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Original Research: Cardiothoracic Surgery |

Thoracoscopic PneumonectomyThoracoscopic Pneumonectomy: An 11-Year Experience

Athar Battoo, MD; Ariba Jahan; Zhengyu Yang, MS; Chukwumere E. Nwogu, MD; Sai S. Yendamuri, MD, FCCP; Elisabeth U. Dexter, MD; Mark W. Hennon, MD; Anthony L. Picone, MD, FCCP; Todd L. Demmy, MD, FCCP
Author and Funding Information

From the Roswell Park Cancer Institute, Buffalo, NY.

CORRESPONDENCE TO: Todd L. Demmy, MD, FCCP, Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY 14263; e-mail: Todd.Demmy@roswellpark.org


This was a poster presentation at the International Association for the Study of Lung Cancer 15th World Conference on Lung Cancer, October 30, 2013, Sydney, NSW, Australia.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(5):1300-1309. doi:10.1378/chest.14-0058
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BACKGROUND:  It is unclear whether thoracoscopic (video-assisted thoracoscopic surgery [VATS]) pneumonectomy improves outcomes compared with open approaches.

METHODS:  One hundred seven consecutive pneumonectomies performed at an experienced center from January 2002 to December 2012 were studied retrospectively. Forty cases were open, and 50 successful VATS and 17 conversions were combined (intent-to-treat [ITT] analysis).

RESULTS:  The VATS cohort had more preoperative comorbidities (three vs two, P = .003), women (57% vs 30%, P = .009), and older ages (65 years vs 63 years, P = .07). Although advanced clinical stage was less for VATS (26% vs 50% stage III, P = .035), final pathologic staging was similar (25% vs 38%, P = .77). Pursuing a VATS approach yielded similar complications (two vs two, median, P = .73) with no catastrophic intraoperative events like bleeding. Successful VATS pneumonectomy rates rose from 50%-82% by the second half of the series (P < .001). Completion pneumonectomy cases (13.4% VATS, 7.5% open) had similar outcomes. Having similar initial discomforts as patients undergoing open surgery, more patients undergoing VATS were pain-free at 1 year (53% vs 19%, P = .03). Conversions resulted in longer ICU stays (4 days vs 2 days, P = .01). Advanced clinical stage (III-IV) ITT VATS had longer median overall survival (OS) (42 months vs 13 months, log-rank P = .042). Successful VATS cases with early pathologic stage (0-II) had a median OS of 80 vs 16 months for converted and 28 months for open (log rank = 0.083).

CONCLUSIONS:  Attempting thoracoscopic pneumonectomy at an experienced center appears safe but does not yield the early pain/complication reductions observed for VATS lobectomy. There may be long-term pain/survival advantages for certain stages that warrant further study and refinement of this approach.

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