Surgery for Lung Cancer Is Less Stressful on Patients

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Minimally Invasive Surgery for Lung Cancer Is Less Stressful on Patients than Standard Open Surgery Says American College of Surgeons

10/10/2006 5:05:00 PM

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To: National Desk, Health Reporter

Contact: Sally Garneski, 312-202-5409, or Cory Petty, 312-202-5328, or pressinquiry@facs.org both of the American College of Surgeons

CHICAGO, Oct. 10 /U.S. Newswire/ -- Patients who have video- assisted thoracoscopic surgery (VATS) have fewer complications, particularly pneumonia, than those who undergo standard open surgery. That finding was reported by researchers who have conducted what is considered to be the first study to focus predominantly on the morbidity associated with minimally invasive surgery for stage I non-small-cell lung cancer. The researcher, who reported on the study today at the 2006 Clinical Congress of the American College of Surgeons, explained that the incidence of postoperative pneumonia was significantly lower in patients who had VATS, compared to the traditional approach.

"Pneumonia is not uncommon after any type of lung surgery. This is the downside of operating on the lung," according to Bryan A. Whitson, MD, a surgery research fellow in the Thoracic Oncology Laboratory led by Michael A. Maddaus, MD, FACS at the University of Minnesota, Minneapolis. However, patients who underwent VATS had fewer occurrences of pneumonia, and the difference was highly statistically significant (P=0.0004). "Probably the biggest reason why patients in the VATS group had fewer complications was that minimally invasive surgery is less of an interruption of the normal physiology. Patients are able to take bigger breaths after the operation, and they don't require as much pain medication. The procedure is not as big a stress on patients," he said.

Minimally invasive surgery also may have less of an effect on the body's immune system, Whitson explained. "VATS may not be as immunosuppressive as an open operation, so patients may be better able to fight infection," he said.

"It has been speculated by several investigators over the last five or six years that VATS is less stressful and less immunosuppressive. Data are starting to accumulate to support both arguments," he added. Among the findings from the study are the results presented at the Clinical Congress of the American College of Surgeons, which is one of the first to compare the incidence of postoperative complications following conventional open surgery and VATS in a large series of patients. The researchers reviewed the postoperative course of all patients who had an operation for stage I non-small-cell lung cancer between January 1998 and June 2005 at the University of Minnesota. Of the total 147 patients, 88 had a standard thoracotomy and 59 had VATS. The length of the operation, amount of blood lost during the operation, and postoperative length of stay in the hospital were the same in both groups. There also was no difference in survival between the two groups of patients. While median survival has not yet been reached, it is (greater than) 7 years for patients who had the standard approach and (greater than) 4 years for those who had VATS.

Except for pneumonia, the rate of complications was the same in both groups of patients. There was no difference in the incidence of atrial fibrillation (abnormal rhythm involving the upper chamber of the heart), myocardial infarction (heart attack), wound infection, or urinary tract infection, even though patients in the VATS group had more concomitant illnesses before the operation. More patients in the VATS group had hypertension, renal insufficiency, or a history of other malignancies.

According to Whitson, approximately 30 percent of patients with lung cancer have stage I disease, which means the malignancy is confined to the lung. Treatment involves surgical removal of the affected lobe of the lung. The standard surgical approach is thoracotomy (an operation that opens the chest), during which surgeons make an incision at the level of the nipple and along the rib cage, then cut and spread open the ribs to gain access to the lung. The affected lung is deflated, examined and surgically removed. During VATS, surgeons make several small incisions at different spots on the chest, through which they insert surgical instruments as well as a camera to illuminate the surgical field. Surgeons make a separate incision between 4 and 8 centimeters to get the tumor out, Whitson explained.

The University of Minnesota and other major cancer centers will be participating in a prospective clinical trial sponsored by the Cancer and Leukemia Group B (CALGB) that will assess the rate of complications and quality of life of 450 patients following operations that use both approaches for stage I lung cancer. "The results of that larger, multi-institutional trial hopefully will validate this work," Whitson concluded.

Adam Boettcher; Ricardo Bardales; Robert Kratzke, MD; Peter Dahlberg, MD, PhD, FACS; Rafael Andrade, MD; and Michael Maddaus, MD, FACS, were involved in the study of VATS for stage I NSCLC.

For more information, please visit http://www.facs.org

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