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Thoracoscopic Lobectomy Has Increasing Benefit in Patients With Poor Pulmonary Function: An STS Database Analysis
DuyKhanh P Ceppa*1, Andrzej S Kosinski*1, Mark F Berrry*1, Betty C Tong*1, David H Harpole1, John D Mitchell*2, Thomas A D'Amico1, Mark W Onaitis*1
1Duke University, Durham, NC;2University of Colorado Denver School of Medicine, Denver, CO

OBJECTIVE: Single-institution series demonstrate benefit of thoracoscopic (VATS) lobectomy over lobectomy via thoracotomy in poor pulmonary function patients (FEV1 or DLCO <60% predicted). We ask whether VATS lobectomy is beneficial in high-risk pulmonary patients.
METHODS: The STS General Thoracic Database was queried for patients having undergone lobectomy by either thoracotomy or VATS between 2000 and 2010. Postoperative pulmonary complications included those defined by the STS database.
RESULTS: In the STS database, 12,970 patients underwent lobectomy (thoracotomy n=8439; VATS n=4531) and met inclusion criteria. The overall rate of pulmonary complications was 13.4% (1133/8439) and 9.8% (443/4531) in patients undergoing lobectomy with thoracotomy and VATS, respectively (p<0.0001). In a multivariable model of pulmonary complications, thoracotomy approach (OR 1.33, p<0.001), decreasing FEV1 % predicted (OR 1.01 per unit, p<0.001) and DLCO % predicted (OR 1.01 per unit, p<0.001), and increasing age (1.02 per year, p<0.001) independently predict pulmonary complications. When examining pulmonary complications in patients with FEV1<60 % predicted, thoracotomy patients have markedly increased pulmonary complications when compared to VATS patients (Figure)(p=0.023). No significant difference is noted with FEV1>60% predicted.
CONCLUSIONS: Poor pulmonary function predicts respiratory complications regardless of approach. Respiratory complications increase at a significantly greater rate in lobectomy patients with poor pulmonary function following thoracotomy compared with VATS. Planned surgical approach should be considered when determining if a high risk patient is an appropriate resection candidate.

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