Thoracoscopy versus thoracotomy: a prospective comparison of trauma and quality of life

Reliable comparisons of thoracoscopy (TCC) and anterolateral thoracotomy (ATT) with regard to trauma and post-operative quality of life are rare. This study was conducted to quantify the results of TCC, which was expected to show an advantage.

Using a matched-pair design (matching criteria: comparable intracavitary procedure, benign/malignant disease and sex), 22 patients were compared who underwent either TCC or ATT (Wilcoxon matched-pairs signed-ranks test, P<0.05).

Incision and operation time were shorter for TCC (TCC 5.3 vs ATT 23.7 cm, P=0.003; TCC 64 vs ATT 87 min, P=0.029). Differences in favor of TCC were detected for interleukin 6 (IL6) (TCC 17.2 vs ATT 105.6 pg/ml, P=0.036) in the immediate postoperative period, C-reactive protein (CRP) (TCC 28.2 vs ATT 86.6 mg/l; P=0.010) on the day 1 after the operation, forced vital capacity (FVC) (TCC 2.5 vs ATT 1.5 l, P=0.0173), elevation of the arm (EA) (TCC 143 vs ATT 109; P=0,026), pain on coughing (CP) (TCC 2.5 vs ATT 6.9 patients; P=0.009) and Spitzer Index (SI) (TCC 9.2 vs ATT 7,1 patients; P=0.009), as well as CP (TCC 1.4 vs ATT 4.4 patients; P=0,005) on day 4 after the operation. Forced expiratory volume in the first second, pain, creatin kinase, blood glucose and neopterin showed no differences.

In terms of surgical trauma and quality of life ICC is superior to ATT in the immediate postoperative period. With the exception of pain and coughing, there were no differences after postoperative day 4.