title: Muscle sparing versus posterolateral thoracotomy for pulmonary lobectomy: randomised controlled trial.
abstract: Muscle sparing thoracotomy (MST) has been proposed as an alternative to posterolateral thoracotomy (PLT) for pulmonary lobectomy. This issue has been addressed by few clinical reports. To explore that subject, a prospective, controlled randomised, double-blind trial comparing MST through the auscultatory triangle and PLT was planned. The study included patients scheduled for pulmonary lobectomy for stage I or II non-small-cell lung cancer and were followed for three years. The primary endpoints were pain, analgesic consumption and post-thoracotomy pain syndrome. The secondary endpoints included morbidity plus shoulder and pulmonary functions. The trial randomised 100 patients into two groups. Postoperative pain results were similar, although analgesic consumption was higher in the PLT group (P=0.001). The MST group had a shorter hospital stay (P=0.003). Three years post-thoracotomy syndrome was unaffected by the type of incision. The women suffered more than men during the early and late postoperative time. An inverse correlation between incision length and pain was found. Immediate shoulder strength was significantly better in the MST group (P=0.004) but postoperative pulmonary function and complications were comparable. The two incisions results were very similar in the patient outcome, however, few aspects indicated the MST as the more suitable incision for pulmonary lobectomy.
authors.affiliation: Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza, 35, 20122 Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Nosotti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Baisi
authors.forename: Paolo
authors.initials: P
authors.lastname: Mendogni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Palleschi
authors.forename: Davide
authors.initials: D
authors.lastname: Tosi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rosso
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D011013:Pneumonectomy / Q000379:methods*; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*
chemical_list: D000700:Analgesics