Open AccessVideo‐assisted thoracic surgery is an optimal alternative to conventional thoracotomy for reoperations for ipsilateral pulmonary lesions
Author(s) -
Chen Donglai,
Mao Rui,
Kadeer Xiermaimaiti,
Sun Weiyan,
Zhu Erjia,
Peng Qiao,
Chen Chang
Publication year - 2018
Publication title -
thoracic cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 28
eISSN - 1759-7714
pISSN - 1759-7706
DOI - 10.1111/1759-7714.12854
Subject(s) - medicine , thoracotomy , surgery , contraindication , cardiothoracic surgery , vats lobectomy , video assisted thoracoscopic surgery , dissection (medical) , thoracoscopy , anesthesia , lung , pneumonectomy , alternative medicine , pathology
Background Ipsilateral pulmonary reoperation is empirically considered a contraindication of video‐assisted thoracic surgery (VATS) because of intrapleural adhesion and the destruction of anatomical structures caused by previous surgery. The purpose of this study was to present our experience of the use of VATS for ipsilateral reoperations. Methods The medical records of patients who underwent VATS reoperation or re‐thoracotomy between January 2006 and March 2017 were retrospectively reviewed. Data were compared to assess the feasibility and safety of VATS for ipsilateral reoperations. Results The study enrolled 64 patients, including 36 patients who underwent attempted ipsilateral VATS reoperations (VATS group) and 28 who underwent conventional re‐thoracotomy as a control with clinicopathological characteristics similar to those in the VATS group. Intrapleural severe adhesions were detected in 28 (77.8%) and 22 (78.6%) patients in the VATS and re‐thoracotomy groups, respectively ( P = 0.906), and their dissection required a longer period in the VATS group ( P = 0.014). VATS reoperations were converted to re‐thoracotomy or video‐assisted mini re‐thoracotomy in three patients because of bleeding or difficulty in dissecting hilar structures. There were no significant differences in resection methods, time to reoperation, intraoperative blood loss, or drainage time between the two groups. However, patients in the VATS group had a shorter hospital stay ( P < 0.01) and fewer complications ( P = 0.042). Conclusion VATS is an optimal alternative to re‐thoracotomy for ipsilateral pulmonary lesions, regardless of intrapleural adhesions and the destruction of anatomical structures caused by former operations in selected patients.