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OBJECTIVE: The approach to VATS lobectomy has historically shifted from posterior (PA) to anterior approach (AA). One of the reasons is the direct access to the hilar structures. Diehard posterior approach surgeons still see merits in it such as familiar orientation to open thoracotomy and ease of systematic nodal dissection. This study compares two separate databases of two approaches in our institution, comparing operative speed and safety
METHODS: Historical data of two surgeons practicing the posterior approach between 2005 - 2010 were compared to data of the third surgeon 2010 - 2013 who practices the anterior approach. Systematic nodal dissection was routine in PA, whereas nodal sampling was practiced in AA. Data pertaining to PA include the initial learning curve of theatre team at the time of establishing the VATS programme. Limited data were comparable between the two databases, including Age, sex, WHO performance status, Predicted Post Operative FEV1%, lobe removed, histology, Drain dwell time, operative time, Length of Stay in hospital, conversion, and ITU admission
RESULTS: Between April 2007 and November 2013, 276 consecutive patients were identified to have undergone first time VATS lobectomy, pneumonectomy or segmentectomy for early lung cancer. 84 were anterior and 192 were posterior approach. There was no sex or age preponderance. There was no difference in surgical spectrum between AA and PA. The median hospital stay remained 4.0±4.0 days in both approaches. There
were 2 port site seedlings in PA and none in AA. There was significantly higher number admitted to ITU/HDU in PA, 24 (12.5%) compared to AA 3 (3.6%), p=.02. Overall operative time was considerably faster in the AA, 166 ± 43 min compared to PA, 210 ± 72 min, p=000. There was no difference in conversion, 8(9.5%) in AA versus 24 (12.5%) in PA, p=.477. There were no in hospital mortality in both groups
CONCLUSIONS: Both AA and PA are equally safe in VATS lobectomy. The anterior approach seems to be quicker and less patients went to ITU for observation or treatment