VATS Lobectomy: the Impact of Pre-operative Asprin Use
Alan D. Sihoe, Denise Wong, Ivan Cheung, Oscar Chiu, Jason Chung, Nicky Anto, Farah Munir.
The University of Hong Kong, Hong Kong, China.
Patients receiving lung cancer surgery often have risk factors for cardiovascular disease, and may be on anti-platelet therapy pre-operatively. Although Video Assisted Thoracic Surgery (VATS) may offer clinical advantages over open surgery, adequacy of hemostasis with VATS in patients on aspirin remains a concern for some. The impact of aspirin use on VATS lobectomy has rarely been studied.
Patients receiving lobectomy and lymph node dissection with curative intent for lung cancer by a single surgeon - and for whom a complete VATS approach was intended - were selected for study. The cohort included 105 patients, of whom 10 (9.5%) were taking aspirin. Aspirin was stopped 5-7 days before surgery in 4 of those patients.
No mortality or major morbidity was encountered. One or more minor complications occurred in 18 patients (17.1%), including 16 with air leaks. Minor non-air leak complications were more common in patients previously taking aspirin (17% versus 1%, p=0.01). Stopping aspirin pre-operatively did not influence complication risks, but reduced the incidence of intra-operative blood loss of 200ml or more (67% versus 0%, p=0.04). Aspirin use up to the time of surgery showed a trend to be associated with a longer mean operation time (267 mins versus 175 mins, p=0.09). Aspirin use increased the incidence of chest drainage of over 250ml in the first 24 hours post-operatively (70% versus 32%, p=0.02). Excluding patients with prolonged air leaks, patients taking aspirin up to the time of surgery had longer mean chest drain durations (5 days versus 3 days, p=0.02). Compared to those who had stopped or never taken aspirin, patients taking aspirin up to the time of surgery had a higher risk of conversion to thoracotomy (33% versus 7%, p=0.03) and a higher incidence of prolonged chest drainage for 5 days or more (75% versus 22%, p=0.02).
Aspirin use may adversely affect outcomes and recovery after VATS lobectomy for lung cancer. Surgical risks may be reduced by stopping aspirin pre-operatively. However, the absolute risks posed by aspirin are not prohibitively high, and failure to stop should not be considered a categorical contraindication for VATS lobectomy.
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