Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery.
BACKGROUND
The National Emphysema Treatment Trial, a randomized trial comparing lung volume reduction surgery with medical therapy for severe emphysema, included randomized and nonrandomized comparisons of the median sternotomy and video-assisted thoracoscopic approaches for lung volume reduction surgery.


METHODS
Lung volume reduction surgery was performed by median sternotomy only at 8 centers and video-assisted thoracoscopy only at 3 centers; 6 centers randomized the approach to lung volume reduction surgery. Mortality, morbidity, functional status, and costs were assessed.


RESULTS
In the nonrandomized comparison, 359 patients received lung volume reduction surgery by median sternotomy, and 152 patients received lung volume reduction surgery by video-assisted thoracoscopy. The 90-day mortality was 5.9% for median sternotomy and 4.6% for video-assisted thoracoscopy (P =.67). Overall mortality was 0.08 deaths per person-year for median sternotomy and 0.10 deaths per person-year for video-assisted thoracoscopy (video-assisted thoracoscopy-median sternotomy risk ratio, 1.18; P =.42). Complication rates were low and not statistically different for the 2 approaches. The median hospital length of stay was longer for median sternotomy than for video-assisted thoracoscopy (10 vs 9 days; P =.01). By 30 days after surgery, 70.5% of median sternotomy patients and 80.9% of video-assisted thoracoscopy patients were living independently (P =.02). Functional outcomes were similar for median sternotomy and video-assisted thoracoscopy at 12 and 24 months. Costs for the operation and the associated hospital stay and costs in the 6 months after surgery were both less for video-assisted thoracoscopy than for median sternotomy (P <.01 in both cases). Similar results were noted for the randomized comparison.


CONCLUSIONS
Morbidity and mortality were comparable after lung volume reduction surgery by video-assisted thoracoscopy or median sternotomy, as were functional results. The video-assisted thoracoscopic approach to lung volume reduction surgery allowed earlier recovery at a lower cost than median sternotomy.
McKenna
Robert J
RJ
NETT Coordinating Center, 615 N Wolfe St, Room 5010, Baltimore, MD 21205, USA.
Benditt
Joshua O
JO
DeCamp
Malcolm
M
Deschamps
Claude
C
Kaiser
Larry
L
Lee
Shing M
SM
Mohsenifar
Zab
Z
Piantadosi
Steven
S
Ramsey
Scott
S
Reilly
John
J
Utz
James
J
D000368:Aged; D016063:Blood Loss, Surgical; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D011013:Pneumonectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D011182:Postoperative Care; D011183:Postoperative Complications; D011656:Pulmonary Emphysema / Q000191:economics / Q000601:surgery*; D012121:Respiration, Artificial; D013249:Sternum / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome