Video-assisted thoracic surgery lobectomy does not offer any functional recovery advantage in comparison to the open approach 3 months after the operation: a case matched analysis†.
OBJECTIVE
The objective of the present study was to compare functional loss [forced expiratory volume in one second to forced vital capacity ratio (FEV1), DLCO and VO2max reduction] after VATS versus open lobectomies.


METHODS
We performed a prospective observational study on 195 patients who had a pulmonary lobectomy from June 2010 to November 2014 and who were able to complete a 3-months functional evaluation follow-up program. Since the VATS technique was our first choice for performing lobectomies from January 2012, we divided the patients into two groups: the OPEN group (112 patients) and the VATS group (83 patients). The open approach was intended as a muscle sparing/nerve sparing lateral thoracotomy. Fourteen baseline factors were used to construct a propensity score to match the VATS-group patients with their OPEN-group counterparts. These two matched groups were then compared in terms of reduction of FEV1, DLCO and VO2max (Mann-Whitney test).


RESULTS
The propensity score analysis yielded 83 well-matched pairs of OPEN and VATS patients. In both groups, 3 months postoperatively, we found a reduction in FEV1, DLCO and VO2max values (OPEN patients: FEV1-10%, DLCO -11.9%, VO2max - 5.5%; VATS patients: FEV1-7.2%, DLCO-10.6%, VO2max-6.9%). The reductions in FEV1, DLCO and VO2max were similar to those in the two matched groups, with a Cohen effect size <0.2 for all the comparisons.


CONCLUSIONS
In 3 months, both OPEN patients and VATS patients experienced a reduction in their preoperative functional parameters. VATS lobectomy does not offer any advantages in terms of FEV1, DLCO and exercise capacity recovery in comparison to the muscle-sparing thoracotomy approach.
Unit of Thoracic Surgery, AOU Ospedali Ruiniti, Ancona, Italy.
Michele
M
Salati
Department of Thoracic Surgery, St. Jame's University Hospital, Leeds, UK.
Alessandro
A
Brunelli
Unit of Thoracic Surgery, AOU Ospedali Ruiniti, Ancona, Italy.
Francesco
F
Xiumè
Unit of Thoracic Surgery, AOU Ospedali Ruiniti, Ancona, Italy.
Marco
M
Monteverde
Unit of Thoracic Surgery, AOU Ospedali Ruiniti, Ancona, Italy.
Armando
A
Sabbatini
Unit of Thoracic Surgery, AOU Ospedali Ruiniti, Ancona, Italy.
Michela
M
Tiberi
Department of Thoracic Surgery, St. Jame's University Hospital, Leeds, UK.
Cecilia
C
Pompili
t33 company Srl, Ancona, Italy.
Roberto
R
Palloni
Unit of Thoracic Surgery, AOU Ospedali Ruiniti, Ancona, Italy.
Majed
M
Refai
D000368:Aged; D006801:Humans; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011013:Pneumonectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D012129:Respiratory Function Tests / Q000706:statistics & numerical data; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000706:statistics & numerical data
Oxygen consumption; Pulmonary function; Video-assisted thoracic surgery