Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy

doi:10.1016/S0003-4975(00)01513-7

The Annals of Thoracic Surgery

Volume 70, Issue 3, September 2000, Pages 938-941

https://doi.org/10.1016/S0003-4975(00)01513-7 Get rights and content

Abstract

Background. Whether video-assisted thoracic surgery (VATS) improves postoperative pulmonary function is still controversial. We compared postoperative pulmonary function after VATS lobectomy and standard lobectomy.

Methods. Eleven patients who had undergone standard lobectomy and 10 patients who had undergone VATS lobectomy were studied. Arterial blood gas analyses were performed on the 4th, 7th, and 14th postoperative days. Pulmonary function, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV_1.0), and peak flow rate (PFR) were measured on the 7th and 14th postoperative days (early phase), and approximately 1 year after surgery (late phase).

Results. Pulmonary function, as assessed with arterial oxygen partial pressure (PaO₂) (p = 0.054), arterial oxygen saturation (O_2SAT) (p = 0.063), FVC (p = 0.10), and FEV_1.0 (p = 0.08), was better after VATS lobectomy than after thoracotomy on the 7th postoperative day. PFR was significantly better after VATS on both the 7th and 14th postoperative days (p = 0.008 and p = 0.03, respectively).

Conclusions. VATS lobectomy had advantages on early postoperative pulmonary function. We conclude that VATS lobectomy is a beneficial alternative to standard thoracotomy, especially for patients with poor pulmonary reserve.

Section snippets

Patients

From November 1996 through August 1997, 31 consecutive patients with primary lung cancer underwent lobectomy at our institution. Twenty-one patients underwent lobectomy by posterolateral thoracotomy and 10 patients underwent VATS lobectomy. Of these 31 patients, 3 patients with hilar lung cancer were excluded from this study because preoperative pulmonary function was thought to be impaired by obstructed or narrowed bronchi. An additional 7 patients who underwent thoracotomy were excluded

Results

The patient characteristics are shown in Table 1. The two groups did not differ significantly with respect to age, tumor size, preoperative arterial oxygen partial pressure (PaO₂), arterial carbon dioxide partial pressure (PaCO₂), arterial oxygen saturation (O_2SAT), and FEV_1.0%. The percentage of the predicted vital capacity (%VC) was significantly better in the thoracotomy group (p = 0.002). However, the mean value in the VATS group (92.9 ± 12.1%) was sufficiently high for lobectomy. The

Comment

VATS is a new approach for thoracic surgery. Several previous studies have already demonstrated the benefit of this new approach 1, 2, 3, 5, 6. Landreneau and coworkers 1, 2 found that the patients who underwent VATS had less pain, less shoulder dysfunction, and decreased morbidity. Tschernko and colleagues [6] found that the plasma epinephrine levels 3 and 15 hours after VATS were significantly lower than those after axillary thoracotomy. According to these results, VATS is considered

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Original article: general thoracicPulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy

Abstract

Section snippets

Patients

Results

Comment

Ann Thorac Surg

J Thorac Cardiovasc Surg

Chest

Ann Thorac Surg

Original article: general thoracic
Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy