Negative Outcomes following Video-Assisted Thoracic Surgery

Abstract

The author reviewed his personal experience with 776 video-assisted thoracoscopic procedures on 526 patients over a 34-month period, with particular attention to perioperative complications and procedure failures. There was one death (mortality rate 0.2%). Nonfatal complications comprised persistent air leaks (13), bleeding (4), wound infection (2), intercostal neuralgia (5), cerebrovascular accident (1), reexpansion pulmonary edema (1), deep vein thrombosis (1), prolonged ventilatory support (1), and port site recurrence (1), giving rise to an overall nonfatal complication rate of 5.5%. Procedure failures consisted of 4 incidences of recurrence of pneumothorax (out of 213 cases or 1.9%); 2 recurrences of malignant pleural effusion (out of 39 cases or 5.1%); 2 recurrences following resections for stage I lung cancer (out of 32 cases or 6.3%). Proportionally more complications and procedure failures were seen in the first 17 months compared to the following 17 months, in spite of the fact that more technically advanced procedures were performed in the latter period. Careful patient selection and attention to details are essential in optimizing surgical results.