A new retrospective study on the advantages of thoracoscopic pneumonectomy over standard, open lobectomy entitled “Thoracoscopic Pneumonectomy: An 11-Year Experience” was published in Chest by Dr. Athar Battoo, from Roswell Park Cancer Institute (RPCI) in Buffalo, along with colleagues. Thoracoscopic pneumonectomies and lobectomies are procedures used to remove cancerous lung tissue or the entire lung in the case of lung cancer.
In this study, Dr. Demmy and his colleagues retrospectively analyzed all patients that were submitted to pneumonectomies at RPCI between 2002 and 2012. During this time period, 107 pneumonectomies were performed, among which 40 cases were done through an open surgery technique, 50 were submitted to a video-assisted thoracoscopic surgery (VATS), and 17 cases were changed from VATS to an open procedure.
“We performed a relatively large number of pneumonectomies without a significant event in the operating room such as excessive bleeding, which has been one of the major concerns that have prevented other surgeons from trying this technique,” said Dr. Demmy.
The researchers also reported an increase in the success rate of the surgeries from 50% to 82% when video-assisted thoracoscopic surgery pneumonectomies were performed.
“During the past 20 years, portions of the lungs have been removed for lung cancer through lobectomies, and that has been shown to be better done through small incisions or through thoracoscopic lobectomy compared with standard, open lobectomy,” said Todd Demmy, MD, FACS, Clinical Chair of the Department of Thoracic Surgery and Professor of Oncology at RPCI, in a press release. “We wanted to see if any of the benefits of the lobectomy — which typically involves removal of 20-50% of the organ — carry forward when you take the whole lung out in a pneumonectomy.”
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Due to the fact that VATS pneumonectomy did not provide reduction in pain after surgery or incidence of complications when compared to thoracoscopic lobectomy, Dr. Demmy stated that ” . . . with time, those patients who underwent VATS pneumonectomy tended to have better pain ratings, whereas people who had large incisions with the open technique still had a lot of pain a year later.”
The researchers noted that 53% of patients who received VATS pneumonectomies reported being pain-free after the procedure, compared with 19% of patients who were submitted to an open surgical technique. In addition, patients with early-pathological-stage cancer that received successful VATS pneumonectomies had a median longer survival rate of 80 months compared to 16 and 28 months, respectively, for patients who were scheduled for a VATS procedure that was changed to an open procedure, and for patients who were scheduled for an open procedure from the beginning. Patients with advanced clinical stage disease that underwent the VATS procedure had a longer median overall survival of 42 months, compared with 13 months for those who received the open technique.
“Patients who need to undergo pneumonectomy tend to have worse tumors; they often need chemotherapy, and the VATS procedure might help them start chemotherapy or complete it if they have less pain from surgery,” said Dr. Demmy. “Less pain may also reduce the patient’s need for narcotics, and we’re finding now that narcotics may actually have an adverse effect on cancer patients and may increase the growth rate of some tumors, so reducing pain is essential.”
The researchers at Roswell Park Cancer Institute (RPCI) concluded that performing thoracoscopic pneumonectomy — the removal of the entire lung by a minimally invasive endoscopic approach — at an experienced center appears to be safe and may provide advantages to the patients in regard to pain and survival in the long term.
Currently, the researchers are monitoring the patients that were submitted to pneumonectomies in order to gain further knowledge into the issue and thus reduce the number of open pneumonectomies performed at the Roswell Park Cancer Institute.