Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance

Daniel G Nicastri, Juan P Wisnivesky, Virginia R Litle, Jaime Yun, Cynthia Chin, Francine R Dembitzer, Scott J Swanson
Journal of Thoracic and Cardiovascular Surgery 2008, 135 (3): 642-7

OBJECTIVE: Controversies regarding the safety, morbidity, and mortality of thoracoscopic lobectomy have prevented the widespread acceptance of the procedure. This series analyzed the safety, pain, analgesic use, and discharge disposition in patients who underwent thoracoscopic lobectomy and segmentectomy at a single institution.

METHODS: We collected data from 153 consecutive patients who underwent thoracoscopic (video-assisted thoracic surgery) lobectomy and assessed the perioperative outcomes, postoperative pain, and chemotherapy course. A total of 111 of 127 patients with lung cancer had stage I non-small cell lung cancer. The operative technique required 2 ports and an access incision (5-8 cm), individual hilar ligation, and lymph node dissection performed without rib-spreading devices.

RESULTS: There were 9 major complications (6%), including 1 perioperative death (0.7%). Conversion to thoracotomy occurred in 14 patients (9.2%). Blood transfusion was required in 11 patients (7%). The median chest tube time was 3 days, and the length of hospital stay was 4 days; 94.4% of patients went home at the time of discharge, and 5.6% of patients required a rehabilitation facility. At a median postsurgical follow-up time of 2 weeks, the mean postoperative pain score was 0.6 (0-3), 73% of patients did not use narcotics for pain control, and 47% of patients did not use any pain medication. Of patients receiving chemotherapy (N = 26), 73% completed a full course on schedule and 85% received all intended cycles.

CONCLUSION: Thoracoscopic (video-assisted thoracic surgery) lobectomy can be performed safely. Discharge independence and low pain estimates in the early postoperative period suggest that this approach may be beneficial. Furthermore, there is a trend toward improved tolerance of chemotherapy.

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