Thoracoscopic minimally invasive surgery for non-small cell lung cancer in patients with chronic obstructive pulmonary disease

Fei Cui, Jun Liu, Wenlong Shao, Jianxing He


Objective: To determine the incidence of peri-operative complications in non-small cell lung cancer (NSCLC) patients with co-existent chronic obstructive pulmonary disease (COPD) who undergo lung resection via traditional and minimally invasive techniques.
Methods: A retrospective analysis was conducted of 152 NSCLC patients with COPD who underwent thoracoscopic minimally invasive surgery. Particular attention is given to the relationship between disease severity or surgical approach and the incidence of complications.
Results: The prevalence of respiratory and cardiac complications was significantly higher in patients with severe/extremely severe COPD than those with mild to moderate COPD (respiratory compications: 37.3% vs. 20.4%, P=0.022; cardiac complications: 16.9% vs. 6.5%, P=0.040). Patients who underwent complete-video assisted thoracoscopic surgery (c-VATS) had a significantly lower overall morbidity of adverse reactions than those who had undergone VATS major resection (26.3% vs. 42.1%, P=0.044). Among patients with severe/extremely severe COPD, there was no significant difference in the incidence of any complication between the lobectomy group and wedge resection group (38.8% vs. 70.0%, P=0.072). Overall, the occurrence of adverse reactions was significantly lower in patients who underwent c-VATS than in those who had undergone VATS major resection surgery (34.2% vs. 61.9%, P=0.038).
Conclusions: VATS techniques are suitable for COPD patients and are demonstrated here to lower the incidence of postoperative complications when compared with more invasive approaches.