Comparison of staged thoracoscopy and median sternotomy for lung volume reduction.
BACKGROUND
Lung volume reduction operations have proved beneficial for emphysematous patients, but questions remain about the role of a unilateral procedure.


METHODS
Fifty patients were prospectively enrolled in a lung volume reduction surgery program for emphysema with staged unilateral video-assisted thoracoscopic procedures (VATS group). These patients were compared with 29 patients having bilateral lung volume reduction procedures by median sternotomy.


RESULTS
The VATS group was slightly older and had shorter 6-minute walk distances, but otherwise the two groups were similar. Hospital stays were shorter for each unilateral VATS procedure, but the total of the two hospital stays was longer than the stay for the sternotomy group (21.1 versus 14.8 days). Complications were comparable, there were no in-hospital deaths, and there was significant difference in the 1-year mortality rate (VATS, 6% versus sternotomy, 13.8%; p = 0.137). Functional test results were comparable between the groups with improvements in percent predicted forced expiratory volume in 1 second (VATS, 41%, and sternotomy, 40%), 6-minute walk distances (VATS, 48%, and sternotomy, 26%), dyspnea scores, and acid base measurements.


CONCLUSIONS
Staged lung volume reduction operations do not appear to offer any measurable advantages over a single hospitalization and bilateral lung volume reduction procedures.
Hazelrigg
S R
SR
Division of Thoracic and Cardiovascular Surgery, Southern Illinois University School of Medicine, Springfield 62794-1312, USA. shazelrigg@siumed.edu
Boley
T M
TM
Magee
M J
MJ
Lawyer
C H
CH
Henkle
J Q
JQ
D000368:Aged; D016022:Case-Control Studies; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000601:surgery*; D013249:Sternum / Q000601:surgery*; D013906:Thoracoscopy; D016896:Treatment Outcome