Advantages of thoracoscopic lobectomy include less
postoperative pain, shorter hospitalization, and improved delivery of
adjuvant chemotherapy. The incidence of postoperative complications has not been thoroughly assessed. This study analyzes morbidity after lobectomy to compare the thoracoscopic approach and
thoracotomy.
METHODS: By using a prospective database, the outcomes of patients who underwent lobectomy from 1999-2009 were analyzed with respect to postoperative complications. Propensity-matched groups were analyzed based on preoperative variables and stage.
RESULTS: Of the 1079 patients in the study, 697 underwent thoracoscopic lobectomy, and 382 underwent lobectomy by means of
thoracotomy. In the overall analysis thoracoscopic lobectomy was associated with a lower incidence of
atrial fibrillation (P = .01),
atelectasis (P = .0001), prolonged air leak (P = .0004), transfusion (P = .0001),
pneumonia (P = .001),
sepsis (P = .008),
renal failure (P = .003), and death (P = .003). In the propensity-matched analysis based on preoperative variables, when comparing 284 patients in each group, 196 (69%) patients who underwent thoracoscopic lobectomy had no complications versus 144 (51%) patients who underwent
thoracotomy (P = .0001). In addition, thoracoscopic lobectomy was associated with a lower incidence of
atrial fibrillation (13% vs 21%, P = .01), less
atelectasis (5% vs 12%, P = .006), fewer prolonged air leaks (13% vs 19%, P = .05), fewer transfusions (4% vs 13%, P = .002), less
pneumonia (5% vs 10%, P = .05), less
renal failure (1.4% vs 5%, P = .02), shorter
chest tube duration (median of 3 vs 4 days, P < .0001), and shorter length of
hospital stay (median of 4 vs 5 days, P < .0001).
CONCLUSIONS: Thoracoscopic lobectomy is associated with a lower incidence of major complications, including
atrial fibrillation, compared with lobectomy by means of
thoracotomy. The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.