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Does Thoracoscopic Surgery Decrease the Morbidity of Combined Lung and Chest Wall Resection?

Authors :
Chukwumere Nwogu
Miriam Huang
Mark Hennon
Sai Yendamuri
Elisabeth U. Dexter
John M. Kane
Todd L. Demmy
Anthony Picone
Source :
The Annals of Thoracic Surgery. 99:1929-1935
Publication Year :
2015
Publisher :
Elsevier BV, 2015.

Abstract

Background Because the traditional open lung approach with en bloc chest wall resection carries substantial risk for complications and death, we studied our thoracoscopic approach for this operation. Methods From 2007 to 2013, all consecutive video-assisted thoracoscopic (VATS) and open chest wall resections at a comprehensive cancer center were tabulated retrospectively. Data were analyzed by approach, type, and cause of early major morbidity and mortality. Lung cancer cases (the largest subset, T3) were analyzed separately. Statistical tests included the Kruskal-Wallis test for continuous variables and the χ 2 for categoric variables. Survival data were analyzed by the Kaplan-Meier method and log-rank tests. Results Of 47 chest wall resections performed, 17 (36%) were performed by VATS with no conversions. Resections were performed for primary non-small cell lung cancer (15 VATS and 16 thoracotomy), sarcoma (11), metastatic disease from a separate primary (2), and benign conditions (3). Patients undergoing a VATS approach were older (76 vs 56 years, p = 0.003), and the operative times, blood loss, and ribs resected were similar between groups. Patients undergoing VATS had shorter intensive care unit and hospital lengths of stay, but both groups had high hospital morbidity and mortality, largely resulting from postoperative pneumonia or respiratory systemic inflammatory response syndrome (n = 5), stroke (n = 2), and postoperative colon ischemia (n = 1). Groups had a 90-day mortality of 26.7% and 25% respectively. Stage-matched survival curves for both approaches were superimposable ( p =0.88). Conclusions Thoracoscopic chest wall resection was feasible, expanded our case selection, and reduced prosthetic reconstruction. It did not, however, protect frail, elderly patients reliably. Briefer, less traumatic operations may be needed for this cohort.

Details

ISSN :
00034975
Volume :
99
Database :
OpenAIRE
Journal :
The Annals of Thoracic Surgery
Accession number :
edsair.doi.dedup.....c051d8e9d69ac6e4204f5e535f0c89f3
Full Text :
https://doi.org/10.1016/j.athoracsur.2015.02.038