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DOI: 10.1055/s-2003-37763
© Georg Thieme Verlag Stuttgart · New York
Untersuchungen zur Komplikationsrate nach thorakoskopischer und konventioneller Lobektomie
Thorakoskopie beim BronchialkarzinomComplication Rate After Thoracoscopic and Conventional LobectomyPublication History
Publication Date:
11 March 2003 (online)
Zusammenfassung
Ziel: Unterschiede hinsichtlich postoperativer Komplikationen nach thorakoskopischer Lobektomie im Vergleich zur konventionellen Operationsmethode (Thorakotomie) bei Patienten mit einem primären nicht-kleinzelligen Bronchialkarzinom sollen analysiert werden.
Methodik: 42 Patienten mit dem Verdacht auf ein primäres Bronchialkarzinom (Stadium T1 oder T2) wurden einer thorakoskopischen Lobektomie (n=28) oder konventionellen Lobektomie (n=14) zugeführt und prospektiv hinsichtlich der Komplikationen im unmittelbaren postoperativen Verlauf (30 Tage) untersucht. Beide Gruppen unterschieden sich nicht hinsichtlich Alter, Co-Morbidität, Tumorlokalisation und Tumorstadium.
Ergebnisse: Die Patienten mit einer konventionellen Lobektomie hatten eine signifikant höhere postoperative Komplikationsrate im Vergleich zum thorakoskopischen Operationsverfahren (50 % vs. 14,2 %, p=0,03).
Schlussfolgerung: Die thorakoskopische Lobektomie kann für den Patienten eine alternative, komplikationsärmere Operationsmethode darstellen.
Abstract
Aim: To determine whether a thoracoscopic lobectomy used for treatment of primary non-small cell lung cancer shows a higher or lower morbidity in comparison to the conventional resection (thoracotomy) postoperatively.
Methodology: 42 patients with the presumption diagnosis of a lung cancer reveived a thoracoscopic lobectomy (n=28) or a conventional lobectomy (n=14). Postoperative complication rate (30 days) was analysed prospectively. There were no differences between the groups referring to age, co-morbidity, localisation of the tumor and stage.
Results: Patients with a conventional operation revealed a significant higher morbidity in comparison to the patients of the thoracoscopic group (50 % vs. 14.2 %, p=0.03).
Conclusion: The thoracoscopic lobectomy represents a safe operation method and an alternative to the conventional operation (thoracotomy).
Schlüsselwörter
Thorakoskopie - Bronchialkarzinom - Morbidität
Key words
Thoracoscopy - lung cancer - morbidity
Literatur
- 1 Asamura H, Nakayama H, Kondo H, Tsuchiya R, Shimosato Y, Naruke T. Lymph Node involvement, recurrence and prognosis in resected small, peripheral, non-small-cell lung carcinomas: are these carcinomas candidates for video-assisted lobectomy?. J Thorac Cardiovasc Surg. 1996; 111 1125-1134
- 2 Bhatnagar N K, Berndt S. A solution to prolonged air leak after video-assisted thoracoscopic lobectomy. Ann Thorac Surg. 1995; 59 260-261
- 3 Ciriaco P, Mazzone P, Canneto B, Zannini P. Supraventricular arrhythmia following lung resection for non-small cell lung cancer and its treatment with amiodarone. Euro J Cardio Thorac Surg. 2000; 18 12-16
- 4 Dieter R A, Kuzycz G B. Complications and contraindications of thoracoscopy. Int Surg. 1997; 82 232-239
- 5 Downey R J. Complications after video-assisted thoracic surgery. Chest Surg Clin North Am. 1998; 8 907-917
-
6 Eckersberger F. Leitlinien zur Minimal-Invasiven Chirurgie in der onkologischen Thoraxchirurgie. Langenbecks Arch Chir Suppl II (Kongressbericht) 1997; 246 - 250
- 7 Giudicelli R, Thomas P, Lonjon T, Ragni J, Morati N. et al . Video-assisted minithoracotomy versus muscle-sparing thoracotomy for performing lobectomy. Ann Thorac Surg. 1994; 58 712-718
- 8 Hazelrigg S t. R. for the video assisted thoracic surgery study group data. Ann Thorac Surg. 1993; 56 1039-1044
- 9 Hoksch B, Ablaßmaier B, Walter M, M üller J M. Thoracoscopic pulmonary lobectomy with lymphadenectomy in a cadaver model. Acta Chirurgica Austriaca - European Surgery. 2000; 32 82-87
-
10 Hoksch B, Ablaßmaier B, Walter M, Müller J M. The thoracoscopic lymphadenectomy in a cadaver model. Canad J Surg 2002 April: in press
- 11 Jiménez M F. Prospective study on video-assisted thoracoscopic surgery in the resection of pulmonary nodules: 209 cases from the Spanish video-assisted thoracic surgery group. Eur J Cardiothorac Surg. 2001; 19 562-565
- 12 Kaiser L R, Bavaria J E. Complications of thoracoscopy. Ann Thorac Surg. 1993; 56 796-798
- 13 Kirby T J, Mack M J, Landreneau R J, Rice T W. Initial experience with video-assisted thoracoscopic lobectomy. Ann Thorac Surg. 1993; 56 1248-1253
- 14 Krasna M J. Complications of thoracoscopy. Ann Thorac Surg. 1996; 61 1066-1069
- 15 Lewis R J. Simultaneously stapled lobectomy: A safe technique for video-assisted thoracic surgery. J Thorac Cardiovasc Surg. 1995; 109 619-625
- 16 Lewis R J, Caccavale R J, Sisler G E, Bocage J P. Does VATS favor seeding of carcinoma of the lung more than a conventional operation?. Int Surg. 1997; 82 127-130
- 17 Mack M J, Scruggs G R, Kelly K H, Shennib H, Landreneau R J. Video-assisted thoracic surgery: Has technology found its place?. Ann Thorac Surg. 1997; 64 211-215
- 18 McKenna R. Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. J Thorac Cardiovasc Surg. 1994; 107 879-882
- 19 McKenna R J, Wolf R K, Brenner M, Fischel R J, Wurnig P. Is lobectomy by video-assisted thoracic surgery an adequate cancer operation?. Ann Thorac Surg. 1998; 66 1903-1908
- 20 Neustein S M, Kahn P, Krellenstein D J, Cohen E. Incidence of arrhythmias after thoracic surgery: thoracotomy versus video-assisted thoracoscopy. J Cardiothoracic Vascular Anesthesia. 1998; 12 659-661
- 21 Poulin E C, Labbé R. Fully thoracoscopic pulmonary lobectomy and specimen extraction through rib segment resection. Surgical Endoscopy. 1997; 11 354-358
- 22 Rossi L, Litwin D E, Gowda K. Anatomic thoracoscopic lobectomy (ATL) without minithoracotomy: preliminary experience. Surg Laparosc Endosc. 1996; 6 49-55
- 23 Roviario G, Varoli F, Rebuffat C, Vergani C, Maciocco M, Scalambra S M, Sonnino D, Gozi G. Videothoracoscopic staging and treatment of lung cancer. Ann Thorac Surg. 1995; 59 971-974
- 24 Santillan-Doherty P, Cuellar-Rodriguez J, Argote-Greene L M, Hernández-Calleros J. Nonanatomic thoracoscopic wedge resection for diffuse lung disease and indeterminate pulmonary nodule. World J Surg. 2001; 26 43-48
- 25 Schirren J, Trainer S, Schneider P, Hendricks H, Mü ller K M, Vogt-Moykopf I. Sind videoassistierte thorakoskopische Resektionsverfahren in der onkologischen Chirurgie vertretbar?. Chirurg. 1994; 65 664-670
- 26 Schwieger I, Gamulin Z, Suter P M. Lung function during anesthesia and respiratory insufficiency in the postoperative period: physiological and clinical implications. Acta Anaesthesiol Scand. 1989; 33 527-534
- 27 Sonett J R. VATS and thoracic oncology: Anathema or opportunity. Ann Thorac Surg. 1999; 68 795-796
- 28 Stamatis G, Fechner S. Die videothorakoskopische Lobektomie. Chirurg. 1996; 67 425-435
- 29 Stammberger U, Steinacher C, Hillinger S, Schmid R A, Kinsberger T, Weder W. Early and long-term complaints following video-assisted thoracoscopic surgery: Evaluation in 173 patients. Eur J Cardio Thorac Surg. 2000; 18 7-11
- 30 Stoelben E, Wehrmann U, Ockert D, Saeger H D. VATS: Möglichkeiten und Grenzen chirurgischer Therapie maligner Lungenerkrankungen. Zentralbl Chir. 1998; 123 1129-1133
- 31 Sugi K, Kaneda Y, Nawaia K, Fujita N, Ueda K, Nawata S, Esaio K. Cost analysis for thoracoscopy: Thoracoscopic wedge resection and lobectomy. Surgery Today. 1998; 28 41-45
- 32 Tschernko E M, Hofer S, Bieglmayr C, Wisser W, Haider W. Early postoperative stress: Video-assisted wedge resection/lobectomy vs conventional axillary thoracotomy. Chest. 1996; 109 1636-1642
- 33 Walker W S, Carnochan F M, Pugh G C. Thoracoscopic pulmonary lobectomy: Early operative experience and preliminary clinical results. J Thorac Cardiovasc Surg. 1993; 106 111-117
- 34 Walker W S, Carnochan F M, Tin M. Thoracoscopic assisted pulmonary lobectomy. Thorax. 1993; 48 921-924
- 35 Walker W S, Pugh G C, Craig S R, Carnochan F M. Continued experience with thoracoscopic major pulmonary resection. Int Surg. 1996; 81 255-258
- 36 Waller D A, Forty J, Morritt G N. Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax. Ann Thorac Surg. 1994; 58 327-376
- 37 Yim A PC, Liu H P. Complications and failures of video-assisted thoracic surgery: Experiences from two centers in Asia. Ann Thorac Surg. 1996; 61 538-541
PD Dr. Beatrix Hoksch
Klinik und Poliklinik für Chirurgie · Charité Campus Mitte · Fakultät der Humboldt-Universität zu Berlin
Schumannstr. 20/21
10117 Berlin
Phone: 0 30/4 50 52 21 08
Email: hoksch@t-online.de