P-170COMPARISON OF VIDEO-ASSISTED THORACOSCOPIC SURGERY AND OPEN LOBECTOMY FOR BENIGN DISEASE: AN INTENT-TO-TREAT COHORT STUDY

• Published in: Interactive cardiovascular and thoracic surgery 2013-07, Vol.17 (suppl_1), p.S44-S45
• Main Authors: Orsini, Bastien, Baste, J.-M., Rinieri, P., D'Journo, X.B., Thomas, P.A., Peillon, C.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt288.170

Objectives To compare the results of elective open (OL) versus intent-to-treat thoracoscopic lobectomies (TL) for benign disease in a two-centre cohort study. Methods From January 2010 to December 2012, 58 patients with a benign lung disease having undergone a lobectomy in two tertiary referral centres were reviewed. Nine patients were already considered for an open procedure due to the evidence for severe parenchymal and/or pleural scarring at CT scan, and were not included in the analysis. We thus identified a group of 49 patients. In 33 a thoracoscopic lobectomy was attempted whereas 16 received in first intention an open procedure at the surgeon's discretion. All files were reviewed and an intent-to-treat comparison was performed. Results Underlying conditions were benign tumours (6 TL; 2 OL), emphysema (1 TL; 2 OL), bronchiectasis (12 TL; 5 OL), chronic lung infections (5 TL; 0 OL), tuberculosis (4 TL; 5 OL), arterio-venous malformations (1 TL; 0 OL), lung sequestration (1 TL; 1 OL), and miscellaneous (3 TL; 1 OL). Three TL patients (5.9%) underwent conversion to thoracotomy. Operative time was 135 (60-300 min) in the TL group and 90 (60-233 min) in the OL group (P < 0.05). In-hospital mortality was nil in both groups. Median chest tube time was 4 days (1-17 days) vs 5.5 (3-14 days) respectively (P = 0.048). Respective median postoperative stay was 5 days (.-18 days) and 8 days (6-22) (P < 0.05). An uneventful postoperative course was observed in 20 patients (60.6%) vs 5 (31.3%) (P < 0.05). Hospital re-admissions were experienced by 1 patient of the TL group (3%) and 2 of the OL group (12.5%) (P = 0.16). Conclusions VATS lobectomy for benign disease is feasible, safe, and has the potential to lower postoperative morbidity in comparison with thoracotomy. Inflammation induced adhesions remain the key limiting factor but seem to be correctly identifiable on the basis of CT-scan findings. Disclosure All authors have declared no conflicts of interest.