What is the advantage of a thoracoscopic lobectomy over a limited thoracotomy procedure for lung cancer surgery?

Background. To clarify any advantages of video-assisted thoracoscopic surge ry (VATS) over anterior limited thoracotomy (ALT) for lobectomy in lung can cer, we compared the two procedures in a retrospective analysis. Methods. Sex- and age-matched (+/- 5 years) lung cancer patients in clinica l stage 1 who underwent lobectomy by means of VATS (n = 33) or ALT (n = 33) were compared in terms of the number of resected lymph nodes, operating ti me, intraoperative blood loss, duration of postoperative chest tube drainag e, and chest pain. Pain was evaluated using a visual analog scale and analg esic requirements. Vital capacity NO, respiratory muscle strength, and anal gesic requirements up to POD 7 (p < 0.001). However, there were no signific ant differences in pain on POD 14. There were also no significant differenc es in intraoperative factors or in the postoperative impairment of VC, resp iratory muscle strength, and 6 MW test results. Results. Compared with the ALT group, the VATS group experienced less pain between postoperative day (POD) 1 and POD 7 (p < 0.05 to 0.001) and had low er Conclusions. Although VATS lobectomy reduces chest pain during the first we ek after surgery compared with ALT, this advantage is lost within 2 weeks. Both techniques result in similar impairments of pulmonary function, respir atory muscle strength and walking capacity. Therefore, if curative resectio n of lung cancer by VATS would be technically difficult for any reason, inc luding the sur-eon's skill and experience, a limited open thoracotomy would be preferable from the standpoints of safety and the patient's prognosis. (C) 2001 by The Society of Thoracic Surgeons.results of a 6-minute walking (6 MW) test were also compared preoperatively and 1 and 2 weeks postoperati vely.