The Journal of Thoracic and Cardiovascular Surgery
Volume 143, Issue 1 , Pages 47-54.e1, January 2012

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

  • Eugenio Pompeo, MD

      Affiliations

    • Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
    • Corresponding Author InformationAddress for reprints: Eugenio Pompeo, MD, Cattedra di Chirurgia Toracica, Policlinico Università Tor Vergata, V.le Oxford, 81, 00133 Rome, Italy.
    • ,
  • Paola Rogliani, MD

      Affiliations

    • Department of Pneumology, Policlinico Tor Vergata University, Rome, Italy
    • ,
  • Federico Tacconi, MD

      Affiliations

    • Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
    • ,
  • Mario Dauri, MD

      Affiliations

    • Department of Anesthesiology, and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
    • ,
  • Cesare Saltini, MD

      Affiliations

    • Department of Pneumology, Policlinico Tor Vergata University, Rome, Italy
    • ,
  • Giuseppe Novelli, PhD

      Affiliations

    • Department of Biopathology and Diagnostic Imaging, Policlinico Tor Vergata University, Rome, Italy
    • ,
  • Tommaso C. Mineo, MD

      Affiliations

    • Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
    • ,
  • Awake Thoracic Surgery Research Group

Received 6 May 2011; received in revised form 1 August 2011; accepted 23 September 2011. published online 07 November 2011.

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

 

 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.

PII: S0022-5223(11)01068-3

doi:10.1016/j.jtcvs.2011.09.050

The Journal of Thoracic and Cardiovascular Surgery
Volume 143, Issue 1 , Pages 47-54.e1, January 2012

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