Does thoracoscopic pneumonectomy for lung cancer affect survival?

Background: Although thoracoscopic pneumonectomy may be performed safely, its effect on survival is unknown.

Methods: Seventy patients underwent elective pneumonectomy for malignancy at a comprehensive cancer center (Roswell Park Cancer Institute, Buffalo, NY) from 2002 to 2008. Using the same incision set as thoracoscopic lobectomy, candidates for a thoracoscopic pneumonectomy had adequate hilar visualization using flexible thoracoscopy, tissue control using novel retractors, and intrapericardial exposure when appropriate. The bronchus was divided last to prevent excessive traction on the main pulmonary artery.

Results: Thirty-four percent of patients had neoadjuvant therapy, proportionally distributed among groups. Patients in the thoracoscopic group had shorter lengths of stay in the hospital and less operative blood loss. Eight patients who were converted to thoracotomy had significantly more operative blood loss. The complication rates were similar among thoracoscopic, converted, and open groups. For both the thoracoscopic and open groups there was 1 death before 30 days. Between 30 and 90 days there was 1 death in the thoracoscopic group as a result of disease progression and 2 deaths in the open group as a result of cardiovascular causes. There was a modest improvement in overall survival in the video-assisted thoracic surgery group relative to the thoracotomy group, but the former group had smaller tumors. When stratified by stage, there was no survival difference.

Conclusions: Pneumonectomy performed either by means of thoracoscopy or thoracotomy resulted in equivalent survival. Further studies and follow-up are needed to verify the benefits of video-assisted thoracic surgery pneumonectomy for lung cancer.