Early and long-term complaints following video-assisted thoracoscopic surgery: evaluation in 173 patients.

Abstract

I congratulate Stammberger et al. [1] for their excellentarticle which considers the problem of long-term pain afterthoracic surgery. However, the authors conclusion that long-term pain is improved after video-assisted thoracoscopy(VATS) compared to thoracotomy cannot be made fromthis study as there was no control group of patients under-going open thoracotomy. Other evidence suggests that thisconclusion is incorrect. The authors refer to the retrospec-tive study of Landreneau et al. [2] which found that VATSimproved long-term pain compared to thoracotomy before 1year but made no difference after 1 year. Additionally, twoprospective controlled trials (one randomized) have shownno difference in long-term pain between open thoracotomyand VATS [3,4].The definition of chronic postthoracotomy pain is painpersisting beyond 2 months after surgery. At 3 months,28.3% of the patients in this study had pain, which iscomparable to long-term pain after open thoracotomy[2,3,5]. Furthermore, questionnaire-based studies, espe-cially retrospective ones, are unreliable.Long-term pain continues to be a major disadvantage ofthoracotomy. Stammberger et al. [1] have highlighted themany advantages that VATS has over open thoracotomywith regard to acute pain, pulmonary function, postopera-tive recovery and return to work. However, there is noevidence that VATS improves long-term pain outcomesand this must be considered when counselling patients forsurgery.References