Uniportal Vats Reduced The Occurrence Of Postthoracotomy Pain Syndrome After Lobectomy For Lung Cancer
Kyoji Hirai1, Yutaka Enomoto1, Jitsuo Usuda2.
1Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan, 2Nippon Medical School, Chiba, Japan.
(Background) Postthoracotomy pain syndrome (PTPS) is troublesome complications for thoracic surgeons. In performing minimally invasive surgery (MIS), the occurrence of PTPS should never happen. U-VATS, one of MIS for thoracic diseases has been gradually spreading over a part of countries. It may be also a promising surgical procedure that can reduce PTPS in thoracic surgery. We examined the occurrences of PTPS between U-VTAS and Multi-port VATS(M-VATS) lobectomy for lung cancer. (Methods) We compared between 142 cases of U-VATS and 70 case of M-VATS lobectomies. General operative outcomes, Numeric rate scale (NRS), analgesics usage, and evaluation of neuropathic pain using painDETCT questionnaire(PDQ) were assessed in detail. The diagnostic criteria for PTPS on postoperative month (POM) 2 is determined whether patient has more than one item as follows: 1) Patients with NRS 3, 2) Patients use the analgesics, 3)Patients has more than one item of 7 symptoms in PDQ. (Results) There were no significant differences both groups in terms of operation time, blood loss, lymph node retrieval, drainage duration, and hospital stay. The average of NRS on POM 2 was 0.2 in U-VATS and 1.5 in M-VATS(P<0.01), and the average number of days used analgesics within 2 months after surgery was 7.3 and 13.3(P<0.01). As for frequency of symptoms related to PTPS after surgery on POM 2, allodynia (2.8 in U-VATS v.s.10% in M-VATS), hypoesthesia(2.8 v.s.8.6%) and numbness(1.4 v.s.3.5%)could be often found in both groups. Ultimately, the occurrence of PTPS in U-VATS and M-VATS was 2.8 and 10 %, respectively(P=0.027). (Conclusion) U-VATS significantly reduce the occurrence of PTPS compared to M-VATS
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