Morbidity in Video-Assisted Thoracoscopic Lobectomy for Clinical Stage I Non-Small Cell Lung Cancer: Is VATS Lobectomy Really Safe?

Abstract

Objective: The objective of this study was to compare video-assisted thoracoscopic lobectomy (VATS lobectomy) with standard thoracotomy in terms of morbidity and mortality.

Patients and Methods: 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.

Results: 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.

Conclusions: 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.

Key words

thoracic surgery - lung cancer - VATS - morbidity - lobectomy

References

• 1 McKenna Jr R J, Houck W, Fuller C B. Video-assisted thoracic surgery lobectomy: experience with 1100 cases.  Ann Thorac Surg. 2006;  81 421-426
• 2 Yim A PC, Izzat M B, Liu H P, Ma C C. Thoracoscopic major lung resections: an Asian perspective.  Semin Thorac Cardiovasc Surg. 1998;  10 326
• 3 Kaseda S, Aoki T, Hangai N. Video-assisted thorac surgery (VATS) lobectomy: the Japanese experience.  Semin Thorac Cardiovasc Surg. 1998;  10 300
• 4 Hermansson U, Konstantinov I E, Aren C. Video-assisted thoracic surgery (VATS) lobectomy: the initial Swedish experience.  Semin Thorac Cardiovasc Surg. 1998;  10 285
• 5 Walker W S, Codispoti M, Soon S Y, Stamenkovic S, Carnochan F, Pugh G. Long-term outcomes following VATS lobectomy for non-small cell bronchogenic carcinoma.  Eur J Cardiothorac Surg. 2003;  23 397-402
• 6 Roviaro G, Varoli F, Uergani C, Maciocco M. Video-assisted thoracoscopic surgery (VATS) major pulmonary resections: the Italian experience.  Semin Thorac Cardiovasc Surg. 1998;  10 313
• 7 Solaini L, Prusciano F, Bagioni P, Di Francesco F, Basilio Poddie D. Video-assisted thoracic surgery major pulmonary resections. Present experience.  Eur J Cardiovasc Surg. 2001;  20 437-442
• 8 McKenna R J, Fischel R JF, Wolf R, Wurnig P. VATS lobectomy: the Los Angeles experience.  Semin Thorac Cardiovasc Surg. 1998;  10 321
• 9 Daniels L J, Balderson S S, Onaitis M W, D'Amico T A. Thoracoccopic lobectomy: a safe and effective strategy for patients with stage I lung cancer.  Ann Thorac Surg. 2002;  74 860-864
• 10 Sugiura H, Morikawa T, Kaji M, Sasamura Y, Kondo S, Katoh H. Long-term benefits for the quality of life after video-assisted thoracoscopic lobectomy in patients with lung cancer.  Surg Laparosc Endosc. 1999;  9 403-410
• 11 Demmy T L, Curtis J J. Minimally invasive lobectomy directed toward frail and high-risk patients: a case-control study.  Ann Thorac Surg. 1999;  68 194-200
• 12 Mack M J, Scruggs G R, Kelly K M, Shennib H, Landreneau R J. Video-assisted thoracic surgery: has technology found its place?.  Ann Thorac Surg. 1997;  64 211-215
• 13 Kirby T J, Mack M J, Landreneau R J, Rice T W. Initial experience with video-assisted thoracoscopic lobectomy.  Ann Thorac Surg. 1993;  56 1248-1253
• 14 Craig S R, Walker W S. Potential complications of vascular stapling in thoracoscopic pulmonary resection.  Ann Thorac Surg. 1995;  59 736-737