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Ann Thorac Surg 2007;84:1107-1113
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Pulmonary Segmentectomy by Thoracotomy or Thoracoscopy: Reduced Hospital Length of Stay With a Minimally-Invasive Approach

^a Department of Surgery, Duke University School of Medicine, Durham, North Carolina
^b Thoracic Surgery, St. Luke’s Health Network, Bethlehem, Pennsylvania

Accepted for publication May 4, 2007.

^_* Address correspondence to Dr Burfeind, Thoracic Surgery, St. Luke’s Health Network, 701 Ostrum St, Suite 201, Bethlehem, PA 18015 (Email: burfeiw{at}slhn.org).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: Previous studies have discouraged limited pulmonary resection for primary lung cancer, but pulmonary segmentectomy has advantages for some patients. Furthermore, while thoracoscopic lobectomy has been increasingly applied with well-demonstrated advantages compared with thoracotomy, few data exist regarding thoracoscopic approaches to pulmonary segmentectomy. This study compares thoracoscopic segmentectomy (TS) with open segmentectomy (OS).

Methods: This is a retrospective review of prospectively collected data for 77 consecutive segmentectomy patients treated between 2000 and 2006 at a single center. Preoperative, intraoperative, and postoperative variables for patients undergoing TS (n = 48) were compared with those undergoing OS (n = 29). Student’s t tests were used for continuous data and Fisher’s exact tests for dichotomous data.

Results: Baseline demographics were similar between groups. Indications for pulmonary resection included non-small cell lung cancer (n = 39), metastatic disease (n = 30), and other diagnoses (n = 8). All common segmentectomies were represented. No thoracoscopic cases required conversion to open procedures. Operative times, estimated blood loss, and chest tube duration were similar between groups. Outcomes were similar except that hospital length of stay was significantly less among TS patients (length of stay 6.8 ± 6 days OS versus 4.3 ± 3 days TS; p = 0.03). Thirty-day mortality was 6.9% (2 of 29) for the OS group compared with 0% for the TS group. Long-term survival rates were significantly better in the TS group (p = 0.0007).

Conclusions: Thoracoscopic segmentectomy is a safe and feasible procedure, comparing favorably with OS by reducing hospital length of stay. For experienced thoracoscopic surgeons, TS appears to be a sound option for lung-sparing, anatomic pulmonary resections.

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