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Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery:
doi: 10.1097/IMI.0000000000000058
Original Articles

Experience With Thoracoscopic Pneumonectomies at a Single Institution

Kim, Anthony W. MD; Fonseca, Annabelle L. MBBS; Boffa, Daniel J. MD; Detterbeck, Frank C. MD

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Abstract

Objective

The aim of this study was to review a single-institution experience with video-assisted thoracoscopic pneumonectomy (VATP).

Methods

From July 2008 through December 2012, the medical records of all patients undergoing pneumonectomy (total and completion) for lung cancer were reviewed. Clinical parameters were recorded and analyzed.

Results

During this period, 16% (7/45) of pneumonectomies for malignancy were performed thoracoscopically. Patient selection was performed in the context of a multidisciplinary tumor board. Of the seven VATPs, five were standard (Video 1, available at http://links.lww.com/INNOV/A40) and two were completion pneumonectomies (Video 2, available at http://links.lww.com/INNOV/A41). Indications were primary lung cancer in six (three adenocarcinoma, one squamous carcinoma, one large cell neuroendocrine carcinoma, and one mixed adenocarcinoma cell and small cell lung carcinoma) and metastatic esophageal cancer in one patient. Preoperative selection was based on unfavorable location of the primary tumor, which excluded the possibility of a lesser resection such as sleeve resection while permitting an R0 resection by pneumonectomy. Pathologic staging was consistent with clinical staging except for one patient who was upstaged. There were four complications: atrial fibrillation, pneumonia, and two bronchopleural fistulas. The median length of stay was 4 days (excluding one outlier). Distant disease recurrence occurred in one patient. Kaplan-Meier survival at 24 months was 75%.

Conclusions

Introduction of VATP into the armamentarium of the experienced thoracoscopic surgeon is feasible with acceptable outcomes and a complication profile that is not dissimilar to the open pneumonectomy experience. Greater experience with this approach should provide additional data to more objectively evaluate the merits of this approach.

Copyright © 2014 by the International Society for Minimally Invasive Cardiothoracic Surgery

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