Usefulness of video-assisted thoracic surgery (Two Windows Method) in the treatment of lung cancer for elderly patients.

Background: We have been performing it less invasively by making just two, small skin incisions (Two Windows Method) for lung cancer surgery. We assess the usefulness of VATS by the Two Windows Method in elderly patients.
Methods: The subjects were 32 of the 75-year-old or older patients with primary lung cancer in our department. We assessed cases in which thoracotomy was performed and the cases in which VATS by Two Windows Method was performed, and compared postoperative complications, hospital deaths, and postoperative length of stay.
Results: Operations by video-assisted thoracic surgery (VATS) by the Two Windows Method were completed in 20 of the 32 patients, and a conversion to thoracotomy was done in two patients (rate 9%). Ultimately, thoracotomy was performed in a total of 12 cases, including these two. In the thoracotomy patients, the most common postoperative complication was pneumonia/atelectasis (4 cases) secondary to poor sputum expectoration. There were 2 hospital deaths due to septicemia, and there was 1 due to pulmonary artery embolism. In the VATS patients, the rate of occurrence of postoperative complications was 30%, and clearly lower than the 67% among the thoracotomy patients (p<0.05). No hospital death occurred among the VATS patients. The postoperative hospital stay of the VATS patients (21 days) was shorter than that of the thoracotomy patients (31 days), (p<0.05).
Conclusions: VATS by the Two Windows Method is safer than thoracotomy, and it should be considered first for lung cancer surgery in the aged.