Objective

Video-assisted thoracoscopic surgery (VATS) has become the gold standard for lung cancer resection and constitutes a key component of enhanced recovery programmes. We sought to determine whether there is a difference in patient-reported pain scores and hospital length of stay (LOS) between those undergoing lobectomy via VATS compared to neurovascular bundle-sparing thoracotomy (NVBST).

Methods

We retrospectively analysed an e-database of all lobectomies for primary lung cancer performed by 1 surgeon over 1 year. For VATS, standard 3-port posterior approach was used. For NVBST, 8cm serratus-sparing posterolateral incision was used; closure was effected using intracostal sutures running through holes drilled into the lower rib. In all patients, paravertebral catheters and a single chest drain were sited. Pain scores on postoperative days (POD) 0, 1, 2 and 3 and LOS were compared.

Results

From September 2014 to September 2015, there were 93 lobectomies (39 NVBST, 54 VATS). The two groups had similar baseline characteristics, including: mean age+/- standard deviation (SD) 65.8y+/-11.1 for NVBST, 65.4+/-10.5 for VATS. There was no statistically significant difference between pain scores: mean+/-SD for NVBST vs. VATS on POD0 1.61+/-0.93 vs. 1.74+/-1.19, POD3 1.53+/-0.86 vs. 1.27+/- 0.94. Shoulder pain scores were similar. LOS was longer for NVBST (median 8.5d vs. 6.0), p<0.05.

Conclusion

Our study shows that there is no difference in pain scores following lobectomy via VATS vs. NVBST. However, LOS is shorter for VATS. The establishment of VATS as standard technique for lung resection has catalysed the parallel evolution of improved thoracotomy techniques. Continued development of both techniques as part of enhanced recovery programmes will ensure better outcomes for all patients undergoing lung cancer resection.