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The Journal of Cardiovascular Surgery 1999 October;40(5):721-3

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Usefulness of video-assisted thoracic surgery (Two Windows Method) in the treatment of lung cancer for elderly patients

Kaga K., Park J., Nishiumi N., Iwasaki M., Inoue H.

From the Department of Surgery School of Medicine, Tokai University Bohseidai, Isehara, Japan


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Back­ground. We ­have ­been per­forming it ­less inva­sively by ­making ­just two, ­small ­skin inci­sions (Two Win­dows ­Method) for ­lung ­cancer sur­gery. We ­assess the use­ful­ness of ­VATS by the Two Win­dows ­Method in eld­erly ­patients.
­Methods. The sub­jects ­were 32 of the 75-­year-old or ­older ­patients ­with pri­mary ­lung ­cancer in our depart­ment. We ­assessed ­cases in ­which thor­a­cotomy was per­formed and the ­cases in ­which ­VATS by Two Win­dows ­Method was per­formed, and com­pared post­op­er­a­tive com­pli­ca­tions, hos­pital ­deaths, and post­op­er­a­tive ­length of ­stay.
­Results. Oper­a­tions by ­video-­assisted tho­racic sur­gery (­VATS) by the Two Win­dows ­Method ­were com­pleted in 20 of the 32 ­patients, and a con­ver­sion to thor­a­cotomy was ­done in two ­patients (­rate 9%). Ulti­mately, thor­a­cotomy was per­formed in a ­total of 12 ­cases, ­including ­these two. In the thor­a­cotomy ­patients, the ­most ­common post­op­er­a­tive com­pli­ca­tion was pneu­monia/ate­lec­tasis (4 ­cases) sec­on­dary to ­poor ­sputum expec­to­ra­tion. ­There ­were 2 hos­pital ­deaths due to sep­ti­cemia, and ­there was 1 due to pul­mo­nary ­artery embo­lism. In the ­VATS ­patients, the ­rate of occur­rence of post­op­er­a­tive com­pli­ca­tions was 30%, and ­clearly ­lower ­than the 67% ­among the thor­a­cotomy ­patients (p<0.05). No hos­pital ­death ­occurred ­among the ­VATS ­patients. The post­op­er­a­tive hos­pital ­stay of the ­VATS ­patients (21 ­days) was ­shorter ­than ­that of the thor­a­cotomy ­patients (31 ­days), (p<0.05).
Con­clu­sions. ­VATS by the Two Win­dows ­Method is ­safer ­than thor­a­cotomy, and it ­should be con­sid­ered ­first for ­lung ­cancer sur­gery in the ­aged.

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