Original article
General thoracic
Pulmonary Segmentectomy by Thoracotomy or Thoracoscopy: Reduced Hospital Length of Stay With a Minimally-Invasive Approach

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.
https://doi.org/10.1016/j.athoracsur.2007.05.013Get rights and content

Background

Previous studies have discouraged limited pulmonary resection for primary lung cancer, but pulmonary segmentectomy has advantages for some patients. Furthermore, while thoracoscopic lobectomy has been increasingly applied with well-demonstrated advantages compared with thoracotomy, few data exist regarding thoracoscopic approaches to pulmonary segmentectomy. This study compares thoracoscopic segmentectomy (TS) with open segmentectomy (OS).

Methods

This is a retrospective review of prospectively collected data for 77 consecutive segmentectomy patients treated between 2000 and 2006 at a single center. Preoperative, intraoperative, and postoperative variables for patients undergoing TS (n = 48) were compared with those undergoing OS (n = 29). Student’s t tests were used for continuous data and Fisher’s exact tests for dichotomous data.

Results

Baseline demographics were similar between groups. Indications for pulmonary resection included non-small cell lung cancer (n = 39), metastatic disease (n = 30), and other diagnoses (n = 8). All common segmentectomies were represented. No thoracoscopic cases required conversion to open procedures. Operative times, estimated blood loss, and chest tube duration were similar between groups. Outcomes were similar except that hospital length of stay was significantly less among TS patients (length of stay 6.8 ± 6 days OS versus 4.3 ± 3 days TS; p = 0.03). Thirty-day mortality was 6.9% (2 of 29) for the OS group compared with 0% for the TS group. Long-term survival rates were significantly better in the TS group (p = 0.0007).

Conclusions

Thoracoscopic segmentectomy is a safe and feasible procedure, comparing favorably with OS by reducing hospital length of stay. For experienced thoracoscopic surgeons, TS appears to be a sound option for lung-sparing, anatomic pulmonary resections.

Section snippets

Patients and Methods

After local Institutional Review Board approval waiving individual patient consent owing to the retrospective nature of the review, the Duke University Medical Center Surgical Billing Office was queried for Current Procedural Terminology codes linked with sublobar anatomic resection (segmentectomy) by either an open approach or by a thoracoscopic approach between January 1, 2000, and January 31, 2006. Careful attention was paid to individual operative notes and surgical pathology reports to

Results

Seventy-seven patients were identified who underwent pulmonary segmentectomy in the stated time period; 29 patients underwent OS and 48 patients underwent TS. The distribution of segmentectomy procedures performed per study year is depicted in Figure 1, with TS achieving increased utilization during the study period and OS procedures remaining stable. Approximately 1,500 lobectomy procedures were performed during this time frame; therefore, the number of segmentectomies reported represents

Comment

Although thoracoscopic lobectomy has achieved increased utilization over the past several years, thoracoscopic segmentectomy has merely been superficially mentioned in the literature [12, 18, 22]. Our data demonstrate that TS is feasible and can be performed safely and with good outcomes for experienced thoracoscopic surgeons. Furthermore, these data demonstrate that TS techniques are applicable to the treatment of primary lung cancer, benign pulmonary conditions, and to metastatic pulmonary

References (32)

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