Difference in the impairment of vital capacity and 6-minute walking after a lobectomy performed by thoracoscopic surgery, an anterior limited thoracotomy, an anteroaxillary thoracotomy, and a posterolateral thoracotomy.
OBJECTIVE
Postoperative vital capacity (VC) and the 6-min walking (6MW) test were used to compare the differences in impairment of the pulmonary function and walking capacity in patients undergoing a lobectomy by video-assisted thoracoscopic surgery (VATS), an anterior limited thoracotomy (ALT), an anteroaxillary thoracotomy (AAT), or a posterolateral thoracotomy without muscle sparing (PLT).


METHODS
The study was a retrospective analysis. Lung cancer patients who underwent a lobectomy by VATS, ALT, AAT, or PLT (28 in each group) were matched by sex and age (+/-5 years). VC was measured before surgery and at 1, 2, 4, 12, and 24 weeks after surgery. The distance covered during the 6MW test (6MWD) was measured before surgery and in a postoperative test 1 week after surgery.


RESULTS
Compared with the VATS, ALT, and AAT groups, PLT patients showed a significant impairment of VC from 1 to 24 weeks after surgery ( P < 0.05-0.001) and also a significant impairment of 6MWD 1 week after surgery ( P < 0.01-0.001). The AAT group showed a significant impairment of 6MWD 1 week after surgery compared with the VATS and ALT groups ( P < 0.001 and P < 0.05, respectively). There was no significant difference in the impairment of either VC or 6MWD between VATS and ALT.


CONCLUSIONS
The PLT without a muscle sparing procedure therefore cannot be recommended for general lung cancer surgery because of the impairment of both walking capacity and pulmonary function which continues long after surgery. VATS and ALT are better procedures than AAT regarding the recovery of walking capacity early after surgery. VATS and ALT are similar to each other regarding the impairment of pulmonary function and walking capacity after surgery.
Nomori
Hiroaki
H
Department of Thoracic Surgery, Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan.
Ohtsuka
Takashi
T
Horio
Hirotoshi
H
Naruke
Tsuguo
T
Suemasu
Keiichi
K
D000368:Aged; D005080:Exercise Test; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013908:Thoracotomy; D016138:Walking