Prior thoracoscopic surgery may improve reoperative pulmonary resection

Objectives: although video-assisted thoracoscopic surgery for pulmonary resection appears to be associated with more favorable postoperative outcomes than thoracotomy, no reports have discussed its benefit at subsequent reoperative pulmonary resection. Methods: between January 2000 and December 2009, 144 patients underwent reoperative pulmonary resections for benign and malignant nodules at the Mayo Clinic, Rochester. Their data were evaluated retrospectively. Twenty-three (16%) patients had prior video-assisted thoracoscopic surgery, and 121 (84%) had undergone a prior open thoracotomy. Intraoperative and short-term postoperative outcomes were analyzed and compared between the two groups, using the chi-square test or Mann-Whitney test. Results: overall reoperative mortality was 1.38% and morbidity was 49.3%. Intraoperative factor analysis showed that the prior video-assisted thoracoscopic surgery group more often underwent anatomical resection (p=0.0011) and showed a tendency towards a lower conversion rate from video-assisted thoracoscopic surgery to thoracotomy at reoperative pulmonary resection (p=0.051). Short-term postoperative outcomes showed that the prior video-assisted thoracoscopic surgery group had a significantly lower morbidity rate (p=0.013), significantly shorter hospital stay (p=0.002), and a tendency for a shorter duration of chest tube drainage (p=0.09). Conclusion: our results suggest that prior video-assisted thoracoscopic surgery may lead to improved postoperative outcomes at subsequent reoperative pulmonary resection. Video-assisted thoracoscopic surgery may be favored for future potential reoperative pulmonary resections.