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Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach.
Ann Thorac Surg. 2007 Oct; 84(4):1107-12; discussion 1112-3.AT

Abstract

BACKGROUND

Previous studies have discouraged limited pulmonary resection for primary lung cancer, but pulmonary segmentectomy has advantages for some patients. Furthermore, while thoracoscopic lobectomy has been increasingly applied with well-demonstrated advantages compared with thoracotomy, few data exist regarding thoracoscopic approaches to pulmonary segmentectomy. This study compares thoracoscopic segmentectomy (TS) with open segmentectomy (OS).

METHODS

This is a retrospective review of prospectively collected data for 77 consecutive segmentectomy patients treated between 2000 and 2006 at a single center. Preoperative, intraoperative, and postoperative variables for patients undergoing TS (n = 48) were compared with those undergoing OS (n = 29). Student's t tests were used for continuous data and Fisher's exact tests for dichotomous data.

RESULTS

Baseline demographics were similar between groups. Indications for pulmonary resection included non-small cell lung cancer (n = 39), metastatic disease (n = 30), and other diagnoses (n = 8). All common segmentectomies were represented. No thoracoscopic cases required conversion to open procedures. Operative times, estimated blood loss, and chest tube duration were similar between groups. Outcomes were similar except that hospital length of stay was significantly less among TS patients (length of stay 6.8 +/- 6 days OS versus 4.3 +/- 3 days TS; p = 0.03). Thirty-day mortality was 6.9% (2 of 29) for the OS group compared with 0% for the TS group. Long-term survival rates were significantly better in the TS group (p = 0.0007).

CONCLUSIONS

Thoracoscopic segmentectomy is a safe and feasible procedure, comparing favorably with OS by reducing hospital length of stay. For experienced thoracoscopic surgeons, TS appears to be a sound option for lung-sparing, anatomic pulmonary resections.

Authors+Show Affiliations

Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17888955

Citation

Atkins, B Zane, et al. "Pulmonary Segmentectomy By Thoracotomy or Thoracoscopy: Reduced Hospital Length of Stay With a Minimally-invasive Approach." The Annals of Thoracic Surgery, vol. 84, no. 4, 2007, pp. 1107-12; discussion 1112-3.
Atkins BZ, Harpole DH, Mangum JH, et al. Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach. Ann Thorac Surg. 2007;84(4):1107-12; discussion 1112-3.
Atkins, B. Z., Harpole, D. H., Mangum, J. H., Toloza, E. M., D'Amico, T. A., & Burfeind, W. R. (2007). Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach. The Annals of Thoracic Surgery, 84(4), 1107-12; discussion 1112-3.
Atkins BZ, et al. Pulmonary Segmentectomy By Thoracotomy or Thoracoscopy: Reduced Hospital Length of Stay With a Minimally-invasive Approach. Ann Thorac Surg. 2007;84(4):1107-12; discussion 1112-3. PubMed PMID: 17888955.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach. AU - Atkins,B Zane, AU - Harpole,David H,Jr AU - Mangum,Jennifer H, AU - Toloza,Eric M, AU - D'Amico,Thomas A, AU - Burfeind,William R,Jr PY - 2007/01/30/received PY - 2007/05/03/revised PY - 2007/05/04/accepted PY - 2007/9/25/pubmed PY - 2007/12/22/medline PY - 2007/9/25/entrez SP - 1107-12; discussion 1112-3 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 84 IS - 4 N2 - BACKGROUND: Previous studies have discouraged limited pulmonary resection for primary lung cancer, but pulmonary segmentectomy has advantages for some patients. Furthermore, while thoracoscopic lobectomy has been increasingly applied with well-demonstrated advantages compared with thoracotomy, few data exist regarding thoracoscopic approaches to pulmonary segmentectomy. This study compares thoracoscopic segmentectomy (TS) with open segmentectomy (OS). METHODS: This is a retrospective review of prospectively collected data for 77 consecutive segmentectomy patients treated between 2000 and 2006 at a single center. Preoperative, intraoperative, and postoperative variables for patients undergoing TS (n = 48) were compared with those undergoing OS (n = 29). Student's t tests were used for continuous data and Fisher's exact tests for dichotomous data. RESULTS: Baseline demographics were similar between groups. Indications for pulmonary resection included non-small cell lung cancer (n = 39), metastatic disease (n = 30), and other diagnoses (n = 8). All common segmentectomies were represented. No thoracoscopic cases required conversion to open procedures. Operative times, estimated blood loss, and chest tube duration were similar between groups. Outcomes were similar except that hospital length of stay was significantly less among TS patients (length of stay 6.8 +/- 6 days OS versus 4.3 +/- 3 days TS; p = 0.03). Thirty-day mortality was 6.9% (2 of 29) for the OS group compared with 0% for the TS group. Long-term survival rates were significantly better in the TS group (p = 0.0007). CONCLUSIONS: Thoracoscopic segmentectomy is a safe and feasible procedure, comparing favorably with OS by reducing hospital length of stay. For experienced thoracoscopic surgeons, TS appears to be a sound option for lung-sparing, anatomic pulmonary resections. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/17888955/Pulmonary_segmentectomy_by_thoracotomy_or_thoracoscopy:_reduced_hospital_length_of_stay_with_a_minimally_invasive_approach_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(07)00990-3 DB - PRIME DP - Unbound Medicine ER -