Elsevier

The Annals of Thoracic Surgery

Volume 70, Issue 5, November 2000, Pages 1644-1646
The Annals of Thoracic Surgery

Original article: general thoracic
Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy

https://doi.org/10.1016/S0003-4975(00)01909-3Get rights and content

Abstract

Background. Data regarding pulmonary function and prognosis after video-assisted thoracic surgery lobectomy are limited.

Methods. From September 1992 to April 2000, 204 video-assisted thoracic surgery lobectomies were performed, and their preoperative and postoperative pulmonary function test results and prognoses were evaluated.

Results. The postoperative to preoperative ratio of pulmonary function tests (vital capacity and forced expiratory volume in 1 s) were better in video-assisted thoracic surgery lobectomy than in open thoracotomy (p < 0.0001). Furthermore, the 5-year survival rate of pathologic stage I lung cancers after video-assisted thoracic surgery was 97.0%, whereas that after open thoracotomy was 78.5% (p = 0.0173; Mantel-Cox).

Conclusions. Pulmonary function and prognosis were far better after video-assisted thoracic surgery lobectomy than after open thoracotomy.

Section snippets

Patients and methods

From September 1992 through April 2000, we performed 204 major lung resections under VATS: 13 segmentectomies, 187 lobectomies, and 4 pneumonectomies. There were 120 male and 84 female patients with an average age of 64 years (range, 28 to 87 years). The patients consisted of 159 cases with lung cancer, 13 with bronchiectasis, 9 with granulomas, 8 with metastatic tumors, and 15 with miscellaneous diseases. After intubation with a double-lumen endotracheal tube (Broncho-Cath, Mallinckrodt

Results

Among spirometry variables, the data of vital capacity and forced expiratory volume in 1 s are presented in Table 2. A comparison of postoperative and preoperative values was made between the VATS lobectomy and open thoracotomy groups; the average postoperative vital capacity was divided by the average preoperative value in both the VATS lobectomy and open thoracotomy groups. The resulting quotients were 0.849 and 0.668, respectively (Fig 2). A comparison of another spirometry variable, forced

Comment

Although open thoracotomy has long been adopted as a standard approach in lung resection, it contributes to morbidity, mortality, and prolonged, painful recovery of the patient. All these things are believed to come from the extent of the incision. On the other hand, the less destructive nature of VATS lobectomy is associated with low mortality and morbidity, early recovery, less deformity of the thorax, and better survival than open thoracotomy. Although medical insurance allowed only patients

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