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Ann Thorac Surg 2007;83:1578
© 2007 The Society of Thoracic Surgeons

Correspondence

Thoracoscopic Lobectomy for Impaired or Complex Patients: An Update

Todd L. Demmy, MD

Department of Thoracic Surgery, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263

(Email: todd.demmy{at}roswellpark.org).

To the Editor:

The updated indications and intermediate results of thoracoscopic lobectomy for frail or complicated patients are presented using the same methods previously described [1]. In more than 100 consecutive months ending August 2002, 72 patients with vital organ impairment or other comorbidities underwent elective thoracoscopic lobectomy. Organ dysfunction and other problems that warranted thoracoscopic lobectomy are presented in Table 1.


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  		Table 1 Reasons for Selecting Thoracoscopic Lobectomy
 
Hospital stay, chest tube duration, and return to preoperative activity remained faster for thoracoscopy patients. There were 21 late deaths for the video-assisted thoracic surgery group (57% vs 52% for a case-matched open group, not significant) caused by cancer progression (51%), cardiovascular events (24%), respiratory events (15%), or other (10%). There were no isolated local cancer recurrences after thoracoscopic lobectomy.

The second half of the series had no deaths, fewer major complications (22.2% vs 11.1%; p = 0.05), more upper lobectomies (63% vs 50%; p = 0.03), and fewer conversions for unfavorable anatomy (3 patients), adhesions, or hemorrhage (2.8% vs 13%; p = 0.08). Three weeks postoperatively, narcotic freedom favored thoracoscopic cases (64% vs 9% open; p < 0.01). The cancer and leukemia group B protocol 140301 will compare traditional and thoracoscopic lobectomies prospectively.


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 References
 

  1. Demmy TL, Curtis JJ. Minimally invasive lobectomy directed toward frail and high-risk patients: a case-control study Ann Thorac Surg 1999;68:194-200.[Abstract/Free Full Text]



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 Ann. Thorac. Surg.Home page
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Is Video-Assisted Thoracic Surgery Lobectomy Better? Quality of Life Considerations
Ann. Thorac. Surg., February 1, 2008; 85(2): S719 - S728.
[Abstract] [Full Text] [PDF]

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