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Thoracoscopic Lobectomy is Associated with Fewer Postoperative Complications
N. Villamizar, M. Darrabie, R. Prince-Petersen, M. Onaitis, D. H. Harpole, E. Toloza, T. A. D'Amico. Duke University, Durham, NC,
BACKGROUND:
Advantages of thoracoscopic lobectomy include less postoperative pain, shorter hospitalization, and improved delivery of adjuvant chemotherapy to eligible patients. Other outcome variables, such as the incidence of postoperative complications, have not been thoroughly assessed. This study analyzes morbidity and mortality after lobectomy to compare outcomes using the thoracoscopic approach and thoracotomy.
METHODS:
Using a prospective database, the outcomes of 583 consecutive patients who underwent lobectomy were analyzed with respect to preoperative patient characteristics and all postoperative complications, including atrial fibrillation, pneumonia, sepsis, renal failure, and death.
RESULTS:
Of the 583 eligible patients in the study, 300 underwent thoracoscopic lobectomy and 283 underwent lobectomy with thoracotomy. Patients who underwent thoracoscopic lobectomy were older (66 ± 10 years v 62 ± 12 years; p=0.001), but there were no differences in the incidence of baseline patient characteristics of obstructive lung disease, pulmonary function, hypertension, coronary artery disease, or renal disease. Compared to lobectomy by thoracotomy, thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (58 [20.5%] v 38 [12.7%]; p=0.01), pneumonia (24 [8.5%] v 9 [3.0%]; p=0.004), sepsis (6 [2.1]% v 0; p=0.01), renal failure (12 [4.2%] v 3 [1.0%]; p=0.01), and death (11 [3.9%] v 2 [0.7%]; p=0.008).
CONCLUSIONS:
Thoracoscopic lobectomy is associated with lower incidence of many major complications, compared to thoracotomy by lobectomy. The underlying factors responsible for this advantage should be analyzed, which may be used to improve the safety and outcomes of other thoracic procedures.
Postoperative complications| Feature | THOR
(n=283) | VATS
(n=300) | P value | | Atrial Fibrillation, n (%) | 58 (20.5) | 38 (12.7) | 0.01 | | Prolonged air leak, n (%) | 35 (12) | 33 (11) | 0.6 | | Atelectasis, n (%) | 30 (11) | 14 (5) | 0.007 | | Pneumonia, n (%) | 24 (8.5) | 9 (3.0) | 0.004 | | Transfusion, n (%) | 15 (5) | 6 (2) | 0.03 | | Renal Failure, n (%) | 12 (4.2) | 3 (1.0) | 0.01 | | Sepsis, n (%) | 6 (2.1) | 0 | 0.01 | | PE, n (%) | 4 (1.4) | 0 | 0.04 | | Bleeding, n (%) | 3 (1.1) | 2 (0.7) | 0.6 | | Bronchopleural Fistula, n (%) | 3 (1.1) | 1 (0.3) | 0.28 | | Ventricular arrhythmia, n (%) | 3 (1.1) | 1 (0.3) | 0.28 | | MI, n (%) | 2 (0.7) | 1 (0.3) | 0.52 | | DVT, n (%) | 2 (0.7) | 0 | 0.14 | | CVA, n (%) | 1 (0.4) | 1 (0.3) | 0.96 | | Death, n (%) | 11 (3.9) | 2 (0.7) | 0.008 |
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