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Eur J Cardiothorac Surg 2002;21:155-156
© 2002 Elsevier Science NL
Letter to the Editor |
Department of Thoracic Surgery, Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan
Received 26 July 2001; received in revised form 14 October 2001; accepted 16 October 2001.
* Corresponding author. Tel.: +81-3-3451-8211; fax: +81-3-3451-6102
e-mail: hnomori{at}qk9.so-net.ne.jp
Posterolateral thoracotomy (PLT) has been frequently used for non-cardiac thoracic surgery. Although this procedure provides excellent access for lung cancer surgery, it requires the transection of large muscles which contributes to postoperative pulmonary insufficiency and postoperative chest pain. In an attempt to decrease these shortcomings, minimally invasive thoracotomy procedures, such as muscle-sparing thoracotomy (MST), limited thoracotomy and video-assisted thoracoscopic surgery (VATS) have been used with some success [1–5]. However, although VATS involves a more limited thoracic incision than the MST or limited thoracotomy, the difference in impairment of postoperative pulmonary function between these techniques is still controversial [1,2].
Between 1991 and 2000, we conducted lobectomy and lymph node dissection for 220 patients with lung cancer. We have changed the PLT to a more limited approach as follows: PLT without muscle sparing from 1991 to 1994, antero-axillary thoracotomy (AAT) from January 1995 to December 1996 [3], anterior limited thoracotomy (ALT) from January 1997 to July 1999 [4], and VATS since August 1999 [5]. To compare the difference in impairment of pulmonary function and walking capacity in patients undergoing lobectomy by those procedures, we compared postoperative vital capacity (VC) and the 6-min walking (6MW) test.
The study was a retrospective analysis. The 28 patients in each group were consecutively selected in order of the most recent patients to match for sex and age (±5 years). VC was measured before surgery and 1, 2, 4, 12 and 24 weeks after surgery. The distance covered during the 6MW test (6MWD) was measured before surgery and in a postoperative test 1 week after surgery. The percentage changes in postoperative VC and 6MWD compared with those preoperative values were evaluated.
No significant differences were observed between the groups in terms of preoperative pulmonary function, 6MW, lobectomy site or pathologic tumor stage. Because the chest tubes were removed within 5 days of surgery in all patients, postoperative VC and 6MWD values were measured without chest tubes in situ. Compared with the VATS, ALT and AAT groups, PLT patients showed a significant impairment of VC from 1 to 24 weeks after surgery (P<0.05–0.001) and also a significant impairment of 6MWD 1 week after surgery (P<0.01–0.001). The AAT group showed a significant impairment of 6MWD 1 week after surgery compared with the VATS and ALT groups (P<0.001 and P<0.05, respectively). There was no significant difference in impairment of either VC or 6MWD between VATS and ALT.
These results indicate that transection of a large muscle group and the wide intercostal space opened up in the PLT procedure impaired walking capacity and pulmonary function, not only early after surgery but also long after, compared with the other minimally invasive thoracotomy procedures. The PLT therefore could not be recommended for general lung cancer surgery. VATS and ALT are better procedures than AAT in terms of recovery of walking capacity early after surgery. VATS and ALT are similar to each other in terms of impairment of pulmonary function and walking capacity after surgery.
References
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