title: A comparative study of video-assisted thoracoscopic resection versus thoracotomy for neurogenic tumours arising at the thoracic apex.
abstract: OBJECTIVE
  The surgical outcome of neurogenic tumours arising at the thoracic apex remains largely undefined. In this retrospective study, we compared the efficacy and safety of thoracoscopic surgery and thoracotomy for neurogenic tumours at the thoracic apex in 63 patients who received surgical treatment between 1992 and 2012 at our medical centre.
  
  
  METHODS
  Forty-four (69.8%) patients received thoracotomy (Group A) and 19 (30.2%) patients underwent video-assisted thoracoscopic surgery (Group B). Operative time, estimated blood loss (EBL), postoperative length of hospital stay and nervous system complications were recorded.
  
  
  RESULTS
  The two groups of patients were comparable in demographic and baseline characteristics except that Group A patients had a significantly larger tumour size (mean, 4.9 ± 1.0 cm) than Group B patients (mean, 4.1 ± 1.2 cm; P = 0.01). The mean operative time was markedly greater for Group A (120.2 ± 41.2 min) than Group B (93.2 ± 34.5 min; P = 0.009). Group A had significantly greater EBL (245.23 ± 197.78 ml) than Group B (117.4 ± 138.2 ml; P < 0.001). Total tumour resection was achieved in all patients and all neurogenic tumours were benign. The mean length of postoperative hospital stay was markedly longer in Group A (7.0 ± 2.1 days) than Group B (4.8 ± 2.0; P < 0.001). Postoperatively, brachial plexus injury was found in 1 patient (2.3%) in Group A and 4 patients (21.1%) in Group B (P = 0.026).
  
  
  CONCLUSIONS
  Though thoracoscopic surgery is associated with diminished blood loss, reduced operative time and shortened hospital stay, it has a markedly increased incidence of brachial plexus injury.
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Medical School of Tongji University, Shanghai, China.
authors.forename: Chenlu
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Medical School of Tongji University, Shanghai, China zdp1992@163.com.
authors.forename: Deping
authors.initials: D
authors.lastname: Zhao
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Medical School of Tongji University, Shanghai, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Medical School of Tongji University, Shanghai, China.
authors.forename: Jiaan
authors.initials: J
authors.lastname: Ding
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Medical School of Tongji University, Shanghai, China.
authors.forename: Gening
authors.initials: G
authors.lastname: Jiang
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D001917:Brachial Plexus / Q000293:injuries; D002681:China; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009380:Neoplasms, Nerve Tissue / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013899:Thoracic Neoplasms / Q000473:pathology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
keywords: Brachial plexus injury; Neurogenic tumour; Thoracic inlet tumour; Thoracoscopic surgery