ACUTE AND CHRONIC MORBIDITY DIFFERENCES BETWEEN MUSCLE-SPARING AND STANDARD LATERAL THORACOTOMIES

Introduction: Opinions differ regarding differences between totally mu scle-sparing thoracotomy and standard lateral thoracotomy approaches t o pulmonary resection with respect to operative time, postoperative pa in and morbidity, and occurrence of chronic postthoracotomy pain syndr omes and subjective shoulder dysfunction, Methods: Three hundred thirt y-five consecutive patients undergoing muscle-sparing thoracotomy (n = 148) or lateral thoracotomy (n = 187) to accomplish lobectomy for sta ge I lung cancer during a 48-month period were evaluated, Local rib re section was not employed, and two chest tubes were routinely used afte r operation in both thoracotomy groups. Epidural analgesia use was sim ilar after operation in the two groups (muscle-sparing thoracotomy 38% , lateral thoracotomy 38%). The postoperative hospital courses and pat ient functional statuses at 1 year were examined, Results: Demographic analyses demonstrated no differences between groups in age, sex, or a ssociation of significant comorbid medical illness, Although the opera tive time required for muscle-sparing thoracotomy was shorter, there w ere no differences between thoracotomy approaches in any of the other primary acute postoperative variables analyzed (chest tube duration, l ength of hospital stay, postoperative narcotic requirements, and posto perative mortality), The frequencies of chronic pain and shoulder dysf unction assessed 1 year after operation were also similar between thor acotomy groups, Conclusions: The relative efficacies and rates of occu rrence of acute or chronic morbidity are equivalent after muscle-spari ng thoracotomy and standard lateral thoracotomy. Although muscle-spari ng thoracotomy may possibly be performed more expediently, it appears that the singular advantage of muscle-sparing thoracotomy over standar d lateral thoracotomy involves the preservation of chest wall musculat ure in ease rotational muscle Raps should be needed later.