Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications Journal Article


Authors: Cattaneo, S. M.; Park, B. J.; Wilton, A. S.; Seshan, V. E.; Bains, M. S.; Downey, R. J.; Flores, R. M.; Rizk, N.; Rusch, V. W.
Article Title: Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications
Abstract: Background: The purpose of this study was to determine if the utilization of video-assisted thoracic surgery (VATS) for lobectomy for clinical stage I non-small cell lung cancer in elderly patients results in decreased complications compared with lobectomy by thoracotomy (THOR). Methods: A retrospective, matched case-control study was performed evaluating the perioperative outcomes after lobectomy by VATS versus THOR performed in elderly patients (age ≥70 years) at a single institution. All complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (http://ctep.cancer.gov/reporting/ctc.html). Results: Between May 1, 2002 and December 31, 2005 333 patients (245 THOR, 88 VATS) 70 years old or greater underwent lobectomy for clinical stage I non-small cell lung cancer. After matching based on age, gender, presence of comorbid conditions, and preoperative clinical stage, there were 82 patients in each group. Patients had similar preoperative characteristics. A VATS approach resulted in a significantly lower rate of complications compared with THOR (28% vs 45%, p = 0.04) and a shorter median length of stay (5 days, range 2 to 20 vs 6 days, range 2 to 27, p < 0.001). No patients undergoing VATS lobectomy had higher than grade 2 complications, whereas 7% of complications in the THOR group were grade 3 or higher. There were no perioperative deaths in the VATS patients compared with an in-hospital mortality rate of 3.6% (3 of 82) for THOR patients. Conclusions: A VATS approach to lobectomy for clinical stage I non-small cell lung cancer in the elderly was associated with fewer and overall reduced severity of complications as well as a shorter hospital stay compared with thoracotomy. © 2008 The Society of Thoracic Surgeons.
Keywords: adult; controlled study; treatment outcome; aged; aged, 80 and over; survival analysis; cancer surgery; retrospective studies; major clinical study; case control study; case-control studies; outcome assessment; lung lobectomy; lung non small cell cancer; thoracotomy; lung neoplasms; pneumonectomy; incidence; age factors; surgical approach; retrospective study; risk assessment; postoperative complication; postoperative complications; length of stay; disease severity; preoperative period; probability; intraoperative period; endoscopic surgery; comorbidity; surgical mortality; intermethod comparison; surgical procedures, minimally invasive; thorax surgery; thoracic surgery, video-assisted; statistics, nonparametric; geriatric assessment; geriatric surgery; video assisted thoracic surgery
Journal Title: Annals of Thoracic Surgery
Volume: 85
Issue: 1
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2008-01-01
Start Page: 231
End Page: 236
Language: English
DOI: 10.1016/j.athoracsur.2007.07.080
PUBMED: 18154816
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 49" - "Export Date: 17 November 2011" - "CODEN: ATHSA" - "Source: Scopus"
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MSK Authors
  1. Venkatraman Ennapadam Seshan
    336 Seshan
  2. Andrew Wilton
    27 Wilton
  3. Valerie W Rusch
    764 Rusch
  4. Nabil Rizk
    139 Rizk
  5. Raja Flores
    108 Flores
  6. Bernard J Park
    195 Park
  7. Robert J Downey
    228 Downey
  8. Manjit S Bains
    295 Bains