Pulmonary function after pulmonary resection by posterior thoracotomy, anterior thoracotomy or video-assisted surgery

Abstract

Objective: Predicted postoperative forced expiratory volume in 1 s (ppoFEV1) is estimated in lung cancer patients before pulmonary resection, as well as the clinical stage. This study aims to evaluate ppoFEV1 and ppo-vital capacity (ppoVC) on postoperative day 7 (POD7) and to compare the results following video-assisted thoracic surgery (VATS) and open thoracotomy procedures. Methods: Of the 155 patients who underwent pulmonary resection, 70 had VATS; 30 had muscle-sparing thoracotomy (anterior limiting thoracotomy (AL)); and 55 had postero-lateral thoracotomy (PL). VC and FEV1 were measured on POD7 and compared with the VC and FEV1 before surgery using analysis of covariance (ANCOVA). The ratio of the actual-and the ppoVC and FEV1 was evaluated to identify factors associated with variations in postoperative residual VC/FEV1. Results: There were significant differences by analysis of covariance (ANCOVA) in the VC/FEV1 among the three surgical approaches. In the VATS group, the VC ratio and the FEV1 ratio were 96.5% and 94.7%, respectively; they were significantly higher in the VATS group than in the thoracotomy group (AL: 90.4% and 90.1%, respectively; PL: 87.4% and 87.6%, respectively). Non-chronic obstructive pulmonary disease (COPD) and upper lobectomy were also associated with a low VC ratio and FEV1 ratio. Conclusion: Predicted postoperative pulmonary function might be overestimated in COPD patients or in those undergoing VATS or lower lobectomy. #

Physiologic assessment before video thoracoscopic resection for lung cancer in patients with abnormal pulmonary function

“…In the study by Win et al (18), the authors showed that FEV1 threshold may be lower (45-50% predicted). The literature also suggests that patients with poor respiratory function have perioperative outcomes similar to those with normal lung function when lung resection was performed by VATS (19)(20)(21). In view of data in the literature and the results of this work, the FEV1 threshold below which further explorations are indicated could probably be lowered.…”

Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery

“…Improvements in surgical technique and introduction of VATS may be associated with benefi cial postoperative results. Endoh et al 130 have demonstrated that postoperative fall in lung function is lower in subjects undergoing VATS compared with subjects treated with an open surgical approach. Similarly, improvement in perioperative management and tailoring of therapy to individual patients may produce benefi ts in clinical outcome.…”

Effect of comorbidities on long-term outcomes after thoracoscopic surgery for stage I non-small cell lung cancer patients with chronic obstructive pulmonary disease

“…Recently, reports showing the effectiveness of TS are increasing (19)(20)(21)(22)(23). Endoh et al, for example, reported that pulmonary function was better after pulmonary resection in patients who underwent VATS than in patients who underwent open thoracotomy (24). Moreover, there are several reports of the benefits of TS for patients with poor pulmonary function (6,25).…”