A prospective trial comparing pain and quality of life measures after anatomic lung resection using thoracoscopy or thoracotomy

Abstract

Background: Minimally invasive lung lobectomy and segmentectomy by video-assisted thoracic surgery (VATS) are assumed to result in better quality of life and less postoperative pain compared with standard open approaches. To date, few prospective studies have compared the two approaches. We performed a prospective cohort study to compare quality of life and pain scores during the first 12 months after VATS or open anatomic resection.

Methods: Patients were prospectively enrolled from May 2009 to April 2012. Patients with clinical stage I lung cancer who were scheduled to undergo anatomic lung resection were eligible. The Brief Pain Index and Medical Outcomes Study 36-Item Short Form Health Survey were conducted perioperatively and at four assessments during the first 12 months after the operation. Intent-to-treat analyses using mixed-effects models were used to longitudinally assess the effect of treatment on quality of life components (physical component summary and mental component summary) and pain.

Results: In total, 74 patients underwent thoracotomy, and 132 underwent VATS (including 19 patients who were converted to thoracotomy); 40 and 80 patients, respectively, completed the 12-month surveys. Baseline characteristics were similar between the two groups. Physical component summary and Brief Pain Index scores were similar between the two groups throughout the 12 months of follow-up. The mental component summary score, however, was consistently worse in the VATS group.

Conclusions: Patient-reported physical component summary and pain scores after VATS and thoracotomy were similar during the first 12 months after surgical resection.

Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Results of the Medical Outcomes Study 36-item Short-Form Health Survey. Adjusted physical component summary (PCS) scores were similar between groups (A), whereas adjusted mental component summary (MCS) scores were consistently better in the thoracotomy group (B).

Figure 2

Results of the brief pain index on postoperative days 2-4. Results were reported as pain >4 (on a scale of 1-7); there was no difference in these scores between groups during follow-up.

Figure 3

Results of the brief pain index. Results were reported as pain >4 (on a scale of 1-7); there was no difference in these scores between groups during follow-up.