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Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance.
J Thorac Cardiovasc Surg. 2008 Mar; 135(3):642-7.JT

Abstract

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.

Authors+Show Affiliations

Department of Surgery, Mount Sinai Medical Center, New York, NY 10029, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18329487

Citation

Nicastri, Daniel G., et al. "Thoracoscopic Lobectomy: Report On Safety, Discharge Independence, Pain, and Chemotherapy Tolerance." The Journal of Thoracic and Cardiovascular Surgery, vol. 135, no. 3, 2008, pp. 642-7.
Nicastri DG, Wisnivesky JP, Litle VR, et al. Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg. 2008;135(3):642-7.
Nicastri, D. G., Wisnivesky, J. P., Litle, V. R., Yun, J., Chin, C., Dembitzer, F. R., & Swanson, S. J. (2008). Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance. The Journal of Thoracic and Cardiovascular Surgery, 135(3), 642-7. https://doi.org/10.1016/j.jtcvs.2007.09.014
Nicastri DG, et al. Thoracoscopic Lobectomy: Report On Safety, Discharge Independence, Pain, and Chemotherapy Tolerance. J Thorac Cardiovasc Surg. 2008;135(3):642-7. PubMed PMID: 18329487.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance. AU - Nicastri,Daniel G, AU - Wisnivesky,Juan P, AU - Litle,Virginia R, AU - Yun,Jaime, AU - Chin,Cynthia, AU - Dembitzer,Francine R, AU - Swanson,Scott J, PY - 2007/03/07/received PY - 2007/09/10/revised PY - 2007/09/24/accepted PY - 2008/3/11/pubmed PY - 2008/4/5/medline PY - 2008/3/11/entrez SP - 642 EP - 7 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 135 IS - 3 N2 - 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. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/18329487/Thoracoscopic_lobectomy:_report_on_safety_discharge_independence_pain_and_chemotherapy_tolerance_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(07)01563-2 DB - PRIME DP - Unbound Medicine ER -