Is pneumonectomy using video-assisted thoracic surgery the way to go? Study of data from the Japanese Association for Thoracic Surgery.

BACKGROUND: The number of pneumonectomies performed has been decreasing every year. That decrease is the result of changes in distribution of histological type, stage, and tumor location. To investigate the results of pneumonectomies performed on lung cancer patients in Japan over a period of 15 years, data reported by the Japanese Association for Thoracic Surgery were analyzed.
METHODS: All data shown in the table were derived from official records reported in Japan. Mortality refers to hospital death rather than 30-day death, to more precisely evaluate the safety of the operations.
RESULTS: (1) The number of sleeve lobectomies did not increase. (2) The operative mortality rate with pneumonectomies did not fall. In 2011, the rate of hospital deaths among pneumonectomy patients rose to 3.9% and worsened to 5.3% in 2012, which was more than twice that of 30-day death, despite an improvement in results as a whole. (3) The incidence of lethal bronchopleural fistula showed very little improvement, declining from 11.7 to 9.6%. (4) In 2012, VATS was used in 13.1% of all pneumonectomy patients. That figure stood at only 0.5% in 1997.
CONCLUSION: Regarding pneumonectomies performed in Japan during the period analyzed, use of the less-invasive approach increased but bronchopleural fistula was still a major complication. The rate of hospital deaths among pneumonectomy patients worsened 2 years in a row. What is of critical importance is not the choice of approach--VATS or open thoracotomy--but the surgeon's efforts to find a chance to perform lung-saving surgery.