|
|
||||||||
J Thorac Cardiovasc Surg 2009;138:419-425
© 2009 The American Association for Thoracic Surgery
General Thoracic Surgery |
a Department of Surgery, Duke University Medical Center, Durham, NC
b Department of Thoracic Surgery, St Luke's Health Network, Bethlehem, Pa
Received for publication June 24, 2008; revisions received April 7, 2009; accepted for publication April 24, 2009. * Address for reprints: Thomas A. D'Amico, MD, Department of Surgery, Duke University Medical Center Box 3496, Duke South, White Zone, Room 3589, Durham, NC 27710. (Email: damic001{at}mc.duke.edu).
Objectives: Advantages of thoracoscopic lobectomy include less postoperative pain, shorter hospitalization, and improved delivery of adjuvant chemotherapy. The incidence of postoperative complications has not been thoroughly assessed. This study analyzes morbidity after lobectomy to compare the thoracoscopic approach and thoracotomy.
Methods: By using a prospective database, the outcomes of patients who underwent lobectomy from 1999–2009 were analyzed with respect to postoperative complications. Propensity-matched groups were analyzed based on preoperative variables and stage.
Results: Of the 1079 patients in the study, 697 underwent thoracoscopic lobectomy, and 382 underwent lobectomy by means of thoracotomy. In the overall analysis thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (P = .01), atelectasis (P = .0001), prolonged air leak (P = .0004), transfusion (P = .0001), pneumonia (P = .001), sepsis (P = .008), renal failure (P = .003), and death (P = .003). In the propensity-matched analysis based on preoperative variables, when comparing 284 patients in each group, 196 (69%) patients who underwent thoracoscopic lobectomy had no complications versus 144 (51%) patients who underwent thoracotomy (P = .0001). In addition, thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (13% vs 21%, P = .01), less atelectasis (5% vs 12%, P = .006), fewer prolonged air leaks (13% vs 19%, P = .05), fewer transfusions (4% vs 13%, P = .002), less pneumonia (5% vs 10%, P = .05), less renal failure (1.4% vs 5%, P = .02), shorter chest tube duration (median of 3 vs 4 days, P < .0001), and shorter length of hospital stay (median of 4 vs 5 days, P < .0001).
Conclusions: Thoracoscopic lobectomy is associated with a lower incidence of major complications, including atrial fibrillation, compared with lobectomy by means of thoracotomy. The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.
This article has been cited by other articles:
![]() |
S.-i. Yamashita, K. Tokuishi, T. Moroga, S. Abe, K. Yamamoto, S. Miyahara, Y. Yoshida, J. Yanagisawa, D. Hamatake, M. Hiratsuka, et al. Totally Thoracoscopic Surgery and Troubleshooting for Bleeding in Non-Small Cell Lung Cancer Ann. Thorac. Surg., March 1, 2013; 95(3): 994 - 999. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. Crabtree, V. Puri, R. Timmerman, H. Fernando, J. Bradley, P. A. Decker, R. Paulus, J. B. Putnum Jr., D. E. Dupuy, and B. Meyers Treatment of stage I lung cancer in high-risk and inoperable patients: Comparison of prospective clinical trials using stereotactic body radiotherapy (RTOG 0236), sublobar resection (ACOSOG Z4032), and radiofrequency ablation (ACOSOG Z4033) J. Thorac. Cardiovasc. Surg., March 1, 2013; 145(3): 692 - 699. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. A. D'Amico The best that surgery has to offer J. Thorac. Cardiovasc. Surg., March 1, 2013; 145(3): 699 - 701. [Full Text] [PDF] |
||||
![]() |
C. Cao, C. Manganas, S. C. Ang, S. Peeceeyen, and T. D. Yan Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients Interact CardioVasc Thorac Surg, March 1, 2013; 16(3): 244 - 249. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. Taioli, D.-S. Lee, M. Lesser, and R. Flores Long-term survival in video-assisted thoracoscopic lobectomy vs open lobectomy in lung-cancer patients: a meta-analysis Eur J Cardiothorac Surg, February 14, 2013; (2013) ezt051v1. [Abstract] [Full Text] [PDF] |
||||
![]() |
C.-Y. Wu, J.-S. Chen, Y.-S. Lin, T.-M. Tsai, M.-H. Hung, K. C. Chan, and Y.-J. Cheng Feasibility and Safety of Nonintubated Thoracoscopic Lobectomy for Geriatric Lung Cancer Patients Ann. Thorac. Surg., February 1, 2013; 95(2): 405 - 411. [Abstract] [Full Text] [PDF] |
||||
![]() |
N. R. Villamizar, M. Darrabie, J. Hanna, M. W. Onaitis, B. C. Tong, T. A. D'Amico, and M. F. Berry Impact of T status and N status on perioperative outcomes after thoracoscopic lobectomy for lung cancer J. Thorac. Cardiovasc. Surg., February 1, 2013; 145(2): 514 - 521. [Abstract] [Full Text] [PDF] |
||||
![]() |
C.-F. J. Yang and T. A. D'Amico Thoracoscopic Segmentectomy for Lung Cancer Ann. Thorac. Surg., August 1, 2012; 94(2): 668 - 681. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. C. Tong, M. R. Gustafson, S. S. Balderson, T. A. D'Amico, and S. L. Meyerson Validation of a thoracoscopic lobectomy simulator Eur J Cardiothorac Surg, August 1, 2012; 42(2): 364 - 369. [Abstract] [Full Text] [PDF] |
||||
![]() |
S.-i. Yamashita, K. Tokuishi, K. Anami, T. Moroga, M. Miyawaki, M. Chujo, S. Yamamoto, and K. Kawahara Thoracoscopic segmentectomy for T1 classification of non-small cell lung cancer: a single center experience Eur J Cardiothorac Surg, July 1, 2012; 42(1): 83 - 88. [Abstract] [Full Text] [PDF] |
||||
![]() |
N. Mediratta, D. Barker, J. McKevith, P. Davies, S. Belchambers, and A. Rao Thoracoscopic patch insulation to correct phrenic nerve stimulation secondary to cardiac resynchronization therapy Europace, July 1, 2012; 14(7): 1049 - 1053. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. MURTHY Video-assisted thoracoscopic surgery for the treatment of lung cancer Cleveland Clinic Journal of Medicine, May 1, 2012; 79(e-Suppl_1): e-S23 - e-S25. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. D. Mitchell, J. A. Yu, A. Bishop, M. J. Weyant, and M. Pomerantz Thoracoscopic Lobectomy and Segmentectomy for Infectious Lung Disease Ann. Thorac. Surg., April 1, 2012; 93(4): 1033 - 1040. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. A. Shah, M. E. Barfield, C. R. Kelsey, M. W. Onaitis, B. Tong, D. Harpole, T. A. D'Amico, and M. F. Berry Outcomes After Surgical Management of Synchronous Bilateral Primary Lung Cancers Ann. Thorac. Surg., April 1, 2012; 93(4): 1055 - 1060. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. F. Berry, M. W. Onaitis, B. C. Tong, S. S. Balderson, D. H. Harpole, and T. A. D'Amico Feasibility of hybrid thoracoscopic lobectomy and en-bloc chest wall resection Eur J Cardiothorac Surg, April 1, 2012; 41(4): 888 - 892. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. Gonzalez-Rivas, M. Paradela, E. Fieira, and C. Velasco Single-incision video-assisted thoracoscopic lobectomy: Initial results J. Thorac. Cardiovasc. Surg., March 1, 2012; 143(3): 745 - 747. [Full Text] [PDF] |
||||
![]() |
H. S. Park, F. C. Detterbeck, D. J. Boffa, and A. W. Kim Impact of Hospital Volume of Thoracoscopic Lobectomy on Primary Lung Cancer Outcomes Ann. Thorac. Surg., February 1, 2012; 93(2): 372 - 379. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. J. Park, F. Melfi, A. Mussi, P. Maisonneuve, L. Spaggiari, R. K. C. Da Silva, and G. Veronesi Robotic lobectomy for non-small cell lung cancer (NSCLC): Long-term oncologic results J. Thorac. Cardiovasc. Surg., February 1, 2012; 143(2): 383 - 389. [Abstract] [Full Text] [PDF] |
||||
![]() |
F. Dexter, E. U. Dexter, and J. Ledolter Statistical Grand Rounds: Importance of Appropriately Modeling Procedure and Duration in Logistic Regression Studies of Perioperative Morbidity and Mortality Anesth. Analg., November 1, 2011; 113(5): 1197 - 1201. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. Otake, H. Yasunaga, H. Horiguchi, N. Matsutani, S. Matsuda, and K. Ohe Impact of Hospital Volume on Chest Tube Duration, Length of Stay, and Mortality After Lobectomy Ann. Thorac. Surg., September 1, 2011; 92(3): 1069 - 1074. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. A. D'Amico, J. Niland, R. Mamet, C. Zornosa, E. U. Dexter, and M. W. Onaitis Efficacy of Mediastinal Lymph Node Dissection During Lobectomy for Lung Cancer by Thoracoscopy and Thoracotomy Ann. Thorac. Surg., July 1, 2011; 92(1): 226 - 232. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. G. Lee, B. C. Cho, M. K. Bae, C. Y. Lee, I. K. Park, D. J. Kim, and K. Y. Chung Thoracoscopic Lobectomy Is Associated With Superior Compliance With Adjuvant Chemotherapy in Lung Cancer Ann. Thorac. Surg., February 1, 2011; 91(2): 344 - 348. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Kachare, E. U. Dexter, C. Nwogu, T. L. Demmy, and S. Yendamuri Perioperative outcomes of thoracoscopic anatomic resections in patients with limited pulmonary reserve J. Thorac. Cardiovasc. Surg., February 1, 2011; 141(2): 459 - 462. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. M. Borro, D. Gonzalez, M. Paradela, M. de la Torre, R. Fernandez, M. Delgado, J. Garcia, and E. Fieira The two-incision approach for video-assisted thoracoscopic lobectomy: an initial experience Eur J Cardiothorac Surg, January 1, 2011; 39(1): 120 - 126. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. K. Kim, Y. S. Choi, J. Kim, Y. M. Shim, and K. Kim Outcomes of unexpected pathologic N1 and N2 disease after video-assisted thoracic surgery lobectomy for clinical stage I non-small cell lung cancer J. Thorac. Cardiovasc. Surg., December 1, 2010; 140(6): 1288 - 1293. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. C. Giulianotti, N. C. Buchs, G. Caravaglios, and F. M. Bianco Robot-assisted lung resection: outcomes and technical details Interact CardioVasc Thorac Surg, October 1, 2010; 11(4): 388 - 392. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. D. Kozower, S. Sheng, S. M. O'Brien, M. J. Liptay, C. L. Lau, D. R. Jones, D. M. Shahian, and C. D. Wright STS Database Risk Models: Predictors of Mortality and Major Morbidity for Lung Cancer Resection Ann. Thorac. Surg., September 1, 2010; 90(3): 875 - 883. [Abstract] [Full Text] [PDF] |
||||
![]() |
T. A. D'Amico Operative Techniques in Early-Stage Lung Cancer J Natl Compr Canc Netw, July 1, 2010; 8(7): 807 - 813. [Abstract] [Full Text] [PDF] |
||||
![]() |
K. K. W. Lau, A. E. Martin-Ucar, A. Nakas, and D. A. Waller Lung cancer surgery in the breathless patient -- the benefits of avoiding the gold standard Eur J Cardiothorac Surg, July 1, 2010; 38(1): 6 - 13. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. E. Nwogu, S. Yendamuri, and T. L. Demmy Does Thoracoscopic Pneumonectomy for Lung Cancer Affect Survival? Ann. Thorac. Surg., June 1, 2010; 89(6): S2102 - S2106. [Abstract] [Full Text] [PDF] |
||||
![]() |
N. M. Rueth and R. S. Andrade Is VATS Lobectomy Better: Perioperatively, Biologically and Oncologically? Ann. Thorac. Surg., June 1, 2010; 89(6): S2107 - S2111. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. C. Fernando, M. Schuchert, R. Landreneau, and B. T. Daly Approaching the High-Risk Patient: Sublobar Resection, Stereotactic Body Radiation Therapy, or Radiofrequency Ablation Ann. Thorac. Surg., June 1, 2010; 89(6): S2123 - S2127. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. R. Gopaldas, F. G. Bakaeen, T. K. Dao, G. L. Walsh, S. G. Swisher, and D. Chu Video-Assisted Thoracoscopic Versus Open Thoracotomy Lobectomy in a Cohort of 13,619 Patients Ann. Thorac. Surg., May 1, 2010; 89(5): 1563 - 1570. [Abstract] [Full Text] [PDF] |
||||
![]() |
L. Crino, W. Weder, J. van Meerbeeck, E. Felip, and On behalf of the ESMO Guidelines Working Group Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up Ann. Onc., May 1, 2010; 21(suppl_5): v103 - v115. [Full Text] [PDF] |
||||
![]() |
J. P. Sculier, T. Berghmans, and A. P. Meert Update in Lung Cancer and Mesothelioma 2009 , April 15, 2010; 181(8): 773 - 781. [Full Text] [PDF] |
||||
![]() |
M. F. Berry, N. R. Villamizar-Ortiz, B. C. Tong, W. R. Burfeind Jr, D. H. Harpole, T. A. D'Amico, and M. W. Onaitis Pulmonary Function Tests Do Not Predict Pulmonary Complications After Thoracoscopic Lobectomy Ann. Thorac. Surg., April 1, 2010; 89(4): 1044 - 1052. [Abstract] [Full Text] [PDF] |
||||
![]() |
W. R. Burfeind Jr., N. P. Jaik, N. Villamizar, E. M. Toloza, D. H. Harpole Jr., and T. A. D'Amico A cost-minimisation analysis of lobectomy: thoracoscopic versus posterolateral thoracotomy Eur J Cardiothorac Surg, April 1, 2010; 37(4): 827 - 832. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Paul, N. K. Altorki, S. Sheng, P. C. Lee, D. H. Harpole, M. W. Onaitis, B. M. Stiles, J. L. Port, and T. A. D'Amico Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: A propensity-matched analysis from the STS database J. Thorac. Cardiovasc. Surg., February 1, 2010; 139(2): 366 - 378. [Abstract] [Full Text] [PDF] |
||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |