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THE JOURNAL OF CARDIOVASCULAR SURGERY

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

lingua: Inglese

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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