VATS lobectomy may be preferred in COPD with non-small-cell lung cancer

Image: CC/Wiki. Squamous Cell Carcinoma

1. In COPD patients diagnosed with non-small-cell lung cancer, Video-Assisted Thoracoscopic Surgery (VATS) lobectomy reduced post-operative pulmonary complications and pneumonia when compared to lobectomy by thoracotomy. 

2. Pulmonary resection using VATS lobectomy resulted in shorter hospital stays than thoracotomy. 

Evidence Rating Level: 2 (Good) 

Study Rundown: For patients with non-small-cell lung cancer (NSCLC), pulmonary lobectomy is often the recommended surgical intervention. In patients with comorbid COPD however, this surgery can result in serious post-operative pulmonary complications. The authors analyzed the post-operative outcomes in 283 COPD patients who underwent either VATS lobectomies or lobectomies by thoracotomy to remove NSCLC. A diagnosis of COPD was based on spirometric criteria provided by the Global Initiative for Obstructive Lung Disease. Only patients with stage 1 NSCLC were selected while those who received chemotherapy, radiation, or surgery other than a lobectomy were excluded. The primary study outcome was postoperative complications including mortality. Secondary study outcomes included operation duration and length of hospital stay.

The authors found that using VATS reduced postoperative complications and shortened hospital stays. Notably, the average number of nodes removed in the VATS group was significantly lower than that of the thoracotomy group. It is unclear whether this is attributable to the surgeon’s personal preference or a technical limitation in the VATS technique. The results of this study may be limited by sample size, so future investigations should seek greater enrollment to further assess these surgical strategies.

Click to read the study in the European Journal of Cardio-Thoracic Surgery

Relevant Reading: Impact of COPD on pulmonary complications and on long-term survival of patients undergoing surgery for NSCLC

In-Depth [retrospective cohort]: This study compared the postoperative outcomes of COPD patients who underwent either VATS lobectomy or lobectomy by thoracotomy for NSCLC.  Both postoperative pulmonary complications and pneumonia were significantly lower in the VATS group (p < .01 and p = .01 respectively). Additionally, the duration of hospital stays was reduced in the VATS group (p = .04). Patients from each group were well-matched and though the sample size was small, the data suggests that VATS may be the preferred surgical strategy for COPD patients receiving pulmonary lobectomies.

By Amir Tarsha and Chaz Carrier

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