Open Lobectomy Group Research Articles

Comparison of cost effectiveness between video-assisted thoracoscopic surgery (vats) and open lobectomy: a retrospective study

BackgroundLung cancer is highly prevalent in Chinese population. The association of operative approach with economic burden in these patients remains unknown.ObjectivesThis institution-level cohort study aimed to compare the cost-related clinical outcomes and health care costs among patients undergoing video-assisted thoracoscopic surgery (VATS) and open lobectomy, and to investigate the factors associated with the costs.MethodsThis retrospective cohort study included patients who underwent VATS or open lobectomy in a provincial referral cancer center in China in 2018. Propensity score matching (PSM) method was applied to balance the baseline characteristics in VATS lobectomy and open lobectomy group. Clinical effectiveness measures included post-operative blood transfusion, lung infection, and length of stay (LOS). Hospitalization costs were extracted from hospital information system to assess economic burden. Multivariable generalized linear model (GLM) with gamma probability distribution and log-link was used to analyze the factors associated with total costs.ResultsAfter PSM, 376 patients were selected in the analytic sample. Compared to open lobectomy group, the VATS lobectomy group had a lower blood transfusion rate (2.13% vs. 3.19%, P = 0.75), lower lung infection rate (21.28% vs. 39.89%, P < 0.001) and shorter post-operative LOS (9.4 ± 3.22 days vs. 10.86 ± 4.69 days, P < 0.001). Total hospitalization costs of VATS lobectomy group and open lobectomy were similar: Renminbi (RMB) 84398.03 ± 13616.13, RMB 81,964.92 ± 16748.11, respectively (P = 0.12). Total non-surgery costs were significantly lower in the VATS lobectomy group than in the open lobectomy group: RMB 41948.40 ± 7747.54 vs. RMB 45752.36 ± 10346.42 (P < 0.001). VATS approach, lung infection, longer post-operative length of stay, health insurance coverage, and lung cancer diagnosis were associated with higher total hospitalization costs (P < 0.05).ConclusionsVATS lobectomy has a lower lung infection rate, and shorter post-operative LOS than open lobectomy. Future studies are needed to investigate other aspects of clinical effectiveness and the economic burden from a societal perspective.

Outcomes after pulmonary lobectomy in patients with history of head and neck carcinoma

BackgroundWe aimed to determine whether video assisted thoracic surgery (VATS) was associated with better short-term outcomes compared to open approach and to determine factors affecting long term survival after lobectomy in patients with history of head and neck carcinoma (HNC). MethodsWe performed a retrospective monocentric analysis of consecutive standard lobectomies performed for lung cancer in patients with history of HNC between 2010 and 2017. Patients’ characteristics, surgical approach, lung tumor histology, in-hospital and 90-days morbi-mortality and long term survival were analyzed; VATS and open lobectomy groups were compared. ResultsAmong 85 patients, 52 underwent an open lobectomy and 33 a VATS lobectomy. There was no significant difference between the two groups regarding age, preoperative characteristics, pathology and stage of lung cancer (All p = NS). In the VATS group, there was a significant decrease in proportion of in-hospital postoperative life-threatening complications requiring hospitalization in intensive care unit (12/52 vs. 1/33, p = 0.01). The 90-days postoperative comprehensive complication index was significantly increased in the open thoracotomy group (median (interquartile range):33.5 (0-53.5) vs. 8.7 (0-34.1), p = 0.018). Long term survival was not significantly different between the 2 groups - Log-rank test comparison, p = NS). Patients with squamous cell histology presented a significantly poorer survival (both Log-rank test comparison, p < 0.01). ConclusionsMinimally invasive approach improved in-hospital and 90-days outcomes compared to open surgery for lung cancer resection in patients with history of HNC. The poor long-term results in patients with squamous cell carcinoma highlight the need to improve therapeutic strategies for this subset of patients.

Endoscopic thyroidectomy versus conventional open thyroidectomy for early differentiated thyroid cancer

Introduction: Endoscopic thyroidectomy has been applied prudently for malignant thyroid tumors. The aim of our study was to compare the outcomes of endoscopic lobectomy and conventional open lobectomy for early differentiated thyroid cancer. Materials and Methods: From October 2018 to October 2019, 485 patients with early differentiated thyroid cancer underwent thyroid lobectomy in National hospital of Endocrinology enrolled. Of them, 235 patients underwent endoscopic lobectomy (EL) and 250 patients underwent conventional open lobectomy (OL). Results: The mean age of the patients was lower in the EL group (22,3 ± 3,6 years) than in the OL group (31,0 ± 5,8 years, P = 0,013). The ratio female/male was higher in the EL group than in the OL group (12/1 vs 7/1, P = 0,002). The operation time in the EL group was longer than in the OL group (58,4 ± 12,9 vs 42,3 ± 9 minutes, P = 0,014). However, there was no significant differences between EL group and OL group in tumor size (1,2 ± 0,2 vs 1,1 ± 0,6, P = 0,123), blood loss (12,5 ± 0,9 vs 13,6 ± 1,6ml, P = 0,457), postoperative hospital day (4,35 ± 1,4 vs 4,1 ± 1,1 days, P = 0,061), transient hypoparathyroidism (0,85% vs 0,8%, P = 0,431) or transient recurrent laryngeal nerve injury (1,27% vs 1,2%, P = 0,311). The drainage volume in the EL group was higher than in the OL group (75,5 ± 11,4 vs 54,1 ± 10,1ml, P = 0,046). Postoperative bleeding was similar in two groups (0,42% vs 0,4%, P = 0,457). There was no postoperative complications such as permanent recurrent laryngeal nerve injury, tracheal perforation, conversion to open surgery, chyle leak, surgical site infection. Patients in the EL group experienced with less pain than those in the OL group at 1 and 2 days after operation according to a visual analog scale (VAS) (P = 0,047). Wound site numbness is significantly less pronounced in the OL group (p = 0,032). Cosmetically, patients in the EL group were more satisfied than in OL group according to the questionnaire we used (P = 0,021). Conclusions: Endoscopic thyroidectomy for patients with early differentiated thyroid cancer is a safe and effective procedure with excellent cosmetic outcome. Postoperative hospital length stays and complications were similar to conventional open surgery.

Dynamics of coagulation factor XIII activity after video-assisted thoracoscopic lobectomy for non-small cell lung cancer

The present study was performed to investigate the perioperative dynamics of coagulation factor XIII (FXIII) in patients with non-small cell lung cancer undergoing video-assisted thoracoscopic surgery (VATS) lobectomy compared with open lobectomy. Perioperative coagulation factors including FXIII were analyzed in 30 patients who underwent VATS lobectomy and 10 patients who underwent open lobectomy at Teikyo University Hospital from December 2017 to April 2019. Patients in the VATS lobectomy group showed higher FXIII activity on postoperative day (POD) 5 than patients in the open lobectomy group (P=0.028). The FXIII activity was significantly lower on POD3, POD5, and POD7 than that in the preoperative period and on POD1, even in patients who had undergone VATS lobectomy (P<0.001). No factors were found to affect the maintenance of FXIII in the VATS lobectomy group. The postoperative decrease of FXIII activity differed between patients who underwent VATS lobectomy and those who underwent open lobectomy. Based on the characteristics of FXIII, the FXIII activity may be a good marker of the invasiveness of VATS lobectomy versus open lobectomy.

PMD38 THE CLINICAL AND ECONOMIC ANALYSES OF VIDEO ASSISTED THORACOSCOPIC SURGERY FOR LOBECTOMY: EXPERIENCE FROM A TOP ACADEMIC MEDICAL CENTER IN CHINA

Pulmonary lobectomy remains the most commonly performed operation in general thoracic surgery practice. The video assisted thoracoscopic surgery (VATS) for lobectomy which is newly developed technology represents an important option for lung cancer due to less morbidity and mortality compare with open lobectomy. This study aims to investigate the economic and clinical outcomes of VATS lobectomy versus open lobectomy in Chinese real-world setting. A retrospective cohort analysis was conducted using the hospital EMR database of the first affiliated hospital of University of Science and Technology of China. The patient inclusion criteria were specified: 1) hospitalized in thoracic surgery department between 2016 and 2017; 2) performed open lobectomy (116 patients) or VATS lobectomy (710 patients). The primary endpoint was length of stay (LOS), operation time, and interoperative blood loss, along with total hospitalization cost, cost breakdowns, hemorrhage volume and re-operation rate as the exploratory outcomes. Where applicable, t-test and the Kruskal-Wallis test for continuous variables and the Chi-Square test for categorical variables would be determined if the different groups are significant. There were no statistically differences in baseline characteristics. Compared with open lobectomy group, VATS group has shorter LOS (12.26 vs. 15.27, P＜0.001) and less interoperative blood loss (91.15 vs. 255.6, P＜0.001), while its operation time were no statistical significance. Although the total hospitalization costs were similar, CNY46,799.70 in VATS lobectomy group vs CNY45,321.98 in open group (P=0.478), the proportion of material cost in VATS was higher (44% vs. 37%, P＜0.001). Besides, VATS group was associated with significantly less hemorrhage volume, and similar re-operation rate. The VATS lobectomy shows benefits in LOS and interoperative blood loss compare to open lobectomy. Meanwhile, although the consumable material cost proportion is higher in VATS group, the total hospitalization cost will not increase due to cost-savings in medicine and treatment costs.

Robotic lobectomy has the greatest benefit in patients with marginal pulmonary function

BackgroundPatients with limited pulmonary function have a high risk for pulmonary complications following lobectomy. Robotic approach is currently the least invasive approach. We hypothesized that robotic lobectomy may be of particular benefit in high-risk patients.MethodsWe reviewed our institutional Society of Thoracic Surgeons (STS) data on lobectomy patients from 2012 to 2017. Postoperative outcomes were compared between robotic and open lobectomy groups. High-risk patients were identified by pulmonary function test. Risk of pulmonary complication was assessed by binary logistic regression analysis.ResultsA total of 599 patients underwent lobectomy by robotic (n = 287), or by open (n = 312) approach, including 189 high-risk patients. Robotic lobectomy patients had a lower rate of prolonged air leak (6% vs. 10%, p = 0.047), less atelectasis requiring bronchoscopy (6% vs. 16%, p = 0.02), pneumonia (3% vs. 8%, p = 0.01), and shorter length of stay (4 vs. 6 days, p = 0.001). Overall pulmonary complication rate was significantly lower after robotic lobectomy in high-risk patients (28% vs. 45%, p = 0.02), less in intermediate or low risk patients. No significant difference was seen relative to major complication rate (12% vs. 17%, p = 0.09). After multivariate analysis, when adjusting for age, gender, smoking history, FEV1, DLCO, cardiopulmonary comorbidities, and prior chest surgery, the robotic approach remained independently associated with decreased pulmonary complications (odds ratio 0.54, 95% confidence interval [0.34–0.85], p = 0.008).ConclusionsRobotic lobectomy has the potential to decrease the risk of postoperative pulmonary complication as compared with traditional open thoracotomy. In particular, patients with limited pulmonary function derive the most benefit from a robotic approach.

Video-Assisted versus Open Lobectomy in Patients with Compromised Lung Function: A Literature Review and Meta-Analysis.

BackgroundIt has been suggested that video-assisted (VATS) lobectomy is safer than open lobectomy in patients with compromised lung function, but data regarding this are limited. We assessed acute outcomes of VATS compared to open lobectomy in these high-risk patients using a systematic literature review and meta-analysis of data.MethodsThe databases PubMed and Scopus were searched for studies published between 2000 and 2013 that reported mortality and morbidity of VATS in high-risk lung cancer patients defined as having compromised pulmonary or cardiopulmonary function. Study selection, data collection and critical assessment of the included studies were performed according to the recommendations of the Cochrane Collaboration.ResultsThree case-control studies and three case series that included 330 VATS and 257 open patients were identified for inclusion. Operative mortality, overall morbidity and pulmonary morbidity were 2.5%, 39.3%, 26.2% in VATS patients and 7.8%, 57.5%, 45.5% in open lobectomy group, respectively. VATS lobectomy patients experienced significantly lower pulmonary morbidity (RR = 0.45; 95% CI, 0.30 to 0.67; p = 0.0001), somewhat reduced operative mortality (RR = 0.51; 95% CI, 0.24 to 1.06; p = 0.07), but no significant difference in overall morbidity (RR = 0.68; 95% CI, 0.41 to 1.14; p = 0.14).ConclusionThe existing data suggest that VATS lobectomy is associated with lower risk for pulmonary morbidity compared with open lobectomy in lung cancer patients with compromised lung function.

Thoracoscopic lobectomy is associated with improved short-term and equivalent oncological outcomes compared with open lobectomy for clinical Stage I non-small-cell lung cancer: a propensity-matched analysis of 963 cases

Previous literature has reported lower morbidity for video-assisted thoracoscopic surgery lobectomy (VL) compared with open lobectomy (OL); however, most comparative studies have been retrospective and have failed to compare well-matched patient groups, therefore allowing selection bias to influence results. Furthermore, oncological adequacy of VL has recently been questioned, particularly with respect to lymphadenectomy. This study aimed to evaluate short- and long-term outcomes of a large cohort of consecutive patients with c-stage I non-small-cell lung cancer (NSCLC) that underwent either VL or OL. Consecutive patients with c-stage I NSCLC who underwent lobectomy without preoperative therapy were reviewed. Univariable, multivariable and propensity-matched analyses were performed. VL patients who underwent conversion to OL were analysed within the VL group. VL was performed in 307 (32%) patients and OL in 656 (68%). Twenty-two (7%) patients converted from VL to OL. Although there were no differences in overall p-stage grouping, there were fewer patients with pT2 tumours in the VL group (39 vs 48%, P = 0.012) and fewer patients with squamous cell histology (26 vs 18%, P = 0.006). These differences resolved after propensity matching. In unmatched and matched analyses, VL was associated with less overall morbidity, less pulmonary morbidity, fewer atrial arrhythmias, shorter chest tube duration and shorter hospital stay than patients who had OL. Thirty-day in-hospital mortality was 0.3 and 1.4%, for VL and OL groups, respectively (P = NS). In unmatched analysis (log rank), 5-year survival favoured VL (78 vs 68%, P = 0.007); however, after propensity matching there was only a trend towards improved survival with VL (78 vs 73%, P = 0.071). Multivariable Cox regression analysis revealed VL (hazard ratio (HR) 0.64, 95% confidence interval (CI) 0.46-0.92), male sex (HR 1.43, 95% CI 1.10-1.86), Zubrod performance status (HR 3.42, 95% CI 1.26-9.29) and increasing age (HR 1.04, 95% CI 1.03-1.06) to be independent predictors of survival. Patients with clinical Stage I NSCLC undergoing VL have less perioperative morbidity compared with matched OL controls. Regional lymphadenectomy, nodal upstaging, overall and disease-free survival were similar between VL and OL groups. In experienced centres, VL is an acceptable operation for patients with c-stage I NSCLC.

Lymph Node Evaluation Achieved by Open Lobectomy Compared With Thoracoscopic Lobectomy for N0 Lung Cancer

Controversy remains regarding the adequacy of the lymph node evaluation achieved by video-assisted thoracic surgery (VATS) lobectomy for lung cancer. This study compared the completeness of the lymph node dissection or sampling for patients undergoing lobectomy by open thoracotomy vs VATS for clinical N0 lung cancer. This study was a retrospective review of 129 patients who underwent lobectomy for clinical N0 lung carcinoma from December 2008 to January2012. Lobectomy was an open procedure in 69 patients (53.5%) and by VATS in 60 (46.5%). The VATS and open groups were well matched for age (p= 0.50) and forced expiratory volume in 1 second percentage predicted (p= 0.16). The mean pathologic tumor sizes were not significantly different (2.9 ± 0.26 vs 3.4 ± 0.25 cm, respectively; p= 0. 14). The mean number of nodes dissected in the open group was significantly higher (14.7± 1.3 vs. 9.9 ± 0.8 nodes; p= 0.003). In the open lobectomy group, 24.6% of the patients were upstaged to pathologic N1 or N2 compared with 10% in the VATS group (p= 0.05). The Kaplan-Meier 3-year survival was similar between the groups. In our hands, significantly more lymph nodes were dissected, and a higher percentage of patients were upstaged to N1/N2, during open lobectomy compared with VATS lobectomy in patients with clinical stage N0 lung cancer. Although this did not translate into improved survival at 3 years, concern is raised about the adequacy of lymph node dissection during VATS lobectomy.

Video-assisted thoracoscopic surgery versus open lobectomy for stage I lung cancer: A meta-analysis of long-term outcomes

The present study aimed to evaluate the evidence comparing video-assisted thoracoscopic surgery (VATS) and open lobectomy for the treatment of stage I lung cancer using meta-analytical techniques. A literature search was undertaken until July 2011 to identify comparative studies evaluating survival rates, recurrence rates and complications. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with either the fixed- or random-effects model. These studies included a total of 1,362 patients: 668 treated with VATS and 694 treated with open lobectomy. The overall survival was significantly higher in patients treated with VATS than with open thoracotomy (OR=2.01, 95% CI 1.44-2.78) at 5 years. However, there was no statistically significant difference in 1.3-year overall survival between the VATS and open lobectomy groups (OR=3.21, 95% CI 0.77-13.40; OR=0.91, 95% CI 0.49-1.70). The data did not demonstrate a significant difference in locoregional recurrence (OR=0.58, 95% CI 0.33-1.03) compared to the open lobectomy group, but suggested a reduced systemic recurrence rate (OR=0.52, 95% CI 0.23-0.82) and complications (OR=0.36, 95% CI 0.23-0.57) of VATS. VATS was superior to open lobectomy for the prognosis of stage I lung cancer. However, the findings have to be carefully interpreted due to the lower levels of evidence.

Comparison of costs for video-assisted thoracic surgery lobectomy and open lobectomy for non-small cell lung cancer

To promote the broad use of video-assisted thoracic surgery (VATS) for lobectomy (VATSL) in the management of lung cancer, it should be proved cost-effective, especially in the current cost-sensitive climate. This study evaluated and compared the costs of VATSL and open lobectomy (OL) and analyzed how the surgeon's experience level with VATSL affected the cost. In this study, 86 patients in a VATSL group and 97 patients in an OL group underwent surgery for lung cancer. Cost comparisons were performed for the VATSL and OL groups between patients who had no complications and patients with and without complications according to tumor location and the learning period of the surgeon. Postoperative complications occurred for 56 patients (30.6%) (14 VATSL vs 42 OL patients; p < 0.05). Patients who underwent VATSL had significant reductions in both chest tube duration (5.4 vs 9.1 days; p = 0.000) and length of hospital stay (7.1 vs 12.0 days; p = 0.000). The mean operation time for VATSL was not significantly longer than for OL (145.8 vs 136.4 min; p = 0.782). The total hospital cost (i.e., that paid by the patient and national insurance combined) was lower for VATSL than for OL according to comparisons both among all patients ($5,391 vs $5,593, respectively) and among only noncomplicated patients ($4,684 vs $4,769, respectively). In terms of tumor location, the total hospital cost for the VATSL group was lower than for the OL group when the surgery was performed on the right lower lobe (RLL), left upper lobe (LUL), and left lower lobe (LLL). The costs were not significantly different between the two learning periods of the surgeons, except for the cost of anesthesia. In Korea, VATSL for lung cancer had lower complication rates, shorter hospital stays, and lower total hospital costs than OL.

QS15. Thoracoscopic Lobectomy Is Associated With Decreased Morbidity and Decreased Length of Hospital Stay Compared to Open Lobectomy

Introduction: Thoracoscopic lobectomy provides an anatomic resection that adheres to oncologic principles while utilizing multiple port sites and a video camera, obviating the need to spread or divide ribs for exposure. In effect, it offers a minimally invasive alternative to lobectomy via a standard thoracotomy. The purpose of this study was to compare thoracoscopic lobectomy to open lobectomy with respect to short-term morbidity, mortality and other perioperative variables. Methods: Thoracoscopic lobectomies were performed utilizing 4 port sites and a 5-mm 30-degree camera. The lobe was removed via the axillary extended port site after placing it in a bag. Standard anatomic lymph node dissection was performed. Standard posterolateral thoracotomies were performed in the open group. Utilizing our thoracic surgical database, we compared our first (and most recent) 22 consecutive thoracoscopic lobectomies to our most recent 22 consecutive open lobectomies with respect to multiple perioperative variables and endpoints. Groups were compared using a Student’s t-test. Results: The indication for surgery was cancer for the majority of patients in both groups. There were no conversions from thoracoscopic to open in the study group. The first 4/5 patients in the thoracoscopic group received an epidural catheter with a mean duration of 2 days compared to 21/22 in the open group with a mean epidural duration of 2.7 days. There was no significant difference between the thoracoscopic and open groups with respect to age (66.2 vs. 69.5 respectively), gender, pre-operative comorbidities and operative times. There was no operative mortality in either group. However, there were significant differences between the thoracoscopic and open lobectomy groups with respect to post-operative time on the ventilator, length of ICU stay, operative blood transfusions, major complications and hospital length of stay (Table 1). Conclusion: Thoracoscopic lobectomy offers patients a minimally invasive approach to a standard cancer operation and is associated with significantly decreased morbidity, ICU stay, and hospital length of stay compared to open lobectomy. TABLE 1Post-operative endpoints in thoracoscopic vs. open lobectomies. Ventilator (days) ICU (days) OR Transfusions (units) Complications Length of Stay (days) Thoracoscopic 0.0 0.3 0.0 2 (9%) 4.7 Open 0.2 4.3 0.5 11 (50%) 9.7 Open table in a new tab

Clinical characteristics and feasibility of thoracoscopic approach for congenital cystic adenomatoid malformation in adults

Congenital cystic adenomatoid malformation (CCAM) in adults is very rare, and surgical resection is the treatment of choice. We evaluated the clinical characteristics and feasibility and safety of video-assisted thoracic surgery (VATS) in adult patients with CCAM. Retrospective analysis of nine consecutive adult patients with CCAM treated surgically between January 1995 and April 2006 at a single center. The clinical characteristics and surgical outcome were evaluated retrospectively. The records of five men and four women were examined. The median age at diagnosis was 30.5 years (range 16-44 years). The most frequent symptoms were cough (n=4) and hemoptysis (n=2). Three patients had recurrent respiratory infections. Chest computed tomography (CT) was reviewed in all cases. The lesions were on the right side in six patients and on the left in three. All patients had lesions in a single lobe, except one patient who had multi-lobar lesions. The CCAM appeared as thin-walled multi-septated cystic lesions in six patients and as parenchymal consolidations in three patients. Four patients underwent VATS lobectomy and four underwent lobectomy through a conventional open thoracotomy. One patient had open pneumonectomy. The median operating time (160 min in VATS lobectomy and 165 min in open lobectomy), median duration of chest tube drainage (4 days in VATS lobectomy and 6.5 days in open lobectomy), and postoperative complications (one patient in each treatment group) were similar between the VATS and open lobectomy groups. The hospital stay was shorter in the VATS lobectomy group (median 5 days) than in the open lobectomy group (median 7.5 days). No postoperative or procedure-related mortality occurred. CCAM is rare in adults. Patients usually present with recurrent respiratory infections and thin-walled multi-septated cystic lesions. VATS is a feasible and safe technique to treat adult patients with CCAM.

Comparison in prognosis after VATS lobectomy and open lobectomy for stage I lung cancer

Video-assisted thoracoscopic surgery (VATS) has become an attractive surgical procedure, but several issues remain to be resolved. Prognosis after VATS lobectomy is important to evaluate the adequacy of VATS lobectomy as a cancer operation. Interestingly, several investigators, including us, have reported that prognosis after VATS lobectomy was superior to that after open lobectomy in early non-small-cell lung cancer (NSCLC). One of the possible reasons is the low invasiveness of VATS lobectomy. But we considered that patient bias might have some influence favoring VATS lobectomy. To evaluate our hypothesis, we reviewed medical records of stage I NSCLC patients undergoing operation between 1993 and 2002. We compared and evaluated the relationship between patient characteristics and prognosis after VATS and open lobectomy. We focused particularly on histological type, classifying it into four subgroups; (1) bronchioloalveolar carcinoma (BAC), (2) mixed BAC + papillary adenocarcinoma (BAC + Pap), (3) other adenocarcinoma (Other adeno), (4) squamous cell carcinoma + others (Sq + others). A total of 165 patients underwent VATS lobectomy, and 123 patients underwent open lobectomy. The 5-year survival rate of the VATS lobectomy group was 94.5% and that of the open lobectomy group was 81.5%. Univariate Cox regression of survival revealed that male, CEA > 5, Other adeno, Sq + others, open lobectomy, and tumor size > 3 cm were significant negative prognostic variables. Multivariate Cox regression of survival revealed that histological subtype and tumor size were independent prognostic factors, but surgical procedure was not an independent prognostic factor. Prognosis after VATS lobectomy was superior to that after open lobectomy, but patient bias influenced the prognosis in favor of VATS lobectomy, and the surgical procedure itself was not a prognostic factor.

Comparison of video‐assisted minithoracotomy and standard open thoracotomy for the treatment of non‐small cell lung cancer

This study represents a retrospective comparison of video‐assisted thoracic surgery (VATS) lobectomy with standard open lobectomy for non‐small cell lung cancer (NSCLC). The endpoints of this study include surgical stress as measured by interleukin 6 concentration and patient survival. A retrospective review was performed of 240 consecutive patients with clinical stage IA or IB NSCLC who underwent either VATS lobectomy (n = 67) or conventional open lobectomy (n = 173). The amount of blood loss was significantly less in the VATS group (110±75 ml) as compared to 165±90 ml for the open lobectomy group (P<0.05). A significantly lower incidence of postthoracotomy pain occurred in the VATS group (6.2±4.1 times/3days) than in the open lobectomy group (13.5±5.8 times/3 days, P<0.0001). The postoperative interleukin (IL)‐6 serum concentration of was significantly lower in the VATS group (112±43 pg/ml) than that in the open lobectomy group (351±133 pg/ml, P<0.001). There was no statistically significant difference in survival between the VATS and open lobectomy groups. The median follow‐up was 42 months in both groups. VATS lobectomy for NSCLC is a reasonable treatment option for selected patients with stage I NSCLC.

Thoracoscopic lobectomy for benign disease--a single centre study on 64 cases.

Chronic lung infection is the main indication for lobectomy in benign pulmonary disease and may be technically demanding due to inflammatory changes such as adhesions, lymph node enlargement and neovascularization. The role of the thoracoscopic operation in these indications is yet ill-defined. We retrospectively analyzed the results of patients who underwent thoracoscopic lobectomy (TL) between 1992 and June 1999 and compared this study group with patients who underwent open lobectomy (OL), all for benign disease. Data were not normally distributed, therefore, the median and range is given and nonparametric statistical analysis was applied. A total of 117 lobectomies for benign disease (64 TL) were analyzed. Indications included bronchiectasis (36 TL; 18 OL), chronic infections (13 TL; eight OL), tuberculosis (five TL; 15 OL), emphysema (five TL; one OL), AV-malformations (two TL; one OL), severe haemoptysis (four OL), and others (three TL; six OL). Twelve conversions to thoracotomy were necessary due to severe adhesions. One patient in the open lobectomy group died within 30 days postoperative. Drainage time was 5.0 (1-32) days in TL and 6.0 (3-21) days in OL, hospital stay was 8.5 (4-41) days and 10.0 (5-52) days, respectively. Blood loss was 0 (0-2000) ml in TL and 300 (0-6000) ml in OL. Operation time for thoracoscopic lobectomies significantly decreased from 2.5 (1-6) h for cases between 1992 and 1997 (n=49) to 1.5 (0.5-2.5) h for recent cases (n=15) (P<0.01). In addition, a trend towards less blood loss was noted (100 (0-2000) ml vs. 0 (0-400) ml; P=0.06). Drainage time and hospital stay did not differ significantly. Thoracoscopic lobectomy in chronic inflammatory disease can be performed safely in selected patients, especially with bronchiectasis. Conversion rate to thoracotomy is low. Operation time with this approach declined significantly over time.