Lobectomy — Video-assisted thoracic surgery versus muscle-sparing thoracotomy: A randomized trial

Lobectomy — Video-assisted thoracic surgery versus muscle-sparing thoracotomy: A randomized trial

Abstracts/Lung Cancer predicted values to be significantly more sensitive. Of9 patients with a VO,max < 60% of predicted, 8 had complications, inclu...

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Abstracts/Lung

Cancer

predicted values to be significantly more sensitive. Of9 patients with a VO,max < 60% of predicted, 8 had complications, including all 3 patients who died after resections of more than one lobe (sensitivity SO%, specificity 98%). The estimated probability @mbit model SAS software package) of suffering no complication was 0.9 for VO,max > 75% of predicted and 0.1 for a VO,max < 43%. We conclude that exercise testing was a valuable tool and VO,max expressed as a percentage of predicted was the single best indicator of postoperative complications after lung resection. A cutoff value < 60% of predicted was highly predictive of complications and probably prohibitive for resections involving more than one lobe, whereas a VO,max value > 75% of predicted was an excellent indicator of an uneventful postoperative course irrespective of the extent of resection.

Lobectomy - Video-assisted thoracic surgery versus musclesparing thoracotomy: A randomized trial Kirby TJ, Mack MJ, Landreneau RI, Rice TW, LoCicero J III, Lewis RJ. Dept. of Thoracic/Cardiovasz. 9500 Euclid Ave.. Cleveland,

Surg.,

Cleveland

Clinic

Foundation,

OH 44195. J Thorac Cardiovasc

Surg 1995;109:997-1002. Video-assisted thoracic surgery has been adopted by some thoracic surgeons as the preferred approach over thoracotomy for many benign and malignant diseases of the chest. However, little concrete evidence exists to support this technique as the superior approach. This randomized study was carded out to define the advantages of videoassisted lobectomy over muscle-sparing thoracotomy and lobectomy. Sixty-one patients with presumed clinical stage I non-smallcell lung cancer were entered into the study. Each patient was randomized to muscle-sparing thoracotomy and lobectomy or video-assisted lobectomy. Six patients were excluded from the study either because tinai pathologic results revealed nonmalignant disease (3 patients) or because an attempted video-assisted lobectomy was converted to a thoracotomy. This left 30 patients in the thoracotomy group and 25 patients in the video-assisted group. No significant differences existed between the two groups in operating time, intraoperative blood loss, duration of chest tube drainage, or length of hospital stay. Significantly more postoperative complications occurred in the thoracotomy group @ < 0.5) the majority of which were prolonged air leaks. Return to work time was not an issue because the majority of the patients were either retired or not working at the time of the operation. Only three patients had persistent postthoracotomy pain (thoracotomy, n = 2; video-assisted lobectomy, n = I). We conclude that video-assisted lobectomy was not associated with a significant decrease in duration of chest tube drainage, length of hospital stay, postthoracotomy pain, or, in this group of patients, a faster recovery time and return to work. Video-assisted lobectomy continues to expose the patient to the risk of a major pulmonary resection being done in an essentially dosed chest, These results illustrate the need for critical evaluation of video-assisted thoracic surgery before the procedure is accepted as a superior approach based on presumed and thus far unproved advantages.

Initial experience of video assisted thoracoscopic pneumonectomy Craig SR, Walker WS. Deparhnent of Thoracic Surgev, City Hospital, Greenbank Drive, Edinburgh EHIO 5SB. Thorax 1995;50:392-5. Background -Preliminary experience of video assisted thomcoscopic pneumonectomy in six patients with bronchogenic carcinoma is described. Methods - Four left and two right pneumonectomies were performed under video thoracoscopic imaging. Thoracoscopic instruments were passed through two separate stab incisions on the lateral chest wall and a separate 6 cm submammary incision was also created

13 (1995)

185-232

to allow further access for instrumentation and removal of the resected lung. In this initial experience resection was restricted to patients with bronchogenic carcinomas of less than 6 cm in diameter who had no involvement of the mediastinum. Results - There were no operative deaths and no complications attributable to the technique. One patient developed post-operative atrial fibrillation and a small sacral sore and one patient was readmitted with abdominal pain and pyrexia which settled following exclusion of post pneumonectomy empyema. The remaining four patients made a rapid uncomplicated postoperative recovery with less pain and discomfort than that normally associated with a standard posterolatend thoracotomy. Postoperatively the mean (SD) patient controlled morphine consumption was 1.36 (1.90) mg per hour in the first 36 hours compared with the unit mean for open thoracotomyof 1.73 (1.68)mgper hour. Themean linear visual analogue pain score was 15.4 (15.6) in the first 24 hours compared with the unit mean for open thoracotomy of 34.5 (8.5). Conclusions - Video assisted thoracoscopic pneumonectomy can be performed safely in patients who have stage I and stage II bronchogenic carcinomas, up to 6 cm in diameter, with no mediastinal involvement on mediastinoscopy and thoracic computed tomographic assessment. This technique may result in less postoperative pain and discomfort and should allow a quicker return to normal activities. Initial experience ectomy Craig SR, Walker Greenbank Drive,

of video

assisted

WS. Departient Edinburgh

EHlO

thoracoscopic

pneumon-

of Thoracic Surgery, City Hospital, SSB. Thorax 1995;50:392-5.

Backgttwnd - Preliminary experience of video assisted thoracoscopic pneumonectomy in six patients with hronchogenic carcinoma is described. Methods - Four left and two right pneumonectomies were performed under video thoracoscopic imaging. Thoracoscopic instruments were passed through two separate stab incisions on the lateral chest wall and a separate 6 cm submammary incision was also created to allow further access for instrumentation and removal of the resected lung. In this initial experience resection was restricted to patients with bronchogenic carcinomas of less than 6 cm in diameter who had no involvement of the mediastinum. Results - There were no operative deaths and no complications attributable to the technique. One patient developed post-operative atrial fibrillation and a small sacral sore and one patient was readmitted with abdominal pain and pyrexia which settled following exclusion of post pneumonectomy empyema. The remaining four patients made a rapid uncomplicated postoperative recovery with less pain and discomfort than that normally associated with a standard posterolateral thoracotomy. Postoperatively the mean (SD) patient controlled morphine consumption was 1.36 (1.90) mg per hour in the first 36 hours compared with the unit mean for open thoracotomyof 1.73 (1.68)mg per hour. The mean linear visual anaiogue pain score was 15.4 (15.6) in the first 24 hours compared with the unit mean for open thoracotomy of 34.5 (8.5). Conclusions - Video assisted thoracoscopic pneumonectomy can be performed safely in patients who have stage 1 and stage II bronchogenic carcinomas, up to 6 cm in diameter, with no mediastinal involvement on mediastinoscopy and thoracic computed tomographic assessment. This technique may result in less postoperative pain and discomfort and should allow a quicker return to normal activities. On lung cancer in the patient in his eighties Le PimpecBatthes F, Manac’H D, Debrosse D, Souilamas R, Riquet M, Debesse B. Service de Chirwgie Thoracique. Hopital Laennec, 42 Rue de Sews, 75007 Paris. Rev Geriatr 1995;ZO: 17 l-4. From October 1986 to September 1992,18 patients aged 180 years underwent surgery for lung cancer. The accounted for 2.2% of the