• Jae Hyun Jeon, Chang Hyun Kang, Hye-Seon Kim, Yong Won Seong, In Kyu Park, Young Tae Kim, and Joo Hyun Kim.
• Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
• Eur J Cardiothorac Surg. 2014 Apr 1;45(4):640-5.

ObjectivesNon-small-cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD) are at an increased risk of pulmonary complications after pulmonary resection. This study aimed to identify whether video-assisted thoracoscopic (VATS) lobectomy can reduce postoperative pulmonary complications compared with lobectomy by thoracotomy in NSCLC patients with COPD.MethodsAmong a total of 1502 NSCLC patients who underwent lobectomy from April 2005 to June 2012 at the Seoul National University Hospital, 446 (29.7%) were diagnosed with COPD based on the spirometric criteria of the Global Initiative for COPD. Among the 446 patients, 283 presented with stage I NSCLC and were selected for this study. The study patients were divided into two groups: patients undergoing VATS (n = 160) lobectomy and patients undergoing thoracotomy (n = 123) lobectomy. A propensity analysis that incorporated preoperative variables, such as age, sex, Charlson comorbidity index, extent of smoking, preoperative pulmonary function, size of the mass, histological type of the tumour and additional lung resection, was performed, and postoperative outcomes were compared.ResultsMatching based on propensity scores produced 91 patients in each group for the analysis of postoperative outcomes. There were only three operative mortalities in the thoracotomy group, and all of these patients died of postoperative pneumonia. The overall incidence of postoperative complications was 32.9% (30 of 91) and 22.0% (20 of 91) in the thoracotomy group and in the VATS group, respectively (P = 0.14). Compared with lobectomy by thoracotomy, VATS lobectomy was associated with a lower incidence of pulmonary complications (1.1 vs 12.1%; P < 0.01), shorter operation time (165 vs 201 min; P < 0.01) and shorter length of stay (6.0 vs 9.0 days; P = 0.04).ConclusionsVATS lobectomy is associated with a lower incidence of pulmonary complications compared with lobectomy by thoracotomy in stage I NSCLC patients with COPD. VATS lobectomy may be the preferred strategy for appropriately selected NSCLC patients with COPD.

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