PURPOSE: Despite being described in 1991, few surgeons nationwide perform minimally invasive video-assisted thoracic surgery (VATS) lobectomy. Concerns include safety and oncologic adequacy. We initiated VATS lobectomy in 2001 and seek to characterize our experience in a large number of pulmonary resections using different operative techniques.
METHODS: We queried our practice-specific thoracic surgery database for all pulmonary lobectomies performed at Providence Portland Medical Center inclusive of 1995-2005. The database dates to 1980, containing 3,834 patients. It is maintained by dedicated nurse data manager, assuring data integrity and allowing real-time admission-specific follow-up data. The patients were divided into 3 groups: thoracotomy (TH), median sternotomy (MS) and VATS lobectomies (VATS). Each group was analyzed for demographics, operative characteristics including positive margins and presence of lymph node dissection (LND) and outcomes including mortality, complications and length of stay (LOS).
CONCLUSION: VATS lobectomy is technically advanced with a steep learning curve. Patients undergoing VATS lobectomy have better preop pulmonary reserve but the same perioperative risk profile. Complications and LOS are improved for VATS lobectomy compared to thoracotomy and median sternotomy, while intraoperative oncologic adequacy is the same.
CLINICAL IMPLICATIONS: VATS lobectomy provides fewer complications and shorter LOS. Differences in functional outcomes and quality of life need to be investigated for different surgical approaches.
DISCLOSURE: John Handy, Jr, None.