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Ann Thorac Surg 2008;85:231-236. doi:10.1016/j.athoracsur.2007.07.080
© 2008 The Society of Thoracic Surgeons
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Bernard J. Park
Manjit S. Bains
Robert J. Downey
Raja M. Flores
Nabil Rizk
Valerie W. Rusch
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Original Articles: General Thoracic

Use of Video-Assisted Thoracic Surgery for Lobectomy in the Elderly Results in Fewer Complications

Stephen M. Cattaneo, MDa, Bernard J. Park, MDa,*, Andrew S. Wilton, MSb, Venkatraman E. Seshan, PhDb, Manjit S. Bains, MDa, Robert J. Downey, MDa, Raja M. Flores, MDa, Nabil Rizk, MDa, Valerie W. Rusch, MDa

a Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
b Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York

Accepted for publication July 24, 2007.

* Address correspondence to Dr Park, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-867, New York, NY 10021 (Email: parkb{at}mskcc.org).

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

Background: The purpose of this study was to determine if the utilization of video-assisted thoracic surgery (VATS) for lobectomy for clinical stage I non-small cell lung cancer in elderly patients results in decreased complications compared with lobectomy by thoracotomy (THOR).

Methods: A retrospective, matched case-control study was performed evaluating the perioperative outcomes after lobectomy by VATS versus THOR performed in elderly patients (age ≥70 years) at a single institution. All complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (http://ctep.cancer.gov/reporting/ctc.html).

Results: Between May 1, 2002 and December 31, 2005 333 patients (245 THOR, 88 VATS) 70 years old or greater underwent lobectomy for clinical stage I non-small cell lung cancer. After matching based on age, gender, presence of comorbid conditions, and preoperative clinical stage, there were 82 patients in each group. Patients had similar preoperative characteristics. A VATS approach resulted in a significantly lower rate of complications compared with THOR (28% vs 45%, p = 0.04) and a shorter median length of stay (5 days, range 2 to 20 vs 6 days, range 2 to 27, p < 0.001). No patients undergoing VATS lobectomy had higher than grade 2 complications, whereas 7% of complications in the THOR group were grade 3 or higher. There were no perioperative deaths in the VATS patients compared with an in-hospital mortality rate of 3.6% (3 of 82) for THOR patients.

Conclusions: A VATS approach to lobectomy for clinical stage I non-small cell lung cancer in the elderly was associated with fewer and overall reduced severity of complications as well as a shorter hospital stay compared with thoracotomy.






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