General thoracic surgery
Randomized comparison of awake nonresectional versus nonawake resectional lung volume reduction surgery

https://doi.org/10.1016/j.jtcvs.2011.09.050Get rights and content
Under an Elsevier user license
open archive

Objective

The study objective was to assess in a randomized controlled study (NCT00566839) the comparative results of awake nonresectional or nonawake resectional lung volume reduction surgery.

Method

Sixty-three patients were randomly assigned by computer to receive unilateral video-assisted thoracic surgery lung volume reduction surgery by a nonresectional technique performed through epidural anesthesia in 32 awake patients (awake group) or the standard resectional technique performed through general anesthesia in 31 patients (control group). Primary outcomes were hospital stay and changes in forced expiratory volume in 1 second. During follow-up, the need of contralateral treatment because of loss of postoperative benefit was considered a failure event as death.

Results

Intergroup comparisons (awake vs control) showed no difference in gender, age, and body mass index. Hospital stay was shorter in the awake group (6 vs 7.5 days, P = .04) with 21 versus 10 patients discharged within 6 days (P = .01). At 6 months, forced expiratory volume in 1 second improved significantly in both study groups (0.28 vs 0.29 L) with no intergroup difference (P = .79). In both groups, forced expiratory volume in 1 second improvements lasted more than 24 months. At 36 months, freedom from contralateral treatment was 55% versus 50% (P = .5) and survival was 81% versus 87% (P = .5).

Conclusions

In this randomized study, awake nonresectional lung volume reduction surgery resulted in significantly shorter hospital stay than the nonawake procedure. There were no differences between study groups in physiologic improvements, freedom from contralateral treatment, and survival. We speculate that compared with the nonawake procedure, awake lung volume reduction surgery can offer similar clinical benefit but a faster postoperative recovery.

CTSNet classification

12
02
15.1
11
28

Abbreviations and Acronyms

FEV1
forced expiratory volume in 1 second
FVC
forced vital capacity
LVRS
lung volume reduction surgery
Paco2
arterial carbon dioxide tension
Pao2/Fio2
ratio of arterial oxygen tension to fraction of inspired oxygen
QR
quartile range
RV
residual volume
VATS
video-assisted thoracic surgery
WT
walking test

Cited by (0)

Disclosures: Authors have nothing to disclose with regard to commercial support.

Read at the 91st Annual Meeting of The American Association of Thoracic Surgeons, Philadelphia, Pennsylvania, May, 7–11, 2011.

Awake Thoracic Surgery Research Group. Tor Vergata University, Rome, Italy: Eugenio Pompeo, MD (Principal Investigator), Maria Antonietta Ceccon, MD, Ludovica Celidonio, MD, Benedetto Cristino, MD, Maria Elena Cufari, MD, Mario Dauri, MD, Eleonora Fabbi, MD, Francesca Leonardis, MD, Luca Frasca, MD, Mario Marino, MD, Roberto Massa, MD, Tommaso Claudio Mineo, MD, Sarit Nahmias, MD, Giuseppe Novelli, PhD, Ilaria Onorati, MD, Augusto Orlandi, MD, Alessandra Picardi, MD, Paola Rogliani, MD, Alessandro Fabrizio Sabato, MD, Elisabetta Sabato, MD, Cesare Saltini, MD, Anna Maria Servadio, Federico Tacconi, MD, Gian Luca Vanni, MD. University La Sapienza, Rome, Italy: Italo Nofroni, BS.