Details

Autor(en) / Beteiligte

• Kouritas, Vasileios
• Begum, S.S.S.
• Tentzeris, V.
• Milton, R.
• Chaudhuri, N.
• Papagiannopoulos, K.

Titel

P-145VIDEO-ASSISTED THORACOSCOPIC LUNG RESECTIONS: CHALLENGING CURRENT FITNESS GUIDELINES

Ist Teil von

• Interactive cardiovascular and thoracic surgery, 2014-06, Vol.18 (suppl_1), p.S38-S38

Ort / Verlag

Oxford University Press

Erscheinungsjahr

2014

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• Objectives: The assessment of pulmonary physiology is a key factor when determining a patient's fitness for major lung resection and the amount of lung that can safely be resected. Current guidelines are based on experience from open lung resections. Our aim was to investigate whether the use of video-assisted thoracoscopic surgery (VATS), can challenge current guidelines and offer surgical treatment in more patients. Methods: The medical records of 308 consecutive patients who underwent VATS lung resection for cancer, over a period of 4 years (2009-2012), were reviewed. Three groups were constructed; Group A: patients with ppoFEV1 and/or ppoDLCO <40% of predicted who received higher lung resection than preoperatively planned; Group B: patients with ppoFEV1 and/or ppoDLCO <40% of predicted who received the planned operation, and Group C: patients with ppoFEV1 and ppoDLCO >40% of predicted who received higher resection than preoperatively planned. Statistical analysis was performed with ANOVA (Bonferoni's post-hocs), χ2 and Mann-Whitney tests. Results: Sixty-four patients were included in the study (8 patients in Group A, 48 patients in Group B and 8 patients in Group C). Age, gender and body mass index between the 3 groups were similar. The main reason for higher resection was a larger than anticipated/wider invasion of the mass. The number of stage II and III patients were similar amongst all groups but Group B had a higher number of stage I patients (P = 0.038). Morbidity and mortality were similar across all 3 groups (P = 0.393 and 0.717 respectively). The length of hospital stay was also similar (P = 0.118). Conclusions: The use of VATS allowed higher than preoperatively anticipated lung resections to be carried out safely, even in patients with poor pulmonary physiology with no statistically significant increase in morbidity, mortality or length of stay. Although the number of cases analyzed was small, the results challenge current guidelines on assessing fitness of patients undergoing lung resections, particulary when collaborative Institutional data gets analyzed. Disclosure: No significant relationships.