Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy

Abstract

Background: Video-assisted thoracic surgery (VATS) and thoracotomy are standard treatment methods for early lung cancer. We compared their effects on the long-term recovery of pulmonary function in patients with stage I non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed 203 patients with early NSCLC who underwent VATS or thoracotomy at Seoul University Hospital from January 2005 to December 2010. Two matched groups (VATS and thoracotomy) each consisting of 60 patients were created via propensity score matching according to TNM stage, age, sex, smoking history, lung disease history, and preoperative pulmonary function. Results: There were no significant differences in the recovery of forced expiratory volume in 1 second, the forced vital capacity (FVC), or the peak flow rate (PFR), presented as the postoperative value/predicted value, between the VATS and thoracotomy groups during the 12-month follow-up period. The standardized functional loss ratio [(measured postoperative value - predicted postoperative value)/(predicted postoperative value x 100)] did not differ between the two groups at 6 and 12 months. In an intragroup analysis, the postoperative FVC in the thoracotomy group remained below predicted postoperative value during the follow-up period and did not reach the predicted postoperative FVC (6 months/12 months: -6.58%/-2.43%). The analgesic requirements and pain procedures were similar in the VATS and thoracotomy groups during the 12-month follow-up period. Conclusions: There were no significant differences in pulmonary function recovery during the late postoperative period in NSCLC patients receiving VATS versus thoracotomy. We suggest that the volume of the resected lung and preoperative lung function are the main determinants of late recovery, rather than postoperative pain.