Does Thoracoscopic Surgery Decrease the Morbidity of Combined Lung and Chest Wall Resection?
BACKGROUND
Because the traditional open lung approach with en bloc chest wall resection carries substantial risk for complications and death, we studied our thoracoscopic approach for this operation.


METHODS
From 2007 to 2013, all consecutive video-assisted thoracoscopic (VATS) and open chest wall resections at a comprehensive cancer center were tabulated retrospectively. Data were analyzed by approach, type, and cause of early major morbidity and mortality. Lung cancer cases (the largest subset, T3) were analyzed separately. Statistical tests included the Kruskal-Wallis test for continuous variables and the χ(2) for categoric variables. Survival data were analyzed by the Kaplan-Meier method and log-rank tests.


RESULTS
Of 47 chest wall resections performed, 17 (36%) were performed by VATS with no conversions. Resections were performed for primary non-small cell lung cancer (15 VATS and 16 thoracotomy), sarcoma (11), metastatic disease from a separate primary (2), and benign conditions (3). Patients undergoing a VATS approach were older (76 vs 56 years, p = 0.003), and the operative times, blood loss, and ribs resected were similar between groups. Patients undergoing VATS had shorter intensive care unit and hospital lengths of stay, but both groups had high hospital morbidity and mortality, largely resulting from postoperative pneumonia or respiratory systemic inflammatory response syndrome (n = 5), stroke (n = 2), and postoperative colon ischemia (n = 1). Groups had a 90-day mortality of 26.7% and 25% respectively. Stage-matched survival curves for both approaches were superimposable (p=0.88).


CONCLUSIONS
Thoracoscopic chest wall resection was feasible, expanded our case selection, and reduced prosthetic reconstruction. It did not, however, protect frail, elderly patients reliably. Briefer, less traumatic operations may be needed for this cohort.
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York; Department of Surgery, State University of New York at Buffalo, Buffalo, New York.
Mark W
MW
Hennon
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York; Department of Surgery, State University of New York at Buffalo, Buffalo, New York.
Elisabeth U
EU
Dexter
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York; Department of Surgery, State University of New York at Buffalo, Buffalo, New York.
Miriam
M
Huang
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Surgery, State University of New York at Buffalo, Buffalo, New York.
John
J
Kane
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York; Department of Surgery, State University of New York at Buffalo, Buffalo, New York.
Chukwumere
C
Nwogu
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York.
Anthony
A
Picone
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York; Department of Surgery, State University of New York at Buffalo, Buffalo, New York.
Sai
S
Yendamuri
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York; Department of Surgery, State University of New York at Buffalo, Buffalo, New York. Electronic address: todd.demmy@roswellpark.org.
Todd L
TL
Demmy
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009518:New York / Q000453:epidemiology; D061646:Operative Time; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D035441:Thoracic Wall / Q000601:surgery*; D013905:Thoracoplasty / Q000379:methods*; D016896:Treatment Outcome