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Minimally Invasive Techniques |

Anterior Limited Thoracotomy With Intrathoracic Illumination for Lung Cancer*: Its Advantages Over Anteroaxillary and Posterolateral Thoracotomy

Hiroaki Nomori, MD; Hirotoshi Horio, MD; Keiichi Suemasu, MD, FCCP
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*From the Departments of Thoracic Surgery, Saiseikai Central Hospital, Tokyo, Japan.



Chest. 1999;115(3):874-880. doi:10.1378/chest.115.3.874
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Study objective: We developed anterior limited thoracotomy (ALT) with intrathoracic illumination for curative resection of lung cancer. The present study evaluated the benefits of ALT by retrospective comparison with anteroaxillary thoracotomy (AAT) and posterolateral thoracotomy (PLT).

Design: Lung cancer patients, who underwent lobectomy via ALT (n = 28), AAT (n = 28), and PLT (n = 28), were matched by gender and age. Operating time, blood loss during operation, chest tube drainage volume 24 h after surgery, chest tube drainage duration, and vital capacity (VC) and chest pain from early to late postoperative period were studied for ALT, AAT, and PLT. Early postoperative chest pain was evaluated by a visual analog scale and analgesic requirements, and chronic pain was divided into five grades.

Results: No difference was observed in operating time among ALT, AAT, and PLT. ALT has the following advantages over PLT: (1) less blood loss during surgery (p < 0.05); (2) reduced postoperative drainage volume (p < 0.05) resulting in shorter chest tube drainage (p < 0.001); (3) diminished impairment of VC for 1 week to 6 months after surgery (p < 0.01 or p < 0.001); and (4) reduced pain from 1 day and 6 months after surgery (p < 0.001). ALT also has the advantage over AAT in reduced pain 5 days (p < 0.01) and 7 days (p < 0.05) after surgery and in decreased analgesic requirements during 14 days after surgery (p < 0.05).

Conclusion: ALT is a sufficient and minimally invasive thoracotomy alternative to PLT or AAT for curative lung cancer resection.

Abbreviations: AAT = anteroaxillary thoracotomy; ALT = anterior limited thoracotomy; FFL = flexible fiber light; MST = muscle-sparing thoracotomy; PLT = posterolateral thoracotomy; POD = postoperative day; VATS = video-assisted thoracoscopic surgery; VC = vital capacity

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