title: Thoracoscopic pneumonectomy: an 11-year experience.
abstract: BACKGROUND
  It is unclear whether thoracoscopic (video-assisted thoracoscopic surgery [VATS]) pneumonectomy improves outcomes compared with open approaches.
  
  
  METHODS
  One hundred seven consecutive pneumonectomies performed at an experienced center from January 2002 to December 2012 were studied retrospectively. Forty cases were open, and 50 successful VATS and 17 conversions were combined (intent-to-treat [ITT] analysis).
  
  
  RESULTS
  The VATS cohort had more preoperative comorbidities (three vs two, P = .003), women (57% vs 30%, P = .009), and older ages (65 years vs 63 years, P = .07). Although advanced clinical stage was less for VATS (26% vs 50% stage III, P = .035), final pathologic staging was similar (25% vs 38%, P = .77). Pursuing a VATS approach yielded similar complications (two vs two, median, P = .73) with no catastrophic intraoperative events like bleeding. Successful VATS pneumonectomy rates rose from 50%-82% by the second half of the series (P < .001). Completion pneumonectomy cases (13.4% VATS, 7.5% open) had similar outcomes. Having similar initial discomforts as patients undergoing open surgery, more patients undergoing VATS were pain-free at 1 year (53% vs 19%, P = .03). Conversions resulted in longer ICU stays (4 days vs 2 days, P = .01). Advanced clinical stage (III-IV) ITT VATS had longer median overall survival (OS) (42 months vs 13 months, log-rank P = .042). Successful VATS cases with early pathologic stage (0-II) had a median OS of 80 vs 16 months for converted and 28 months for open (log rank = 0.083).
  
  
  CONCLUSIONS
  Attempting thoracoscopic pneumonectomy at an experienced center appears safe but does not yield the early pain/complication reductions observed for VATS lobectomy. There may be long-term pain/survival advantages for certain stages that warrant further study and refinement of this approach.
authors.affiliation: From the The Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Athar
authors.initials: A
authors.lastname: Battoo
authors.affiliation: From the The Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Ariba
authors.initials: A
authors.lastname: Jahan
authors.affiliation: From the The Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Zhengyu
authors.initials: Z
authors.lastname: Yang
authors.affiliation: From the The Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Chukwumere E
authors.initials: CE
authors.lastname: Nwogu
authors.affiliation: From the The Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Sai S
authors.initials: SS
authors.lastname: Yendamuri
authors.affiliation: From the The Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Elisabeth U
authors.initials: EU
authors.lastname: Dexter
authors.affiliation: From the The Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Hennon
authors.affiliation: From the The Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Picone
authors.affiliation: From the The Roswell Park Cancer Institute, Buffalo, NY. Electronic address: Todd.Demmy@roswellpark.org.
authors.forename: Todd L
authors.initials: TL
authors.lastname: Demmy
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011013:Pneumonectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013906:Thoracoscopy / Q000379:methods*; D013997:Time Factors