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Eur J Cardiothorac Surg 2007;31:496-500. doi:10.1016/j.ejcts.2006.12.012
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Muscle-sparing versus posterolateral thoracotomy: a prospective study

1st Department of Thoracic Surgery, General Hospital for Chest Diseases, Athens, Greece

Received 11 September 2006; received in revised form 30 November 2006; accepted 12 December 2006.

^_* Corresponding author. Address: Konstantinoupoleos str. 34A Holargos, 15562 Athens, Greece. Tel.: +30 210 6510388; fax: +30 210 6547695. (Email: kallatha{at}otenet.gr).

Objective: Although the thoracotomy incision is guided in part by the exposure required, both cosmesis and the potential for improved recovery are important factors to be taken into account. We conducted a prospective randomized study in order to compare muscle sparing thoracotomy (MST) and standard posterolateral thoracotomy (PLT) for postoperative pain and physical function during and after hospitalization. Material and method: One hundred patients operated from June through December 2004 were recruited in this study. Fifty patients underwent MST of 6–8 cm and 50 had a PLT of more than 8 cm with division of latissimus dorsi and serratus anterior muscles. Operations performed were atypical resections and lobectomies. Pneumonectomies and operations on tumors invading the chest wall or brachial plexus were excluded. Perioperative care was standardized concerning analgetics and physiotherapy. Postoperative pain (quantitated by the visual analogue scale), preoperative and postoperative pulmonary function, shoulder strength, and range of motion were evaluated. Results: There was no difference in demographics, tumor stage, and type of lung resection. Patients were also matched for the number of chest tubes, length of chest tube duration, and length of hospital stay. Pain reported during hospitalization and after hospital discharge within 1 and 2 months did not differ within the two groups (p > 0.05). Shoulder function was shown to decrease less in cases of MST, but physical function was not found statistically significant in comparison of the two groups (p > 0.05) within 1 month. Rehabilitation was also similar. Conclusion: The rates of occurrence of acute or chronic pain and morbidity were equivalent after MST and PLT. It appears that the single advantage of MST over PLT involves the preservation of chest wall musculature in case rotational muscle flaps should be needed along with a better cosmetic result.

Key Words: Muscle sparing thoracotomy • Posterolateral thoracotomy • Postoperative pain • Shoulder function

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