complications—making it a valuable option in the evolving landscape of thoracic oncology.
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Today, treatment for lung cancer includes both medication and surgery, with significant advancements in outcomes. 


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Thoracoscopic Surgery for Non-Small Cell Lung Cancer (NSCLC): A Less Invasive Treatment Option

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