Five-Year Experience with VATS Segmentectomy for Lung Tumor Resection Shows Improving Outcomes and Superiority over Thoracotomy
Michel J. Sabra, Yahya Alwatari, Anna Xu, Christine Bierema, Luke G. Wolf, Anthony D. Cassano, Shah D. Rachit.
VCU Health, Richmond, VA, USA.
OBJECTIVE: Segmentectomy for early-stage lung cancer, whether through open thoracotomy or video-assisted thoracoscopic surgery, has been shown to be a sound oncologic resection. The aim of this study was to compare thoracotomy and VATS segmentectomy operative outcomes. METHODS: Patients who underwent segmentectomy for benign or malignant tumors in NSQIP database (2013 - 2017) were included. Propensity-matched analysis was conducted between VATS and the thoracotomy groups. VATS patients were also compared longitudinally. RESULTS: VATS segmentectomy was associated with shorter operative time (137 ± 76 vs. 161 ± 87 minutes, P < .001), less days from operation to discharge (3.84 ± 3.93 vs. 5.83 ± 5.28 days, P < .001), and the patients were more likely to be discharged home (94% vs 89%, P = .002). VATS was associated with less post-operative complications compared to thoracotomy: pneumonia (2.92% vs. 5.75%, P=.011), unplanned intubation (1.8% vs. 3.54%, P = .048), ventilator greater than 48 hours (0.67% vs. 2.65%, P = .029), transfusion requirement (1.35% vs. 5.75%, P < .001), and deep venous thrombosis (0.11% vs. 1.11%, P = .028) (Table 1). Compared to the earlier VATS patients, late VATS patients had less post-operative pneumonia (1.83% vs. 3.37%, P = .075), less transfusion requirement (0.7% vs. 2.09%, P = .029), and less days from operation to discharge (3.19 ± 2.92 vs. 4.21 ± 3.96, P < .0001) (Graph 1).CONCLUSIONS: Compared with thoracotomy, VATS segmentectomy is associated with lower postoperative complications and shorter hospital stay. The outcome of VATS segmentectomy has improved over recent years.
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