Original article
General thoracic
Changes in Pulmonary Function in Lung Cancer Patients After Video-Assisted Thoracic Surgery

https://doi.org/10.1016/j.athoracsur.2014.07.066Get rights and content

Background

Video-assisted thoracoscopic surgery (VATS) is widely performed in patients with resectable non-small cell lung cancer. However, it is unknown whether VATS sublobar resection has advantages compared with VATS lobectomy in preserving pulmonary function.

Methods

Three hundred patients with non-small cell lung cancer who underwent VATS were enrolled. Pulmonary function tests were performed three times: preoperatively, and at 3 and 12 months postoperatively. Pulmonary function was compared between the VATS lobectomy group (n = 227) and the VATS sublobar resection group (n = 73).

Results

The VATS sublobar resection group had greater preserved pulmonary function than the VATS lobectomy group at 3 and 12 months postoperatively (p < 0.001). However, a VATS lobectomy of the right upper or right middle lobe revealed no difference in forced vital capacity (−1.21% versus −1.45%; p = 0.88) or the diffusion capacity of carbon monoxide (−3.99% versus −2.45%; p = 0.61) compared with VATS sublobar resection after 12 months. In those who underwent VATS of the right lower lobe, forced expiratory volume in 1 second (−8.60% versus −3.69%; p = 0.12) was not different between the two groups after 12 months. Video-assisted thoracoscopic surgery lobectomy of the left upper or left lower lobe resulted in lower pulmonary function than VATS sublobar resection (p < 0.05).

Conclusions

Patients with non-small cell lung cancer who underwent VATS sublobar resection demonstrated greater pulmonary function than those who underwent VATS lobectomy. However, in right-side VATS lobectomy, some differences dissipated at 1 year.

Section snippets

Patients

A registry and management protocol were started in August 2003 for patients with NSCLC who underwent surgery at Seoul National University Bundang Hospital. Pulmonary function tests (PFTs) were performed at least three times: preoperatively, and at 3 and 12 months postoperatively. From August 2003 to December 2012, 1,799 patients were enrolled in the registry. Among them, 900 patients underwent VATS lobectomy or VATS sublobar resection, which included VATS segmentectomy and VATS wedge resection.

Overall Patient Characteristics

Table 1 shows the baseline characteristics of 300 patients. The two groups did not differ significantly with respect to age, sex, smoking status, operative duration, the duration of chest tube, or hospital stay duration. However, adenocarcinoma was significantly more common in the VATS sublobar resection group. Tumor size and NSCLC stage were significantly larger and more advanced in the VATS lobectomy group. Both groups had similar baseline PFT values with respect to FVC (L), FEV1 (L), FEV1

Comment

Video-assisted thoracoscopic surgery sublobar resection was superior to VATS lobectomy for the preservation of pulmonary function. Video-assisted thoracoscopic surgery has fewer destructive properties than open thoracotomy [14]. Video-assisted thoracoscopic surgery is associated with less pain, low morbidity and mortality, and earlier recovery compared with open thoracotomy 19, 20. The National Comprehensive Cancer Network guidelines also recommend VATS for resectable NSCLC [2]. However, there

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