Table 1:
Best evidence papers
| Author, date, journal and country, Study type (level of evidence) |
Patient group | Outcomes | Key results | Comments |
|---|---|---|---|---|
| Ceppa et al. (2012), Ann Surg, USA [2] Retrospective cohort study (level 3) |
12 970 patients from the (STS) database who underwent lung resection VATS: n = 4531 Thoracotomy: n = 8431 |
Pulmonary complications (atelectasis, pneumonia, acute respiratory distress syndrome, broncho-pleural fistula, ventilatory support >48 h, reintubation and tracheostomy) | Overall incidence: 21.7% in the thoracotomy group compared with 17.8% in the VATS group In ppoFEV1% <60%, thoracotomy patients had increasing complications with decreasing ppoFEV1% compared with VATS (P = 0.023) |
In this large retrospective review, the authors conclude that respiratory complications increase at a significantly greater rate in lobectomy patients with poor pulmonary function after thoracotomy compared with VATS |
| Kachare et al. (2011), J Thorac Cardiovasc Surg, USA [3] Retrospective cohort study (level 3) |
70 lung resection patients with ppoFEV1% <40% VATS: n = 47 Thoracotomy: n = 23 |
Pneumonia Hospital stay Intensive care stay |
Incidence: VATS: 4.3% Thoracotomy: 21.7% (P = 0.035) VATS: 7 days Thoracotomy: 10 days (P = 0.058) VATS: 2 days Thoracotomy: 4 days (P = 0.05) |
The authors conclude that patients with marginal lung function tolerate thoracoscopic resection well |
| Lau et al. (2010), Eur J Cardiothorac Surg, UK [4] Retrospective cohort study (level 3) |
84 lung resection patients with ppoFEV1% <40% Study group: VATS: n = 22 Open segmentectomy: n = 27 Control group: Open lobectomy: n = 35 |
Five-year survival Median length of hospital stay |
Study group: 42% Control group: 18% (P = 0.030) Study group: 8 days (range 3–31) Control group: 12 days (range 4–91) (P = 0.054) |
The authors conclude that patients undergoing open lobectomy have a worse outcome despite adjusting for confounders |
| Endoh et al. (2009), Eur J Cardiothorac Surg, Japan [5] Retrospective cohort study (level 3) |
155 lung resection patients VATS: n = 70 Posterolateral thoracotomy (PLT): n = 55 Anterolateral thoracotomy (AL): n = 30 |
Baseline to postoperative (Day 7) FEV1 ratio Baseline to postoperative (Day 7) VC ratio |
VATS: 94.7% PLT: 87.6% AL: 90.4% VATS: 96.5% PLT: 87.4% AL: 90.1% |
The authors conclude that with respect to respiratory function VATS lobectomy was superior to thoracotomy |
| Kaseda et al. (2000), Ann Thorac Surg, Japan [6] Retrospective review (level 3) |
204 VATS lung resection patients evaluated Study group: VATS: n = 44 Open: n = 77 |
% decrease in FEV1 pre- to postoperatively | VATS = 15% Open = 29% |
The authors conclude that pulmonary function and prognosis were far better after VATS than after open thoracotomy |
| Garzon et al. (2006), Ann Thorac Surg, China [7] Retrospective cohort study (level 4) |
25 lung resection patients with ppoFEV1% <50% VATS lobectomy: n = 13 VATS wedge resection: n = 12 |
Morbidity Survival |
Complications occurred in 28% Respiratory complications in 20% 80% at 1 year 69% at 2 years |
The authors conclude that VATS resection for lung cancer patients with poor lung function can achieve morbidity and survival rates comparable with patients with adequate lung function |
| Linden et al. (2005), Chest, USA [8] Retrospective review (level 4) |
100 lung resection patients with preoperative FEV1 <35% Thoracoscopic wedge resection: n = 65 Thoracotomy: n = 10 VATS lobectomy: n = 4 Others: n = 21 |
Prolonged air leak New oxygen requirement Respiratory failure Pneumonia |
Incidence: 22% Incidence: 11% Incidence: 4% Incidence: 4% |
The authors conclude that lung resection is feasible in patients with FEV1 <35% with acceptable rates of morbidity and mortality Prolonged air leak was the most common complication in those with limited lung function |