title: Post-thoracotomy pain and long-term survival associated with video-assisted thoracic surgery lobectomy methods for clinical T1N0 lung cancer: a patient-oriented, prospective cohort study.
abstract: OBJECTIVE
  To provide a less-invasive procedure for video-assisted thoracic surgery (VATS), we prospectively evaluated the feasibility of two existing VATS approaches.
  
  
  METHODS
  We conducted a prospective cohort study to determine the feasibility of two strictly defined types of VATS lobectomy. Based on free decisions made by patients after hearing similar preoperative explanations using the same table, either one modality was adopted. The perioperative variables, including operation time, blood loss, morbidity, mortality and particularly post-thoracotomy pain and long-term survival, were evaluated for the assisted VATS and the complete VATS groups.
  
  
  RESULTS
  We reviewed 104 consecutive patients who had clinical T1N0M0 non-small-cell lung cancer. Twenty-six patients (ASSIST group) chose lobectomy performed via an anterolateral small thoracotomy by using a rib spreader with a combination of thoracoscopic and direct views. Seventy-eight patients (PURE group) chose complete VATS in which only a monitor was used during smaller-access thoracotomy without a rib spreader. All clinical parameters that were scheduled to be measured during the perioperative period were found to be acceptable using both approaches. The ASSIST group had a significantly high odds ratio of using additional painkillers except epidural anaesthesia when compared with the PURE group, as shown by multivariate logistic regression analysis. Patients in the PURE group exhibited early recovery from surgery, but their operation time was longer. Disease-free and overall 5-year survival rates were equivalent between the two groups.
  
  
  CONCLUSIONS
  Both procedures are feasible with regard to perioperative factors and long-term survival rates. Patients undergoing complete VATS required less medication than those undergoing assisted VATS.
authors.affiliation: Department of General Thoracic Surgery, Kure Medical Center/Chugoku Cancer Center, Hiroshima, Kure, Japan. yamashitay@kure-nh.go.jp
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Hidenori
authors.initials: H
authors.lastname: Mukaida
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Harada
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsubokawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology*; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011446:Prospective Studies; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality
chemical_list: D000700:Analgesics
keywords: Lobectomy; Minimally invasive surgery; NSCLC (non-small-cell lung cancer); VATS (video-assisted thoracic surgery)