Decreased invasiveness via two methods of thoracoscopic lobectomy for lung cancer, compared with open thoracotomy.

摘要

BACKGROUND AND OBJECTIVE: Video-assisted thoracic surgery (VATS) lobectomy for primary lung cancer is considered minimally invasive. However, different procedures may be used for the VATS lobectomy, from complete videoscopic (CV) surgery to a technique similar to the muscle-sparing thoracotomy. We divided patients into two groups based on the surgical approach and analysed the outcomes. METHODS: Two hundred and thirty-one patients were treated using one of two VATS procedures: the video-supported method (VS, n = 63) and the CV method (n = 168). Patients treated by posterolateral thoracotomy (PL, n = 61) were also evaluated for certain postoperative parameters and pulmonary function. The CV method is the standard VATS lobectomy procedure in our institution, but the VS method is used when the CV method becomes difficult because of severe adhesion around the pulmonary artery, or for other reasons. RESULTS: Creatinine phosphokinase and CRP levels, and blood loss were lower in the VS and CV groups than in the PL group. Blood loss during CV was lower than that during VS. Postoperative VC after CV was higher than that after PL. Analgesic requirements in both VATS groups were lower than that in the PL group. The visual analogue scale pain score was lower in both VATS groups than in the PL group. CONCLUSIONS: Two methods of VATS cause less surgical damage than PL. CV, in particular, causes less damage to pulmonary function than PL, and achieves good postoperative quality of life.