P-170 * Comparison of Video-Assisted Thoracoscopic Surgery and Open Lobectomy for Benign Disease: An Intent-To-Treat Cohort Study (original) (raw)
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Thoracoscopic versus open lobectomy: short-term outcomes
Shanghai Chest
Video-assisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage nonsmall cell lung cancer (NSCLC) has spread worldwide and it has become a safe and viable alternative to thoracotomy. The aim of this review was to analyse the evidence presents in the current literature in order to assess the safety and efficacy of VATS versus open lobectomy, in terms of short-term outcomes. To identify relevant articles for inclusion in our analysis, we performed a search of PubMed/Medline database. We looked for randomized controlled trials, case series and comparative studies that reported outcomes following VATS or open lobectomy for NSCLC. Morbidity rates are reduced to 7.7-24.1% and mortality to 0.8-2.5% by the VATS approach. The reported lower morbidity rates included less intraoperative bleeding; shorter duration of air leak; lower incidence of post-operative pneumonia, atelectasis requiring bronchoscopy and atrial fibrillation. Furthermore, VATS lobectomy showed shorter chest tube duration; shorter length of hospital stays; reduced post-operative pain and inflammation; a better pulmonary function in the early post-operative phase, when compared with thoracotomy. Summarizing, thoracoscopic approach represents a valid alternative technique to treat NSCLC compared with standard thoracotomy; it offers patients a faster recovery and a better quality of life and allows high-risk patients to benefit from curative surgical treatment. VATS lobectomy might become the choice surgical approach for early-stage NSCLC.
Annals of the American Thoracic Society, 2016
Rationale: There is a paucity of data regarding the optimal surgical approach for lung lobectomy. Lobectomy performed by videoassisted thoracoscopic surgery (VATS) has been associated with lower morbidity as compared with lobectomy performed by thoracotomy. However, no multicenter studies have shown improved mortality with VATS lobectomy compared with open surgical lobectomy. Objectives: We used data from the United States Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2009 to 2012 to compare VATS with open lobectomy for in-hospital mortality and other short-term outcomes. Methods: We used International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes to identify the patients undergoing lobectomy. We used 1:1 ratio propensity matching with the nearest neighbor method without replacement to generate matched pairs. Measurements and Main Results: Over the 4-year period, 27,451 patients underwent lobectomy. The majority of these procedures were performed by thoracotomy (65%) as compared with VATS (35%). A total of 9,393 matched pairs were created. VATS lobectomy was associated with significantly lower in-hospital mortality when compared with thoracotomy (1.3% vs. 2.5%, P , 0.001). A shorter length of hospital stay was observed for those undergoing VATS lobectomy (6.21 vs. 8.75 d, P , 0.001). The overall rate of perioperative complications was low, with those undergoing VATS being less likely to have any perioperative morbidity. Conclusions: In recent years, the use of VATS for lobectomy has increased relative to thoracotomy. This trend has coincided with increased survival and shorter length of stay for VATS lobectomy compared with thoracotomy. Further studies are needed to identify comorbidities that identify ideal candidates for VATS lobectomy.
Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy
The Journal of Thoracic and Cardiovascular Surgery, 2009
Background: Several single-institution series have demonstrated that compared with open thoracotomy, videoassisted thoracoscopic lobectomy may be associated with fewer postoperative complications. In the absence of randomized trials, we queried the Society of Thoracic Surgeons database to compare postoperative mortality and morbidity following open and video-assisted thoracoscopic lobectomy. A propensity-matched analysis using a large national database may enable a more comprehensive comparison of postoperative outcomes. Methods: All patients having lobectomy as the primary procedure via thoracoscopy or thoracotomy were identified in the Society of Thoracic Surgeons database from 2002 to 2007. After exclusions, 6323 patients were identified: 5042 having thoracotomy, 1281 having thoracoscopy. A propensity analysis was performed, incorporating preoperative variables, and the incidence of postoperative complications was compared. Results: Matching based on propensity scores produced 1281 patients in each group for analysis of postoperative outcomes. After video-assisted thoracoscopic lobectomy, 945 patients (73.8%) had no complications, compared with 847 patients (65.3%) who had lobectomy via thoracotomy (P< .0001). Compared with open lobectomy, video-assisted thoracoscopic lobectomy was associated with a lower incidence of arrhythmias [n ¼ 93 (7.3%) vs 147 (11.5%); P ¼ .0004], reintubation [n ¼ 18 (1.4%) vs 40 (3.1%); P ¼ .0046], and blood transfusion [n ¼ 31 (2.4%) vs n ¼ 60 (4.7%); P ¼ .0028], as well as a shorter length of stay (4.0 vs 6.0 days; P< .0001) and chest tube duration (3.0 vs 4.0 days; P< .0001). There was no difference in operative mortality between the 2 groups. Conclusions: Video-assisted thoracoscopic lobectomy is associated with a lower incidence of complications compared with lobectomy via thoracotomy. For appropriate candidates, video-assisted thoracoscopic lobectomy may be the preferred strategy for appropriately selected patients with lung cancer.
Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer
The Journal of Thoracic and Cardiovascular Surgery, 2009
Background: The optimal surgical technique for lobectomy in lung cancer is not well defined. Proponents of video-assisted thoracic surgery (VATS) hypothesize that less trauma leads to quicker recovery, whereas those who advocate thoracotomy claim it as an oncologically superior procedure. However, a well-balanced comparison of the two procedures is lacking in the literature.
European Journal of Cardio-Thoracic Surgery, 2009
Objective: Video-assisted thoracoscopic surgery (VATS) lobectomy has been employed for the treatment of lung cancer. Many investigators have reported that the outcomes of VATS lobectomy for lung cancer are comparable to those of thoracotomy; however, several controversial issues remain. One of the critical concerns is the safety. VATS lobectomy often requires an emergency conversion to thoracotomy, for example, in the event of massive bleeding. In this study, cases in which VATS lobectomy for lung cancer was converted to thoracotomy intra-operatively (converted VATS lobectomy) were identified. The safety of the converted VATS lobectomy was evaluated. Methods: Between 2003 and 2007, VATS lobectomy was converted to thoracotomy in 24 out of 492 cases. Information regarding the patients' characteristics, reasons for the conversion and perioperative complications as well as the recurrence and survival data were carefully reviewed. The reasons for the conversion were classified into two groups: (1) problems related to the VATS procedure (VATS-related problems) and problems not related to the VATS procedure (non-VATS-related problems). Results: Of the 24 converted cases, 19 (79%) had a history of smoking. Nine patients (38%) had a history of lung disease. Left upper lobectomy was the most frequently associated with conversion (11/24, 46%), followed by right lower lobectomy and right upper lobectomy. The most frequent reasons for the conversion were hilar lymphadenopathy and bleeding (seven patients each), followed by fused fissure. Eight of the conversions were considered to be attributable to VATS-related problems. Perioperative complications were observed in four patients, consisting of prolonged air leak in three patients and transient recurrent laryngeal nerve palsy in one patient. However, there were no life-threatening complications. The median follow-up period was 26 months. Recurrence occurred in two patients: pleural dissemination in one and bone metastasis in the other. Two deaths were observed during the follow-up period: one related to lung cancer and another related to other type of cancer. Conclusions: The safety of the conversion was acceptable. Our findings suggest that VATS lobectomy for lung cancer is feasible from the viewpoint of safety, even after taking into account the potential need for conversion to thoracotomy in some patients. #
Early removal of the chest tube after complete video-assisted thoracoscopic lobectomies
European Journal of Cardio-Thoracic Surgery, 2011
Objective: Chest tubes induce morbidity such as pain, decrease mobility, increase the risk of infection, and prolong the length of hospital stays. This study evaluates a chest-tube protocol containing a high-drainage threshold and a short time period of drainage. Methods: A retrospective study was performed with data collected from all elective complete video-assisted thoracoscopic (c-VATS) (bi-)lobectomies between March 2006 and December 2009. All patients had one chest-tube, postoperatively. The chest tube was removed if there was no air leakage and there was a drainage volume of 400 ml (24 h) À1 or less. We aimed to remove the chest tube on postoperative day 1. Results: This series consists of 110 lobectomies and six bilobectomies. The median duration of chest-tube placement was 1.0 day. In 58.8% of patients (confidence interval (CI) 95%: 49.5-68.0), the drain was removed within 24 h of operation and in 82.5% (CI 95%: 74.2-88.7) within 48 h. In six (6.2%) patients, subcutaneous emphysema developed while the drain was still in place, and was treated with removal of the drain. Persistent air leakage was seen in four (3.4%) patients. One (0.9%) persisting pneumothorax was diagnosed. A pneumothorax after removal of the drain was not diagnosed. No major complications developed in 98 patients (84.5%). The median day of discharge was postoperative day 4. Conclusions: This study shows it is safe, after c-VATS (bi-)lobectomy, to remove the chest tube within 24 h in 58.8%, and within 48 h in 82.5% of patients. As was also shown in other studies, this leads to shorter length of hospital stays, lower costs, and most importantly, reduces patient morbidity without the added risk of complications. #
Scholars Journal of Applied Medical Sciences
Original Research Article Introduction: Video assisted thoracoscopy (VATS) lobectomy has become a standard approach in the management of patients with lung cancer, more so in the recent years. As many literatures has claimed benefits of VATS over thoracotomy in terms of clinical settings, it is also equally important to evaluate whether these benefits translate into cost implications. Objectives: The aim of this study is to investigate the postoperative complications and mortality following VATS lobectomy compared to Open lobectomy and to evaluate whether these clinical implications could translate into cost effectiveness. Materials and methods: A retrospective study of all patients who underwent lobectomy performed by a single surgeon between the year 2014 to 2019 was conducted. Data was obtained through patient's medical notes. Results: A total of 81 patients underwent lobectomy under a single surgeon (VATS n= 39, Thoracotomy n=42). Patients demographics were similar in both groups. Operating time were also similar in both groups. Epidural requirement (hours) were significantly shorter in VATS group (34.8 ± 19.8 vs 55.6 ± 17.9, p<0.001) There were more blood loss in Thoracotomy group (1.4 ± 0.8g/dl vs 1.0 ± 0.5g/dl, p= 0.044). Chest tube days were significantly shorter in the VATS group (4.8 ± 3.8days vs. 7.6 ± 9.2days, p=0.01) and so was length of stay (6.8 ± 4.0 days vs. 8.9 ± 5.9days p=0.026). There were no <30days mortality in both groups. >90days mortality were similar in both groups (21.4% vs 15.4%, p=0.484). Total cost of stay was higher in the Thoracotomy group (RM10,488± 4,436 vs. RM9205 ± 4420, p=0.196). Conclusions: Lobectomy performed via VATS approach results in less epidural requirement, shorter chest tube duration, less blood loss, shorter hospital stay. Shorter duration of hospital stay translates into less cost for the patient and hospital.
Thoracoscopic lobectomy for benign disease - a single centre study on 64 casesq
2000
Objective: Chronic lung infection is the main indication for lobectomy in benign pulmonary disease and may be technically demanding due to inflammatory changes such as adhesions, lymph node enlargement and neovascularization. The role of the thoracoscopic operation in these indications is yet ill-defined. Methods: We retrospectively analyzed the results of patients who underwent thoracoscopic lobectomy (TL) between 1992 and June
Risk factors and short-term outcomes of postoperative pulmonary complications after VATS lobectomy
Journal of cardiothoracic surgery, 2018
Postoperative pulmonary complications (PPCs) are associated with poor outcomes following thoracotomy and lung resection. Video-assisted thoracoscopic surgery (VATS) for lobectomy is now frequently utilised as an alternative to thoracotomy, however patients remain at risk for development of PPC. There is little known of the short-term outcome associated with PPC following VATS lobectomy and if there are any potential risk factors that could be modified to prevent PPC development; our study aimed to investigate this. A prospective observational study of consecutive patients undergoing VATS lobectomy for lung cancer over a 4-year period in a regional centre was performed (2012-2016). Exclusion criteria included re-do VATS or surgery for pulmonary infection. All patients received physiotherapy as necessary from postoperative day 1 (POD1) and PPC was determined using the Melbourne Group Scale. Outcomes included hospital LOS, intensive therapy unit (ITU) admission and hospital mortality. ...