35. Minimally Invasive Pulmonary Lobectomy and High-Risk Patients:
A Case Control Study

Todd L. Demmy, Jack J. Curtis

University of Missouri, Division of Cardiothoracic Surgery

Columbia, Mo.

To compare minimally invasive (VATS) with thoracotomy (Thor), cases were matched using 103 pulmonary lobectomies performed by one surgeon. Of 20 attempted VATS cases, three were converted to Thor uneventfully. A Thor case was paired to each of 17 VATS by age (65±2 vs 64±2 years, NS) sex (59 percent males), lobe (53 percent lower) side (71 percent left), and FEV.1 (72±5 vs. 64±5 percent predicted, NS). Nine VATS and five Thor patients with severe activity impairments of reduced FEV1 (<1.5L or 50 percent predicted) were classified as high risk (HR). Despite more HR cases. VATS yielded shorter hospitalizations (6.0± vs. 11.9±2.7 days , p=0.005), chest tube durations (4.5±0.7 vs. 9.2±2.2 days, p=0.05), and earlier returns to full preoperative activities (2.4±0.3 vs. 3.6±0.3 months, p <0.001). VATS operations had no intraoperative complications, lasted 224±15 minutes, and low risk VATS discharges were faster than HR VATS (3.5±0.5 vs. 8.7±3.0 days, p=0.03). Pain three weeks postop was dramatically better for the VATS group (non/minimal, 50 vs. 0 percent, severe, 14 vs. 64 percent, p <0.01). Complications (nine) or deaths (three) were pulmonary related and occurred largely in the HR group (64 vs 15 percent p<0.01). VATS deaths (two) occurred from aspiration or nosocomial pneumonias in activity-imparied patients. Anticipating complications, VATS appears safe, is less painful, and offers faster recovery for the HR patient without severe activity impairment.