F-110POSTOPERATIVE PULMONARY COMPLICATIONS AFTER LOBECTOMY: VIDEO-ASSISTED THORACOSCOPIC APPROACH AND THORACOTOMY

Objectives Pulmonary complications are the most common postoperative complications in patients undergoing thoracic surgery. The aim of our study was an analysis of the risk of pulmonary complications incidence after video-assisted thoracoscopic (VATS) lobectomy and open lobectomy. Methods In this retrospective study we analyzed the results of treatment of 567 patients operated on due to lung cancer from 2006 to 2012 in our institution. The entry criteria included patients with peripheral tumours less than 6 cm large, without bronchial infiltration, chest wall invasion and mediastinal involvement. In 314 patients VATS lobectomy was performed and in 253 thoracotomy. There were no difference between the VATS and thoracotomy group in terms of gender distribution, age, comorbidity rate, preoperative spirometry and stage of the disease. The postoperative outcome and complication rate was assessed. FEV1 less than 80% predicted, BMI, age, stage and surgical approach were analyzed as risk factors of postoperative pulmonary complications occurrence (atelectasis, pneumonia). Results Compared with open lobectomy, video-assisted thoracoscopic lobectomy was associated with shorter length of stay (mean 8.1 vs 10.7 days, P < 0.0001), chest tube duration (mean 4.0 vs 4.8 days P < 0.0001) and lower intraoperative blood loss (median 100 vs 200 ml P < 0.0001). There were no difference in terms of 30-day mortality (2.3% vs 2.2%), and time of surgery (mean 123.6 vs 126.6 min) between the groups. The total rate of postoperative complications in VATS patients was 29% (n 91) and 50% (n 128) after thoracotomy (OR = 2.29, P < 0.0001). When examining pulmonary complications, thoracotomy patients had more markedly increased pulmonary complications compared with VATS patients (22.3% vs 6.4%, OR = 4.21, P < 0.0001). In a multivariable analysis of pulmonary complications, thoracotomy approach (OR = 5.4, P < 0.0001), decreasing FEV1% predicted (OR = 2.4, P < 0.0001) and increasing age (OR = 1.04, P < 0.001) were independent risk factors of pulmonary complications. Conclusions Video-assisted thoracoscopic lobectomy is associated with significantly lower risk of postoperative pulmonary complications and can be recommended as a favourable approach. Disclosure All authors have declared no conflicts of interest.