Thoracoscopic Lobectomy Has Increasing Benefit in Patients With Poor Pulmonary Function: A Society of Thoracic Surgeons Database Analysis

Objective:Using a national database, we asked whether video-assisted thoracoscopic surgery (VATS) lobectomy is beneficial in high-risk pulmonary patients. Background:Single-institution series demonstrated benefit of VATS lobectomy over lobectomy via thoracotomy in poor pulmonary function patients [FEV1 (forced expiratory volume in 1 second) or DLCO (diffusion capacity of the lung to carbon monoxide) <60% predicted]. Methods:The STS General Thoracic Database was queried for patients having undergone lobectomy by either thoracotomy or VATS between 2000 and 2010. Postoperative pulmonary complications included those defined by the STS database. Results:In the STS database, 12,970 patients underwent lobectomy (thoracotomy, n = 8439; VATS, n = 4531) and met inclusion criteria. The overall rate of pulmonary complications was 21.7% (1832/8439) and 17.8% (806/4531) in patients undergoing lobectomy with thoracotomy and VATS, respectively (P < 0.0001). In a multivariable model of pulmonary complications, thoracotomy approach (OR = 1.25, P < 0.001), decreasing FEV1% predicted (OR = 1.01 per unit, P < 0.001) and DLCO% predicted (OR = 1.01 per unit, P < 0.001), and increasing age (1.02 per year, P < 0.001) independently predicted pulmonary complications. When examining pulmonary complications in patients with FEV1 less than 60% predicted, thoracotomy patients have markedly increased pulmonary complications when compared with VATS patients (P = 0.023). No significant difference is noted with FEV1 more than 60% predicted. Conclusions:Poor pulmonary function predicts respiratory complications regardless of approach. Respiratory complications increase at a significantly greater rate in lobectomy patients with poor pulmonary function after thoracotomy compared with VATS. Planned surgical approach should be considered while determining whether a high-risk patient is an appropriate resection candidate.

[1]  D. Harpole,et al.  Thoracoscopic lobectomy: a safe and effective strategy for patients receiving induction therapy for non-small cell lung cancer. , 2006, The Annals of thoracic surgery.

[2]  D. Harpole,et al.  Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. , 2009, The Journal of thoracic and cardiovascular surgery.

[3]  Ali-Zamir Khan,et al.  Is it safe to include octogenarians at the start of a video-assisted thoracic surgery lobectomy programme? , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[4]  D. Harpole,et al.  Thoracoscopic Lobectomy Is a Safe and Versatile Procedure: Experience With 500 Consecutive Patients , 2006, Annals of surgery.

[5]  R. Mckenna Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. , 1994, The Journal of thoracic and cardiovascular surgery.

[6]  D. Schottenfeld,et al.  Declining FEV1 and chronic productive cough in cigarette smokers: a 25-year prospective study of lung cancer incidence in Tecumseh, Michigan. , 1994, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[7]  K Shimizu,et al.  Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. , 2000, The Annals of thoracic surgery.

[8]  M. Berry,et al.  A model for morbidity after lung resection in octogenarians. , 2011, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[9]  A. Warth,et al.  Intraoperative radiofrequency ablation of lung metastases and histologic evaluation. , 2009, The Annals of thoracic surgery.

[10]  D. Boffa,et al.  Data from The Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. , 2008, The Journal of thoracic and cardiovascular surgery.

[11]  Ken Kodama,et al.  Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. , 2006, The Journal of thoracic and cardiovascular surgery.

[12]  M. Berry,et al.  Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy. , 2010, The Annals of thoracic surgery.

[13]  L. Neumayer,et al.  Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study. , 2007, Journal of the American College of Surgeons.

[14]  L V Rubinstein,et al.  Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. , 1995, The Annals of thoracic surgery.

[15]  Jun Wang,et al.  Video-Assisted Thoracoscopic Surgery Lobectomy for Lung Cancer: The Learning Curve , 2010, World Journal of Surgery.

[16]  Arman Kilic,et al.  Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer. , 2007, The Annals of thoracic surgery.

[17]  H. Gaissert,et al.  Pulmonary complications after lung resection in the absence of chronic obstructive pulmonary disease: the predictive role of diffusing capacity. , 2009, The Journal of thoracic and cardiovascular surgery.

[18]  H. Matsuda,et al.  Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study. , 2004, The Annals of thoracic surgery.

[19]  Amita Sharma,et al.  Radiofrequency ablation for stage I non-small cell lung cancer: management of locoregional recurrence. , 2012, The Annals of thoracic surgery.

[20]  M. Berry,et al.  Risk factors for morbidity after lobectomy for lung cancer in elderly patients. , 2009, The Annals of thoracic surgery.

[21]  Suresh Senan,et al.  Curative treatment of Stage I non-small-cell lung cancer in patients with severe COPD: stereotactic radiotherapy outcomes and systematic review. , 2012, International journal of radiation oncology, biology, physics.

[22]  D. Sugarbaker,et al.  Video-assisted thoracic surgery lobectomy: report of CALGB 39802--a prospective, multi-institution feasibility study. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[23]  T. Demmy,et al.  Safety of Thoracoscopic Lobectomy in Locally Advanced Lung Cancer , 2011, Annals of Surgical Oncology.

[24]  N. Altorki,et al.  Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. , 2010, The Journal of thoracic and cardiovascular surgery.

[25]  A. Jemal,et al.  Cancer statistics, 2012 , 2012, CA: a cancer journal for clinicians.

[26]  D. Boffa,et al.  Self-perceived video-assisted thoracic surgery lobectomy proficiency by recent graduates of North American thoracic residencies. , 2012, Interactive cardiovascular and thoracic surgery.

[27]  D. Waller,et al.  Lung cancer surgery in the breathless patient--the benefits of avoiding the gold standard. , 2010, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[28]  P. Pairolero,et al.  Surgical treatment of non-small cell lung cancer 1 cm or less in diameter. , 2002, The Annals of thoracic surgery.

[29]  B. Naidu,et al.  Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? , 2010, Thorax.

[30]  N. Altorki,et al.  Lobectomy in octogenarians with non-small cell lung cancer: ramifications of increasing life expectancy and the benefits of minimally invasive surgery. , 2011, The Annals of thoracic surgery.

[31]  M. Ferguson Preoperative assessment of pulmonary risk. , 1999, Chest.

[32]  B. Whitson,et al.  Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. , 2008, The Annals of thoracic surgery.

[33]  J. Luketich,et al.  Radiofrequency ablation for the treatment of stage I non-small cell lung cancer in high-risk patients. , 2007, The Journal of thoracic and cardiovascular surgery.

[34]  T. Demmy,et al.  Perioperative outcomes of thoracoscopic anatomic resections in patients with limited pulmonary reserve. , 2011, The Journal of thoracic and cardiovascular surgery.

[35]  R. Mckenna,et al.  Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. , 2006, The Annals of thoracic surgery.

[36]  N. Choi,et al.  Induction chemoradiation compared with induction radiation for lung cancer involving the superior sulcus. , 2002, The Annals of thoracic surgery.

[37]  B. Meyers,et al.  Video-assisted thoracoscopic lobectomy is less costly and morbid than open lobectomy: a retrospective multiinstitutional database analysis. , 2012, The Annals of thoracic surgery.