Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure

doi:10.1016/S0003-4975(01)02804-1

The Annals of Thoracic Surgery

Volume 72, Issue 2, August 2001, Pages 362-365

https://doi.org/10.1016/S0003-4975(01)02804-1 Get rights and content

Abstract

Background. Although lobectomy by the video-assisted thoracic surgical (VATS) approach is assumed to be less invasive than lobectomy by the standard posterolateral thoracotomy (PLT) approach, it has not been scientifically proven.

Methods. Twenty-two consecutive, nonrandomized patients, underwent either a VATS approach (n = 13) or a posterolateral thoracotomy approach (n = 9) to perform pulmonary lobectomy for peripheral lung cancers in clinical stage I. Pain and serum cytokines were measured until postoperative day (POD) 14. Pulmonary function tests were performed on POD 7 and POD 14.

Results. Postoperative pain was significantly less in the VATS group on PODs 0, 1, 7, and 14. Recovery of pulmonary function was statistically better in the VATS group. Negative correlations between the recovery rates of pulmonary function and postoperative pain were observed on POD 7. The serum interleukin-6 level in the PLT group was significantly elevated on POD 0 compared with the VATS group (posterolateral thoracotomy: 21.6 ± 24.3 pg/mL; VATS: 4.1 ± 7.9 pg/mL, p = 0.03).

Conclusions. Lobectomy by the VATS approach generates less pain and cytokine production, and preserves better pulmonary function in the early postoperative phase.

Section snippets

Patient cohorts

A series of 22 consecutive patients requiring single lobectomy for clinical stage I peripheral lung cancer between June 1999 and April 2000 were included in the study. A signed and written, informed consent was obtained from each patient, and the study was approved by the Okayama University Medical School Review Board, Okayama, Japan.

Thirteen patients whose peripheral lung cancer had a maximum diameter less than or equal to 3 cm (T1) and no hilar or mediastinal lymph node swelling (N0) on chest

Results

Patient characteristics and anatomic distribution of the primary lung cancers (ie, lobectomies performed) are shown in Table 1, Table 2. Gender, age, histologic type of tumor, operation time, amount of intraoperative bleeding, duration of chest drainage, duration of epidural anesthesia, pulmonary function, and method of lobectomy performed were not different between the groups. All tumors in the VATS group were pathologic stage I, but one tumor was stage II for hilar lymph node metastasis, and

Comment

As we expected, postoperative pain and recovery of pulmonary function were both superior in the VATS group for 2 weeks postoperatively in this study. Giudicelli and colleagues [11] compared lobectomy by the VATS approach and muscle-sparing thoracotomy without rib resection, and they found that there was no difference in FVC and FEV₁ between the groups, and the difference in pain lasted for only 4 days postoperatively. In the present study, one or two ribs were resected posteriorly and a metal

Acknowledgements

We are indebted to Satsuki Kametaka and the resident surgeons in our department for their conscientious contribution to this study. We also thank Dawn Schuessler for secretarial support.

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Original article: general thoracicPulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure

Abstract

Section snippets

Patient cohorts

Results

Comment

Acknowledgements

Chest

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Surgery

Chest

Ann Thorac Surg

Original article: general thoracic
Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure