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VATS Pulmonary Resection for Lung Cancer: Improved Functional Outcomes compared to Open Techniques
J. R. Handy1, J. W. Asaph2, E. Douville3, G. Y. Ott*3, A. C. Tsen3, P. Fowler3, G. L. Grunkemeier*4, Y. Wu4. 1Providence Cancer Center, Portland, OR, 2Earle A Chiles Research Center, Providence Health & Services, Portland, OR, 3Thoracic & CardioVascular Surgery, The Oregon Clinic, Portland, OR, 4Medical Data Research Center, Providence Health & Services, Portland, OR,
VATS Pulmonary Resection for Lung Cancer: Improved Functional Outcomes compared to Open Techniques
Objective: Minimally invasive video-assisted thoracic surgery (VATS) lobectomy is performed for lung cancer infrequently and has few demonstrated advantages when compared to open techniques. We sought to evaluate VATS vs open resection (OPEN) for lung cancer and impact upon 6 month postoperative (postop) functional health status and quality of life.
Methods: Operative approach was by surgeon preference. VATS was not used in large central tumors or chest wall involvement. OPEN included thoracotomy (muscle sparing and standard techniques) and median sternotomy. Procedures included lobectomy, pneumonectomy, segmentectomy & nonanatomic segmentectomy. All patients were curative intent, underwent staging thoracic lymphadenectomy, and were administered the Short Form 36 Health Survey (SF36) and Ferrans and Powers Quality of Life Index (QLI) preoperatively (preop) and postop.
Results: 301 patients underwent lung cancer resection (OPEN-235; VATS-66). OPEN consisted of 79 (34%) thoracotomy and 156 (66%) sternotomy. Procedures were lobectomy: OPEN-182 (77%), VATS-54 (82%); pneumonectomy: OPEN-19 (8%), VATS-0%; segmentectomy: OPEN-6 (3%), VATS-1 (2%); nonanatomic wedge: OPEN-11 (5%), VATS- 11 (17%). VATS & OPEN patients did not differ in age, gender, comorbidities, smoking status, pulmonary function, performance status, preop radiation therapy, 6-minute walk test or ASA class. OPEN had more induction chemotherapy (13% vs 5%, p=0.049). VATS had more adenocarcinoma (49%) compared to OPEN (32%); p=0.002. Pathologic stage was better in VATS vs OPEN (1A: 59% vs 28%; p< 0.001). VATS & OPEN did not differ statistically regarding extent of resection (although no pneumonectomies or sleeve lobectomies were performed by VATS), operating time, intraoperative fluid requirement, postop complications, operative mortality, or 6-month mortality (VATS-3%, OPEN-10%, p=0.079). VATS had less blood loss (VATS-222, OPEN-498 ml, p<0.001) & shorter length of stay (VATS-5.4, OPEN-6.8 days, p=0.029).
Compared to preop, 6 months postop VATS patients were not significantly different in all SF-36 categories (physical functioning, role functioning-physical, role functioning-emotional, social functioning, bodily pain, mental health, energy, general health) and all QLI categories (quality of life, health & functioning, socioeconomic status, psychological-spiritual status, family status). OPEN, however, was significantly worse in all SF-36 categories except mental health and worse in QLI family status subscale. No postop differences were found in pulmonary function, walk test, chronic pain cause, dyspnea, performance status, or smoking status. 6 month postop pain score improved over preop in VATS but worsened for OPEN (p=0.021). Use of pain medication at 6 months was less in VATS (12%) vs OPEN (38%), p=0.001).
Conclusions: VATS for curative lung cancer resection provides a superior functional health status and patients experience less pain at 6 months postop compared to open techniques.
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