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J Thorac Cardiovasc Surg 2012;143:47-54.e1
© 2012 The American Association for Thoracic Surgery

General Thoracic Surgery

Randomized comparison of awake nonresectional versus nonawake resectional lung volume reduction surgery

Eugenio Pompeo, MDa,*, Paola Rogliani, MDb, Federico Tacconi, MDa, Mario Dauri, MDc, Cesare Saltini, MDb, Giuseppe Novelli, PhDd, Tommaso C. Mineo, MDa Awake Thoracic Surgery Research Group

a Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
b Department of Pneumology, Policlinico Tor Vergata University, Rome, Italy
c Department of Anesthesiology, and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
d Department of Biopathology and Diagnostic Imaging, Policlinico Tor Vergata University, Rome, Italy

Received for publication May 6, 2011; revisions received August 1, 2011; accepted for publication September 23, 2011.

* Address for reprints: Eugenio Pompeo, MD, Cattedra di Chirurgia Toracica, Policlinico Università Tor Vergata, V.le Oxford, 81, 00133 Rome, Italy. (Email: pompeo{at}med.uniroma2.it).

Objective: The study objective was to assess in a randomized controlled study (NCT00566839) the comparative results of awake nonresectional or nonawake resectional lung volume reduction surgery.

Method: Sixty-three patients were randomly assigned by computer to receive unilateral video-assisted thoracic surgery lung volume reduction surgery by a nonresectional technique performed through epidural anesthesia in 32 awake patients (awake group) or the standard resectional technique performed through general anesthesia in 31 patients (control group). Primary outcomes were hospital stay and changes in forced expiratory volume in 1 second. During follow-up, the need of contralateral treatment because of loss of postoperative benefit was considered a failure event as death.

Results: Intergroup comparisons (awake vs control) showed no difference in gender, age, and body mass index. Hospital stay was shorter in the awake group (6 vs 7.5 days, P = .04) with 21 versus 10 patients discharged within 6 days (P = .01). At 6 months, forced expiratory volume in 1 second improved significantly in both study groups (0.28 vs 0.29 L) with no intergroup difference (P = .79). In both groups, forced expiratory volume in 1 second improvements lasted more than 24 months. At 36 months, freedom from contralateral treatment was 55% versus 50% (P = .5) and survival was 81% versus 87% (P = .5).

Conclusions: In this randomized study, awake nonresectional lung volume reduction surgery resulted in significantly shorter hospital stay than the nonawake procedure. There were no differences between study groups in physiologic improvements, freedom from contralateral treatment, and survival. We speculate that compared with the nonawake procedure, awake lung volume reduction surgery can offer similar clinical benefit but a faster postoperative recovery.






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