Comparison of respiratory function recovery in video-assisted thoracic surgery and thoracotomy in patients with lung cancer

Abstract

Introduction: Lobectomy is standard treatment for early lung cancer, with lobectomy by thoracotomy and video-assisted thoracic surgery (VATS) as the most common types. Some studies have shown that VATS lobectomy enables faster recovery of respiratory function than does thoracotomy because the former involves making only a small incision in the chest to access the lung. However, these studies featured only short-term follow-up periods. We evaluated and compared the advantages of VATS lobectomy and thoracotomy in terms of recovery of pulmonary function in patients with early lung cancer. We increased the follow-up period and analyzed respiratory recovery rate during the late postoperative phase.

Methods: Data on 649 patients with early lung cancer who underwent VATS lobectomy and thoracotomy at Seoul University Hospital and Bundang Seoul University Hospital from January 2005 to December 2010 were retrospectively reviewed. We classified the patients into the VATS (n = 406) and thoracotomy groups (n = 243) and compared baseline characteristics, pulmonary function data including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak flow rate (PFR) at 3, 6, and 12 months after surgery.

Results: Among the 649 patients, the pulmonary function testing was conducted on 300, 497, and 362 cases at 3, 6, and 12 months after surgery and only 91 patients underwent all 3-, 6-, and 12-month pulmonary function tests. Repeated-measures analysis of covariance was performed on these 91 patients, and the 649 patients with missing data were analyzed by linear mixed effect model. All confounding factors that may have affected pulmonary function recovery were adjusted. Of the 91 patients, the VATS group exhibited a better FVC than did the thoracotomy group (p < 0.005). After analyzing the 649 patients by linear mixed model, the VATS group also showed better FVC than that of the thoracotomy group and this effect had an interaction over time (103.66 ± 1.27 vs. 96.37 ± 1.49, p < 0.0001 at 6 months, 107.01 ± 1.30, 100.28 ± 1.54, p = 0.0003 at 12 months). No significant differences were observed for in FEV1 or PFR.

Conclusions: VATS lobectomy presented more advantages in terms of recovery of late postoperative FVC than did thoracotomy after surgery, but no significant group differences were observed in FEV1 and PFR. Long-lasting postoperative pain after thoracotomy is thought to be the cause of this result.