A comparative analysis of Pancoast tumour resection performed via video-assisted thoracic surgery versus standard open approaches

Attilio Ignazio Lo Monte, Francesco Paolo Caronia, Alfonso Fiorelli, Maurizio Nicolosi, Enrico Ruffini, Mario Santini

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23 Citations (Scopus)

Abstract

OBJECTIVES: The aim of the present paper was to conduct a comparative analysis of outcomes after thoracoscopic resection versus standardthoracotomy approach in the treatment of Pancoast tumours.METHODS: All consecutive patients with Pancoast tumours undergoing surgical treatment from March 2000 to November 2012 were enrolled.Patients were divided into 2 groups according to whether a thoracoscopic or standard thoracotomy approach was adopted. In additionto morbidity and mortality, (i) intensity of pain; (ii) respiratory function focusing on the postoperative value and its variation withrespect to the predicted value (Delta); (iii) analgesic consumption at different times during the postoperative course; and (iiii) survival ratewere recorded in both groups and the inter-group differences were statistically compared.RESULTS: Of the 45 enrolled patients, 34 (75%) were included in the final analysis (18 in the thoracoscopic group and 16 in the standardgroup). Eleven (25%) patients were excluded because they (i) were unfit for surgery after induction therapy (n = 4); (ii) refused the operation(n = 1) or (iii) had unexpected pleural involvement (n = 6). Compared with the standard group, in the thoracoscopic group we observedless pain (P = 0.01), better recovery of forced vital capacity (P = 0.01) and forced expiratory value in 1 s (P < 0.001), and a reduction inopioid (P = 0.01) and analgesic consumption (P = 0.02). The median survival for all patients was 15 months. Patients with N0/N1 diseasehad better median survival than N2 patients (47 vs 9 months; P = 0.009). One local recurrence in the standard group was observed 1 yearafter operation, whereas 2 local recurrences, 1 in the thoracoscopic group and another in the standard group, were registered 2 years afterthe operation (P = 1.0). Finally, 4 (22%) extrathoracic metastases in the thoracoscopic group and 5 (31%) in the standard group (P = 0.8)were found over the 2 years following the procedure.CONCLUSIONS: In the management of Pancoast tumours, a thoracoscopic approach is safe and may be an effective adjunct to standardsurgical resection in selected cases. Such an approach enabled surgeons to explore the pleural cavity and avoid exploratory thoracotomyin cases of unexpected pleural involvement.
Original languageEnglish
Pages (from-to)426-435
Number of pages10
JournalINTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
Volume19
Publication statusPublished - 2014

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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