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Comparative Study
. 2012 Sep;256(3):487-93.
doi: 10.1097/SLA.0b013e318265819c.

Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis

DuyKhanh P Ceppa  1 , Andrzej S Kosinski, Mark F Berry, Betty C Tong, David H Harpole, John D Mitchell, Thomas A D'Amico, Mark W Onaitis
Affiliations
Comparative Study

Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis

DuyKhanh P Ceppa et al. Ann Surg. 2012 Sep.

Abstract

Objective: Using a national database, we asked whether video-assisted thoracoscopic surgery (VATS) lobectomy is beneficial in high-risk pulmonary patients.

Background: Single-institution series demonstrated benefit of VATS lobectomy over lobectomy via thoracotomy in poor pulmonary function patients [FEV1 (forced expiratory volume in 1 second) or DLCO (diffusion capacity of the lung to carbon monoxide) <60% predicted].

Methods: The STS General Thoracic Database was queried for patients having undergone lobectomy by either thoracotomy or VATS between 2000 and 2010. Postoperative pulmonary complications included those defined by the STS database.

Results: In the STS database, 12,970 patients underwent lobectomy (thoracotomy, n = 8439; VATS, n = 4531) and met inclusion criteria. The overall rate of pulmonary complications was 21.7% (1832/8439) and 17.8% (806/4531) in patients undergoing lobectomy with thoracotomy and VATS, respectively (P < 0.0001). In a multivariable model of pulmonary complications, thoracotomy approach (OR = 1.25, P < 0.001), decreasing FEV1% predicted (OR = 1.01 per unit, P < 0.001) and DLCO% predicted (OR = 1.01 per unit, P < 0.001), and increasing age (1.02 per year, P < 0.001) independently predicted pulmonary complications. When examining pulmonary complications in patients with FEV1 less than 60% predicted, thoracotomy patients have markedly increased pulmonary complications when compared with VATS patients (P = 0.023). No significant difference is noted with FEV1 more than 60% predicted.

Conclusions: Poor pulmonary function predicts respiratory complications regardless of approach. Respiratory complications increase at a significantly greater rate in lobectomy patients with poor pulmonary function after thoracotomy compared with VATS. Planned surgical approach should be considered while determining whether a high-risk patient is an appropriate resection candidate.

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Conflict of interest statement

Disclosure: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Volume of anatomic pulmonary resections in STS General Thoracic Database. The annual number of recorded anatomic pulmonary resections (either lobectomy or segmentectomy) in the STS database increased over the study period. In addition, the percentage of procedures performed thoracoscopically increased each year during the study period. Complete data for the year of 2010 were not available at the time of this study.
Figure 2
Figure 2
Respiratory complications by FEV1 predicted. In patients with FEV1 predicted less than 60%, the rate of increase in pulmonary complications with decreasing FEV1 predicted is significantly greater in patients undergoing pulmonary resection by thoracotomy than in patients undergoing thoracoscopy (P = 0.023).
See this image and copyright information in PMC

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