Nocturnal hypoxemia after lobectomy for lung cancer

Although nocturnal episodic hypoxemia after major abdominal surgery has been reported, the condition of nocturnal oxygen saturation after lung surgery is largely unknown. We evaluated nocturnal oxygen saturation during the perioperative period after lobectomy for lung cancer. This study also compared the postoperative course of nocturnal oxygen saturation after standard lobectomy with posterolateral thoracotomy and lobectomy with video-assisted thoracic surgery.

Twenty-one consecutive patients who had undergone lobectomy for lung cancer by either the posterolateral thoracotomy approach (n = 11) or the video-assisted thoracic surgery approach (n = 10) were studied. Fifteen consecutive patients who had undergone gastrectomy for gastric cancer were also studied. Overnight oxygen saturation was measured on the third and 14th postoperative days.

The frequency of hypoxemia in the lobectomy group was higher than that in the gastrectomy group (p = 0.043). The frequency of hypoxemia on the 14th postoperative day (p = 0.009) and the severity of hypoxemia on the third and 14th postoperative days (p = 0.041, 0.046) for the video-assisted thoracic surgery approach were lower than those for the posterolateral thoracotomy approach. In terms of mean arterial oxygen saturation, heart rate, forced vital capacity, and forced expiratory volume in 1 second, there were no statistically significant differences between the video-assisted thoracic surgery group and the posterolateral thoracotomy group.

Video-assisted thoracic surgery lobectomy was superior in terms of early postoperative nocturnal oxygen saturation. We conclude that the video-assisted thoracic surgery approach is more beneficial than the posterolateral thoracotomy approach for high-risk patients.