title: Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis.
abstract: OBJECTIVE
  Using a national database, we asked whether video-assisted thoracoscopic surgery (VATS) lobectomy is beneficial in high-risk pulmonary patients.
  
  
  BACKGROUND
  Single-institution series demonstrated benefit of VATS lobectomy over lobectomy via thoracotomy in poor pulmonary function patients [FEV1 (forced expiratory volume in 1 second) or DLCO (diffusion capacity of the lung to carbon monoxide) <60% predicted].
  
  
  METHODS
  The STS General Thoracic Database was queried for patients having undergone lobectomy by either thoracotomy or VATS between 2000 and 2010. Postoperative pulmonary complications included those defined by the STS database.
  
  
  RESULTS
  In the STS database, 12,970 patients underwent lobectomy (thoracotomy, n = 8439; VATS, n = 4531) and met inclusion criteria. The overall rate of pulmonary complications was 21.7% (1832/8439) and 17.8% (806/4531) in patients undergoing lobectomy with thoracotomy and VATS, respectively (P < 0.0001). In a multivariable model of pulmonary complications, thoracotomy approach (OR = 1.25, P < 0.001), decreasing FEV1% predicted (OR = 1.01 per unit, P < 0.001) and DLCO% predicted (OR = 1.01 per unit, P < 0.001), and increasing age (1.02 per year, P < 0.001) independently predicted pulmonary complications. When examining pulmonary complications in patients with FEV1 less than 60% predicted, thoracotomy patients have markedly increased pulmonary complications when compared with VATS patients (P = 0.023). No significant difference is noted with FEV1 more than 60% predicted.
  
  
  CONCLUSIONS
  Poor pulmonary function predicts respiratory complications regardless of approach. Respiratory complications increase at a significantly greater rate in lobectomy patients with poor pulmonary function after thoracotomy compared with VATS. Planned surgical approach should be considered while determining whether a high-risk patient is an appropriate resection candidate.
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA. dpceppa@iupui.edu
authors.forename: DuyKhanh P
authors.initials: DP
authors.lastname: Ceppa
authors.forename: Andrzej S
authors.initials: AS
authors.lastname: Kosinski
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
authors.forename: Betty C
authors.initials: BC
authors.lastname: Tong
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.forename: John D
authors.initials: JD
authors.lastname: Mitchell
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
mesh_terms: D000367:Age Factors; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D012955:Societies, Medical; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D016896:Treatment Outcome; D014481:United States