Video-assisted thoracic surgery involving major pulmonary resection for central tumors

Abstract

This pilot study aimed to examine the technical feasibility and safety of video-assisted thoracic surgery (VATS) involving major pulmonary resection for central tumors compared with the perioperative data obtained from historical cohorts who underwent open thoracotomy. Between April 2002 and June 2008, 26 consecutive patients with centrally located lung tumors 6 cm in size or smaller with histologically confirmed or radiologically suspected non-small cell lung cancer were prospectively registered for VATS involving major pulmonary resection at a single institution. These patients were compared with 20 historical cohorts who underwent comparable surgical procedures by open thoracotomy in terms of demographic, perioperative, histopathologic, and outcome variables. One conversion was performed because of the patient's inability to tolerate single-lung ventilation, and this patient was excluded from this study. The two groups showed no differences in terms of demographic, operative, or histopathologic variables. Both groups presented with no mortality. The VATS group demonstrated a significantly lower C-reactive protein level (p = 0.0166), shorter chest tube drainage time (p = 0.0141), shorter epidural tube anesthesia (p < 0.0001), lower analgesic requirements (p = 0.0001), shorter hospital stay (p < 0.0001), and fewer postoperative complications (p = 0.0157) than the open thoracotomy group. Despite the short follow-up time, the two groups were comparable in terms of both recurrence and survival rates. The results indicate that VATS involving major pulmonary resection is technically feasible and safe for selected patients with central lung tumors, with an acceptable perioperative outcome compared with open thoracotomy.