Perioperative outcomes of thoracoscopic anatomic resections in patients with limited pulmonary reserve

Preoperative pulmonary function tests are used to assess operability for either lobectomy or pneumonectomy. Current guidelines for defining high-risk patients for anatomic lung resection on the basis of these tests were developed in the era of open thoracotomy. We studied the outcomes of such high-risk patients after video-assisted thoracoscopic surgical resections to assess the performance of these guidelines.

Records of all patients who underwent anatomic resection from 2001 to 2009 at a single institution were queried for pulmonary function and perioperative outcomes. Patients with predicted postoperative forced expiratory volume in 1 second or predicted postoperative lung carbon dioxide diffusing capacity less than 40% were considered to have limited pulmonary reserve. Perioperative outcomes of patients with limited pulmonary reserve who underwent thoracoscopic resection were documented and compared with those of similar patients who underwent open resection.

Of 600 patients assessed, 70 had limited pulmonary reserve according to our criteria. Forty-seven of them underwent thoracoscopic resection. This cohort had excellent outcomes, with mortality of 2.1%, pneumonia rate of 4.3%, and discharge independence rate of 95.7%. Relative to contemporary patients undergoing open resection (N=23, including 12 conversions), patients undergoing thoracoscopic resection had lower incidence of pneumonia (4.3% vs. 21.7%, P<.05) and shorter intensive care unit stay (2 vs 4 days, P=.05).

Patients with marginal lung function tolerate thoracoscopic anatomic resection well. Reassessment of the traditional pulmonary function test guidelines for operability is warranted in the current era of thoracoscopic lung surgery.