Morbidity in video-assisted thoracoscopic lobectomy for clinical stage I non-small cell lung cancer: is VATS lobectomy really safe?

• Published in: The Thoracic and cardiovascular surgeon Vol. 57; no. 3; p. 156
• Main Authors: Kawachi, R, Tsukada, H, Nakazato, Y, Takei, H, Koshi-ishi, Y, Goya, T
• Format: Journal Article
• Language: English
• Published: Germany 01-04-2009
• Subjects: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Clinical Competence; Female; Humans; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Middle Aged; Neoplasm Staging; Pneumonectomy - adverse effects; Pneumonectomy - methods; Pneumonectomy - mortality; Postoperative Hemorrhage - etiology; Pulmonary Artery - injuries; Pulmonary Veins - injuries; Retrospective Studies; Risk Assessment; Thoracic Surgery, Video-Assisted - adverse effects; Thoracotomy - adverse effects; Thoracotomy - mortality; Time Factors; Treatment Outcome
• ISSN: 0171-6425
• DOI: 10.1055/s-2008-1039267

The objective of this study was to compare video-assisted thoracoscopic lobectomy (VATS lobectomy) with standard thoracotomy in terms of morbidity and mortality.
Two-hundred and forty-nine consecutive patients with clinical (c) stage I non-small cell lung cancer who underwent surgery between 1999 and 2003 were retrospectively analyzed. All of the patients underwent surgical resection that was at least as extensive as lobectomy. VATS lobectomy was performed in 73 patients, and thoracotomy in 176 patients.
The clinical stages were stage IA in 151 (60.6 %), and stage IB in 98 (39.4 %), and the pathological stages were I in 206 (82.7 %), II in 16 (6.4 %), and III in 27 (10.9 %). The mean operation time was 291 minutes for VATS and 215 minutes for thoracotomy ( P = 0.0 042). The mean blood loss was 160 ml and 191 ml ( P = 0.2 738), respectively. Mortality was 1.4 % (1/73) in the VATS group, and 2.3 % (4/176) in the thoracotomy group ( P = 0.6 438). Morbidity was 19.2 % (14/73), and 24.4 % (44/176), respectively ( P = 0.1 315). Air leakage was the most frequent complication. Anastomotic leakage was found in four patients who underwent thoracotomy. The incidence of pulmonary vessel injury was 8.2 % in the VATS group and 1.7 % in the thoracotomy group ( P = 0.0 361). While pulmonary vessel injury was observed frequently in the intermediate part of the study period, the incidence decreased in the late period.
Pulmonary vessel injury, longer operation times, and greater blood loss have been frequently observed with VATS lobectomy. Proficiency is required to perform VATS lobectomy, and the procedure should be performed by a well-trained surgeon as indicated by the results of this study.