Experience With Thoracoscopic Pneumonectomies at a Single Institution

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

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

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.

Author Information

From the Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT USA.

Accepted for publication December 19, 2013.

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Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, June 12–15, 2013, Prague, Czech Republic.

Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Anthony W. Kim, MD, Section of Thoracic Surgery, Yale University School of Medicine, 330 Cedar St, BB 205, New Haven, CT 06520 USA. E-mail: Anthony.kim@yale.edu.

©2014 by the International Society for Minimally Invasive Cardiothoracic Surgery