Fissure‐last video‐assisted thoracoscopic lobectomy for 'non‐upper' lobes. Issue 12 (26th January 2017)

• Record Type: Journal Article
• Authors: Stamenovic, Davor; Bostanci, Korkut; Messerschmidt, Antje; Tillmann, Jahn; Kostic, Marko; Schneider, Thomas
• Is Part Of: ANZ journal of surgery. Volume 87:Issue 12(2017)
• Page Start: 1021
• Page End: 1025
• Publication Date: 2017-01-26
• Subjects: lobectomy -- parenchymal fistula -- pleural air leak -- VATS; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.13884
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract : Background: Surgical approach into the fissural parenchyma may be an important and modifiable factor for the prevention of air leak after anatomical lung resections. Fissureless fissure‐last technique has been described as useful technique to reduce air leak, yet in video‐assisted thoracoscopic surgery (VATS) data are limited and mostly on the upper lobes. The purpose of this study is to evaluate the safety and feasibility of fissureless fissure‐last VATS 'non‐upper' lobectomies and the impact of it on the immediate outcome, especially relating to air leak. Methods: This study is a monocentric single‐surgeon retrospective analysis on prospectively collected data. During 24 months, 46 patients underwent VATS 'non‐upper' lobectomy or lower bilobectomy, with conventional (VATS‐c) technique in 20 and fissureless fissure‐last (VATS‐f) technique in 26 patients. Results were evaluated according to preoperative, perioperative and postoperative parameters. Results: There were no differences between VATS‐c and VATS‐f groups in any characteristics or peri‐ and postoperative variables, except the number of staplers, where it was significantly higher in VATS‐c group (MVATS‐c = 5.7; MVATS‐f = 7.7; P = 0.001). Operation time did not differ between the groups, but showed gender‐related difference, being longer in males (MVATS‐c = 188; MVATS‐f = 157; P = 0.04). Prevalence of air leak was 20%; prolonged air leak (PAL) (>5 days) being 11% and PAL (>7 days) 0%. Patients with air leak were older by tendency (MVATS‐c = 74.9; MVATS‐f = 66.5; P = 0.08), had more complications ( P = 0.025; relative risk = 2.65) and stayed longer at hospital (MVATS‐c = 10.8; MVATS‐f = 7.7; P = 0.02). Postoperative complications were present in 24% of patients. Conclusion: VATS‐f lobectomy is safe and feasible not only for 'upper' but also for 'non‐upper' lobes. When applied to properly selected patients, it may reduce air leak and PAL and thus may potentially reduce the rate of complications.