Thoracoscopic pneumonectomy: an 11-year experience

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• The comparative outcomes of video-assisted thoracoscopic surgery (VATS) pneumonectomy versus open approaches remain unclear.
• VATS aims to reduce invasiveness in thoracic procedures.

Purpose of the Study:

• To retrospectively evaluate the safety and efficacy of VATS pneumonectomy compared to open pneumonectomy.
• To assess short-term and long-term outcomes, including complications, pain, and survival.

Main Methods:

• Retrospective analysis of 107 consecutive pneumonectomies (40 open, 50 VATS, 17 conversions) from 2002-2012.
• Intent-to-treat analysis was used, comparing VATS and open cohorts based on preoperative comorbidities, demographics, and clinical/pathologic staging.

Main Results:

• VATS cohort had more comorbidities and women but less advanced clinical stage.
• Successful VATS pneumonectomy rates improved over time.
• Similar complication rates between VATS and open approaches.
• VATS patients reported being pain-free longer at 1 year (53% vs 19%).
• Advanced clinical stage VATS patients had longer overall survival (42 vs 13 months).

Conclusions:

• Attempting VATS pneumonectomy is safe at experienced centers but doesn't offer immediate pain/complication reduction seen in VATS lobectomy.
• Potential long-term pain and survival advantages for specific stages warrant further investigation and technique refinement.