RESUMO
BACKGROUND: Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use. METHODS: A cost-effectiveness study was performed comparing VATS vs. open thoracic surgery (OPEN) for lung cancer patients. Demographic data, tumor localization, dynamic pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusion capacity (DLCO) and maximal oxygen uptake (VO2max)], surgical approach, postoperative details, and complications were recorded and analyzed. RESULTS: One hundred seventeen patients underwent lung resection by VATS (n=42, 36%; age: 63±9 years old, 57% males) or OPEN (n=75, 64%; age: 61±11 years old, 73% males). Pulmonary function tests decreased just after surgery with a parallel increasing tendency during first 12 months. VATS group tended to recover FEV1 and FVC quicker with significantly less clinical and post-surgical complications (31% vs. 53%, P=0.015). Costs including surgery and associated hospital stay, complications and costs in the 12 months after surgery were significantly lower for VATS (P<0.05). CONCLUSIONS: The VATS approach surgery allowed earlier recovery at a lower cost than OPEN with a better cost-effectiveness profile.
RESUMO
OBJECTIVE: Given the frequent association between chronic obstructive pulmonary disease (COPD) and lung cancer (LC), the objective of this paper is to analyse the prognosis of this comorbidity. METHODS: Multicenter prospective study compiling 2994 consecutive cases of surgically treated LC (1993-1997), the population with non-small cell lung cancer and complete resection was selected for the prognostic study of COPD. COPD is defined when the FEV1/FVC is <0.7 (n=1370; 46%). Overall and conditional survivals (survival likelihood when alive at 2, 3 or 5 years after treatment) as well as the degree of severity (FEV1% percentiles) were calculated to establish prognosis. RESULTS: Although the overall survival is similar whether or not COPD is present (Log-rank: 0.34), the conditional survival analysis is different in every stage at 60 months (Log-rank: 0.02) and different in stage pI at 24-36 months (Log-rank: 0.04). In LC (stage pI) with COPD, the presence of a worst pulmonary function (last FEV1% percentile vs first FEV1% percentile) is a bad prognostic factor (Log-rank: 0.002). CONCLUSIONS: The analysis of conditional survival at 24 months shows that COPD can be considered as a prognostic factor and that there is a clear relationship between the severity of the condition (FEV1%) and survival.
