title: Prior thoracoscopic surgery may improve reoperative pulmonary resection.
abstract: OBJECTIVE
  although video-assisted thoracoscopic surgery for pulmonary resection appears to be associated with more favorable postoperative outcomes than thoracotomy, no reports have discussed its benefit at subsequent reoperative pulmonary resection.
  
  
  METHODS
  between January 2000 and December 2009, 144 patients underwent reoperative pulmonary resections for benign and malignant nodules at the Mayo Clinic, Rochester. Their data were evaluated retrospectively. Twenty-three (16%) patients had prior video-assisted thoracoscopic surgery, and 121 (84%) had undergone a prior open thoracotomy. Intraoperative and short-term postoperative outcomes were analyzed and compared between the two groups, using the chi-square test or Mann-Whitney test.
  
  
  RESULTS
  overall reoperative mortality was 1.38% and morbidity was 49.3%. Intraoperative factor analysis showed that the prior video-assisted thoracoscopic surgery group more often underwent anatomical resection (p = 0.0011) and showed a tendency towards a lower conversion rate from video-assisted thoracoscopic surgery to thoracotomy at reoperative pulmonary resection (p = 0.051). Short-term postoperative outcomes showed that the prior video-assisted thoracoscopic surgery group had a significantly lower morbidity rate (p = 0.013), significantly shorter hospital stay (p = 0.002), and a tendency for a shorter duration of chest tube drainage (p = 0.09).
  
  
  CONCLUSIONS
  our results suggest that prior video-assisted thoracoscopic surgery may lead to improved postoperative outcomes at subsequent reoperative pulmonary resection. Video-assisted thoracoscopic surgery may be favored for future potential reoperative pulmonary resections.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Hamaji
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: K Robert
authors.initials: KR
authors.lastname: Shen
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA wigle.dennis@mayo.edu.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wigle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D016009:Chi-Square Distribution; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D055613:Multiple Pulmonary Nodules / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015999:Multivariate Analysis; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Lung Neoplasms; Pneumonectomy; Reoperation; Thoracic surgery; Thoracotomy; video-assisted