Outpatient thoracoscopic resection of lung nodules within a fast-track recovery program

• Published in: Revue des maladies respiratoires Vol. 33; no. 5; p. 343
• Main Authors: Bardet, J, Zaimi, R, Dakhil, B, Couffinhal, J C, Raynaud, C, Bagan, P
• Format: Journal Article
• Language: French
• Published: France 01-05-2016
• Subjects: Adult; Ambulatory Care - methods; Critical Pathways - organization & administration; Critical Pathways - standards; Female; Humans; Male; Middle Aged; Multiple Pulmonary Nodules - rehabilitation; Multiple Pulmonary Nodules - surgery; Operative Time; Patient Discharge; Pneumonectomy - methods; Pneumonectomy - rehabilitation; Retrospective Studies; Thoracic Surgery, Video-Assisted - rehabilitation; Thoracoscopy - methods; Thoracoscopy - rehabilitation; Time Factors; Outpatient surgery; Thoracoscopie; Fast-track recovery; Chirurgie ambulatoire; Lung nodule; Réhabilitation précoce; Thoracoscopy; Nodule pulmonaire
• ISSN: 1776-2588
• DOI: 10.1016/j.rmr.2015.07.009

The objectives of outpatient surgery are to reduce the risks related to the hospitalization, to improve the postoperative recovery and to optimize contact with family physicians. The objective of this work is to present the first unit of outpatient pulmonary surgery and to report the results of the resections of pulmonary nodules in outpatient surgery in the setting of early discharge.
The indications for the resection of nodules were discussed in a multidisciplinary thoracic oncology meeting. The patients underwent resection of one or more lung nodules by thoracoscopy after verification that they met the anaesthetic and surgical criteria for ambulatory surgery. We analyzed the characteristics of the population, the duration of surgery, the type of resection, the time of the chest drain removal and the postoperative follow-up.
Between November 2013 and December 2014, 51 patients underwent sub-lobar pulmonary resections. Among them 7 patients (4 men and 3 women), with an average age of 57.6 years (39-64) and histories of malignant tumor, underwent 7 atypical resections and two segmentectomies in outpatient surgery (3 patients had two resections). The average operating time was 53.75min (30-90). The chest drain was removed before the third hour in 8 cases and on the third day in one case. The average tumor diameter was 10.375mm (6-23). The histology revealed a metastasis of colorectal carcinoma in 4 cases, a metastasis of a renal carcinoma in 1 case, an in situ adenocarcinoma in 1 case and a benign tumor in 3 cases. Neither recurrence nor complication was observed during an average follow-up of 6 months.
Thanks to a protocol of early mobilisation and discharge included in a well established clinical care pathway, thoracoscopic resection of lung nodules is feasible, with safety in properly selected and prepared patients in outpatient surgery.