This study aims to examine the preferential use of VATS lobectomy in frail or complex patients.
Seventy-two consecutive planned VATS lobectomy cases of one surgeon at affiliated teaching hospitals were studied concurrently over 100 months. The primary reasons for avoiding open thoracotomies were poor pulmonary (15), cardiac (12) or activity (10) performances, or extrathoracic malignancies (12), advanced ages (8), severe orthopedic disabilities (9), and other problems (6). Nineteen matched comparison open cases were available from early in the series before VATS dominated.
Patients had mean tumor sizes of 2.9 cm and were 64±12 years old, 54% female, and 46% active smokers. Patients lost to follow-up (11%) completed 37-months mean surveillance. Lobectomies [RU (18), RM (4), RL (12), LU (20), LL (15), and Bi- (3)] incorporating concomitant staging procedures lasted 220±65 min. Three poor physical activity cases from the first third of cases were the only hospital deaths. Of six patients converted to open thoracotomies, only one was in the second half of the series. Ten complications (pulmonary-related) extended hospitalizations. Hospital stays for surviving VATS patients compared favorably to combined open and converted cases (5.6±4.4 vs. 12.6±11.0 days, p < 0.01). VATS cases had faster activity resumptions and comparable cancer controls. Subsequent urgent operations or oncologic treatments were also expedited.CONCLUSIONS: For impaired patients with advanced or complex diseases, mortality and conversion rate trends for VATS lobectomy show progress while pulmonary complications remain the major source of morbidity.
While further study and refinement is warranted, VATS lobectomy should be considered for high risk patients or others for whom open thoracotomy convalescence would be difficult or would delay other important therapies.
T.L. Demmy, None.