Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy

Nestor Villamizar, Marcus D. Darrabie, William R. Burfeind, Rebecca P. Petersen, Mark W. Onaitis, Eric Toloza, David H. Harpole, Thomas A. D'Amico

Research output: Contribution to journalArticle

222 Citations (Scopus)

Abstract

Objectives: Advantages of thoracoscopic lobectomy include less postoperative pain, shorter hospitalization, and improved delivery of adjuvant chemotherapy. The incidence of postoperative complications has not been thoroughly assessed. This study analyzes morbidity after lobectomy to compare the thoracoscopic approach and thoracotomy. Methods: By using a prospective database, the outcomes of patients who underwent lobectomy from 1999-2009 were analyzed with respect to postoperative complications. Propensity-matched groups were analyzed based on preoperative variables and stage. Results: Of the 1079 patients in the study, 697 underwent thoracoscopic lobectomy, and 382 underwent lobectomy by means of thoracotomy. In the overall analysis thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (P = .01), atelectasis (P = .0001), prolonged air leak (P = .0004), transfusion (P = .0001), pneumonia (P = .001), sepsis (P = .008), renal failure (P = .003), and death (P = .003). In the propensity-matched analysis based on preoperative variables, when comparing 284 patients in each group, 196 (69%) patients who underwent thoracoscopic lobectomy had no complications versus 144 (51%) patients who underwent thoracotomy (P = .0001). In addition, thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (13% vs 21%, P = .01), less atelectasis (5% vs 12%, P = .006), fewer prolonged air leaks (13% vs 19%, P = .05), fewer transfusions (4% vs 13%, P = .002), less pneumonia (5% vs 10%, P = .05), less renal failure (1.4% vs 5%, P = .02), shorter chest tube duration (median of 3 vs 4 days, P < .0001), and shorter length of hospital stay (median of 4 vs 5 days, P < .0001). Conclusions: Thoracoscopic lobectomy is associated with a lower incidence of major complications, including atrial fibrillation, compared with lobectomy by means of thoracotomy. The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.

Original languageEnglish (US)
Pages (from-to)419-425
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume138
Issue number2
DOIs
StatePublished - Aug 2009
Externally publishedYes

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Thoracotomy
Morbidity
Atrial Fibrillation
Pulmonary Atelectasis
Incidence
Renal Insufficiency
Length of Stay
Pneumonia
Air
Chest Tubes
Adjuvant Chemotherapy
Postoperative Pain
Sepsis
Hospitalization
Research Design
Thorax
Databases
Safety

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Villamizar, N., Darrabie, M. D., Burfeind, W. R., Petersen, R. P., Onaitis, M. W., Toloza, E., ... D'Amico, T. A. (2009). Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. Journal of Thoracic and Cardiovascular Surgery, 138(2), 419-425. https://doi.org/10.1016/j.jtcvs.2009.04.026

Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. / Villamizar, Nestor; Darrabie, Marcus D.; Burfeind, William R.; Petersen, Rebecca P.; Onaitis, Mark W.; Toloza, Eric; Harpole, David H.; D'Amico, Thomas A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 138, No. 2, 08.2009, p. 419-425.

Research output: Contribution to journalArticle

Villamizar, N, Darrabie, MD, Burfeind, WR, Petersen, RP, Onaitis, MW, Toloza, E, Harpole, DH & D'Amico, TA 2009, 'Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy', Journal of Thoracic and Cardiovascular Surgery, vol. 138, no. 2, pp. 419-425. https://doi.org/10.1016/j.jtcvs.2009.04.026
Villamizar, Nestor ; Darrabie, Marcus D. ; Burfeind, William R. ; Petersen, Rebecca P. ; Onaitis, Mark W. ; Toloza, Eric ; Harpole, David H. ; D'Amico, Thomas A. / Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. In: Journal of Thoracic and Cardiovascular Surgery. 2009 ; Vol. 138, No. 2. pp. 419-425.
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abstract = "Objectives: Advantages of thoracoscopic lobectomy include less postoperative pain, shorter hospitalization, and improved delivery of adjuvant chemotherapy. The incidence of postoperative complications has not been thoroughly assessed. This study analyzes morbidity after lobectomy to compare the thoracoscopic approach and thoracotomy. Methods: By using a prospective database, the outcomes of patients who underwent lobectomy from 1999-2009 were analyzed with respect to postoperative complications. Propensity-matched groups were analyzed based on preoperative variables and stage. Results: Of the 1079 patients in the study, 697 underwent thoracoscopic lobectomy, and 382 underwent lobectomy by means of thoracotomy. In the overall analysis thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (P = .01), atelectasis (P = .0001), prolonged air leak (P = .0004), transfusion (P = .0001), pneumonia (P = .001), sepsis (P = .008), renal failure (P = .003), and death (P = .003). In the propensity-matched analysis based on preoperative variables, when comparing 284 patients in each group, 196 (69{\%}) patients who underwent thoracoscopic lobectomy had no complications versus 144 (51{\%}) patients who underwent thoracotomy (P = .0001). In addition, thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (13{\%} vs 21{\%}, P = .01), less atelectasis (5{\%} vs 12{\%}, P = .006), fewer prolonged air leaks (13{\%} vs 19{\%}, P = .05), fewer transfusions (4{\%} vs 13{\%}, P = .002), less pneumonia (5{\%} vs 10{\%}, P = .05), less renal failure (1.4{\%} vs 5{\%}, P = .02), shorter chest tube duration (median of 3 vs 4 days, P < .0001), and shorter length of hospital stay (median of 4 vs 5 days, P < .0001). Conclusions: Thoracoscopic lobectomy is associated with a lower incidence of major complications, including atrial fibrillation, compared with lobectomy by means of thoracotomy. The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.",
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T1 - Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy

AU - Villamizar, Nestor

AU - Darrabie, Marcus D.

AU - Burfeind, William R.

AU - Petersen, Rebecca P.

AU - Onaitis, Mark W.

AU - Toloza, Eric

AU - Harpole, David H.

AU - D'Amico, Thomas A.

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N2 - Objectives: Advantages of thoracoscopic lobectomy include less postoperative pain, shorter hospitalization, and improved delivery of adjuvant chemotherapy. The incidence of postoperative complications has not been thoroughly assessed. This study analyzes morbidity after lobectomy to compare the thoracoscopic approach and thoracotomy. Methods: By using a prospective database, the outcomes of patients who underwent lobectomy from 1999-2009 were analyzed with respect to postoperative complications. Propensity-matched groups were analyzed based on preoperative variables and stage. Results: Of the 1079 patients in the study, 697 underwent thoracoscopic lobectomy, and 382 underwent lobectomy by means of thoracotomy. In the overall analysis thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (P = .01), atelectasis (P = .0001), prolonged air leak (P = .0004), transfusion (P = .0001), pneumonia (P = .001), sepsis (P = .008), renal failure (P = .003), and death (P = .003). In the propensity-matched analysis based on preoperative variables, when comparing 284 patients in each group, 196 (69%) patients who underwent thoracoscopic lobectomy had no complications versus 144 (51%) patients who underwent thoracotomy (P = .0001). In addition, thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (13% vs 21%, P = .01), less atelectasis (5% vs 12%, P = .006), fewer prolonged air leaks (13% vs 19%, P = .05), fewer transfusions (4% vs 13%, P = .002), less pneumonia (5% vs 10%, P = .05), less renal failure (1.4% vs 5%, P = .02), shorter chest tube duration (median of 3 vs 4 days, P < .0001), and shorter length of hospital stay (median of 4 vs 5 days, P < .0001). Conclusions: Thoracoscopic lobectomy is associated with a lower incidence of major complications, including atrial fibrillation, compared with lobectomy by means of thoracotomy. The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.

AB - Objectives: Advantages of thoracoscopic lobectomy include less postoperative pain, shorter hospitalization, and improved delivery of adjuvant chemotherapy. The incidence of postoperative complications has not been thoroughly assessed. This study analyzes morbidity after lobectomy to compare the thoracoscopic approach and thoracotomy. Methods: By using a prospective database, the outcomes of patients who underwent lobectomy from 1999-2009 were analyzed with respect to postoperative complications. Propensity-matched groups were analyzed based on preoperative variables and stage. Results: Of the 1079 patients in the study, 697 underwent thoracoscopic lobectomy, and 382 underwent lobectomy by means of thoracotomy. In the overall analysis thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (P = .01), atelectasis (P = .0001), prolonged air leak (P = .0004), transfusion (P = .0001), pneumonia (P = .001), sepsis (P = .008), renal failure (P = .003), and death (P = .003). In the propensity-matched analysis based on preoperative variables, when comparing 284 patients in each group, 196 (69%) patients who underwent thoracoscopic lobectomy had no complications versus 144 (51%) patients who underwent thoracotomy (P = .0001). In addition, thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation (13% vs 21%, P = .01), less atelectasis (5% vs 12%, P = .006), fewer prolonged air leaks (13% vs 19%, P = .05), fewer transfusions (4% vs 13%, P = .002), less pneumonia (5% vs 10%, P = .05), less renal failure (1.4% vs 5%, P = .02), shorter chest tube duration (median of 3 vs 4 days, P < .0001), and shorter length of hospital stay (median of 4 vs 5 days, P < .0001). Conclusions: Thoracoscopic lobectomy is associated with a lower incidence of major complications, including atrial fibrillation, compared with lobectomy by means of thoracotomy. The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.

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