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J Thorac Cardiovasc Surg 2009;138:419-425
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy

^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.