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Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy.
J Thorac Cardiovasc Surg. 2009 Aug; 138(2):419-25.JT

Abstract

OBJECTIVES

Advantages of thoracoscopic lobectomy include less postoperative pain, shorter hospitalization, and improved delivery of adjuvant chemotherapy. The incidence of postoperative complications has not been thoroughly assessed. This study analyzes morbidity after lobectomy to compare the thoracoscopic approach and thoracotomy.

METHODS

By using a prospective database, the outcomes of patients who underwent lobectomy from 1999-2009 were analyzed with respect to postoperative complications. Propensity-matched groups were analyzed based on preoperative variables and stage.

RESULTS

Of the 1079 patients in the study, 697 underwent thoracoscopic lobectomy, and 382 underwent lobectomy by means of thoracotomy. In the overall analysis thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (P = .01), atelectasis (P = .0001), prolonged air leak (P = .0004), transfusion (P = .0001), pneumonia (P = .001), sepsis (P = .008), renal failure (P = .003), and death (P = .003). In the propensity-matched analysis based on preoperative variables, when comparing 284 patients in each group, 196 (69%) patients who underwent thoracoscopic lobectomy had no complications versus 144 (51%) patients who underwent thoracotomy (P = .0001). In addition, thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (13% vs 21%, P = .01), less atelectasis (5% vs 12%, P = .006), fewer prolonged air leaks (13% vs 19%, P = .05), fewer transfusions (4% vs 13%, P = .002), less pneumonia (5% vs 10%, P = .05), less renal failure (1.4% vs 5%, P = .02), shorter chest tube duration (median of 3 vs 4 days, P < .0001), and shorter length of hospital stay (median of 4 vs 5 days, P < .0001).

CONCLUSIONS

Thoracoscopic lobectomy is associated with a lower incidence of major complications, including atrial fibrillation, compared with lobectomy by means of thoracotomy. The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.

Authors+Show Affiliations

Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.No affiliation info availableNo affiliation info availableNo 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

19619789

Citation

Villamizar, Nestor R., et al. "Thoracoscopic Lobectomy Is Associated With Lower Morbidity Compared With Thoracotomy." The Journal of Thoracic and Cardiovascular Surgery, vol. 138, no. 2, 2009, pp. 419-25.
Villamizar NR, Darrabie MD, Burfeind WR, et al. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg. 2009;138(2):419-25.
Villamizar, N. R., Darrabie, M. D., Burfeind, W. R., Petersen, R. P., Onaitis, M. W., Toloza, E., Harpole, D. H., & D'Amico, T. A. (2009). Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. The Journal of Thoracic and Cardiovascular Surgery, 138(2), 419-25. https://doi.org/10.1016/j.jtcvs.2009.04.026
Villamizar NR, et al. Thoracoscopic Lobectomy Is Associated With Lower Morbidity Compared With Thoracotomy. J Thorac Cardiovasc Surg. 2009;138(2):419-25. PubMed PMID: 19619789.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. AU - Villamizar,Nestor R, AU - Darrabie,Marcus D, AU - Burfeind,William R, AU - Petersen,Rebecca P, AU - Onaitis,Mark W, AU - Toloza,Eric, AU - Harpole,David H, AU - D'Amico,Thomas A, PY - 2008/06/24/received PY - 2009/04/07/revised PY - 2009/04/24/accepted PY - 2009/7/22/entrez PY - 2009/7/22/pubmed PY - 2009/7/31/medline SP - 419 EP - 25 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 138 IS - 2 N2 - OBJECTIVES: Advantages of thoracoscopic lobectomy include less postoperative pain, shorter hospitalization, and improved delivery of adjuvant chemotherapy. The incidence of postoperative complications has not been thoroughly assessed. This study analyzes morbidity after lobectomy to compare the thoracoscopic approach and thoracotomy. METHODS: By using a prospective database, the outcomes of patients who underwent lobectomy from 1999-2009 were analyzed with respect to postoperative complications. Propensity-matched groups were analyzed based on preoperative variables and stage. RESULTS: Of the 1079 patients in the study, 697 underwent thoracoscopic lobectomy, and 382 underwent lobectomy by means of thoracotomy. In the overall analysis thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (P = .01), atelectasis (P = .0001), prolonged air leak (P = .0004), transfusion (P = .0001), pneumonia (P = .001), sepsis (P = .008), renal failure (P = .003), and death (P = .003). In the propensity-matched analysis based on preoperative variables, when comparing 284 patients in each group, 196 (69%) patients who underwent thoracoscopic lobectomy had no complications versus 144 (51%) patients who underwent thoracotomy (P = .0001). In addition, thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (13% vs 21%, P = .01), less atelectasis (5% vs 12%, P = .006), fewer prolonged air leaks (13% vs 19%, P = .05), fewer transfusions (4% vs 13%, P = .002), less pneumonia (5% vs 10%, P = .05), less renal failure (1.4% vs 5%, P = .02), shorter chest tube duration (median of 3 vs 4 days, P < .0001), and shorter length of hospital stay (median of 4 vs 5 days, P < .0001). CONCLUSIONS: Thoracoscopic lobectomy is associated with a lower incidence of major complications, including atrial fibrillation, compared with lobectomy by means of thoracotomy. The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/19619789/Thoracoscopic_lobectomy_is_associated_with_lower_morbidity_compared_with_thoracotomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(09)00654-0 DB - PRIME DP - Unbound Medicine ER -