Quality of life, pain, and functional respiratory recovery after lobectomy for early stage non-small cell lung cancer: a review of the literature comparing minimal invasive and open procedures

Abstract

The recent improvement in surgical techniques for non-small cell lung cancer enables evident better results in term of postoperative recovery with lower adverse events. Even though the interest in minimally invasive procedures has increased, more subjective advantages are not always so apparent in the literature. There is indeed a growing interest in the daily life of patients including their management of physical and emotional pain, the perception of quality of life, and pulmonary function recovery. This review aims to highlight the advantages of minimal invasive surgery on pain, quality of life, and functional pulmonary recovery after lobectomy alone for early stage non-small cell lung cancer. Minimal invasive techniques or limited sparing open techniques offer better results in term of postoperative pain than open non-sparing techniques, allowing a lighter analgesia protocol. However, these clear benefits seem to disappear in the mid-term postoperative period. Studies suggest that minimal invasive surgery is non-inferior to thoracotomy in terms of quality of life, and seems to give patients at least a better vision of their health, but larger-scale studies are needed to demonstrate its superiority. Data show clear advantages in the postoperative pulmonary function recovery for minimal invasive surgery compared to that of open procedures, although sparing and anterior incisions can show equivalence. That benefit does not seem to persist in the mid and long term. Nevertheless, the posterolateral thoracotomy appears to have the worse effect on the loss of pulmonary function.

Keywords

Lobectomy / lung cancer / quality of life / pain / pulmonary function

References

[1] Lewis RJ,Caccavale RJ.Imaged thoracic lobectomy: should it be done?.Ann Thorac Surg1992;54:80-3

[2] Moorthy K,Dosis A,Martin S.Dexterity enhancement with robotic surgery..Surg Endosc2004;18:790-5

[3] Morgan JA,Sonett JR,Kohmoto T.Advanced thoracoscopic procedures are facilitated by computer-aided robotic technology..Eur J Cardiothorac Surg2003;23:883-7

[4] Cykert S,Hansen CJ.Patient preferences regarding possible outcomes of lung resection: what outcomes should preoperative evaluations target?.Chest2000;117:1551-9

[5] Williamson A.Pain: a review of three commonly used pain rating scales..J Clin Nurs2005;14:798-804

[6] Nagahiro I,Aoe M,Date H.Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure..Ann Thorac Surg2001;72:362-5

[7] Nomori H,Naruke T.What is the advantage of a thoracoscopic lobectomy over a limited thoracotomy procedure for lung cancer surgery?.Ann Thorac Surg2001;72:879-84

[8] Bendixen M,Kronborg C,Licht PB.Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial..Lancet Oncol2016;17:836-44

[9] Andreetti C,Ibrahim M,D’Andrilli A.Postoperative pain control: videothoracoscopic versus conservative mini-thoracotomic approach..Eur J Cardiothorac Surg2014;46:907-12

[10] Handy JR Jr,Douville EC,Grunkemeier GL.Does video-assisted thoracoscopic lobectomy for lung cancer provide improved functional outcomes compared with open lobectomy?.Eur J Cardiothorac Surg2010;37:451-5

[11] Kwon ST,Reddy RM,Orringer MB.Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection..J Thorac Cardiovasc Surg2017;154:652-9.e1

[12] Van der Ploeg APT,Akkersdijk GP,de Rooij PD.Postoperative pain after lobectomy: robot-assisted, video-assisted and open thoracic surgery..J Robot Surg2020;14:131-6

[13] Akter F,Toufektzian L.In minor and major thoracic procedures is uniport superior to multiport video-assisted thoracoscopic procedures surgery?.Interact Cardiovasc Thorac Surg2015;20:550-5

[14] The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization..Soc Sci Med1995;41:1403-9

[15] Ware JE Jr.The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection..Med Care1992;30:473-83

[16] Aaronson NK,Bergman B,Cull A.The European Organization for Research and Treatment of Cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology..J Natl Cancer Inst1993;85:365-76

[17] Pompili C,Balduyck B.Clinical evaluation of quality of life: a survey among members of European Society of Thoracic Surgeons (ESTS)..Interact Cardiovasc Thorac Surg2015;21:415-9

[18] Pompili C.Quality of life after lung resection for lung cancer..J Thorac Dis2015;7:S138-44 PMCID:PMC4419027

[19] Balduyck B,Lauwers P.Quality of life evolution after lung cancer surgery: a prospective study in 100 patients..Lung Cancer2007;56:423-31

[20] Riszk N,Hsu M,Downey RJ.A prospective trial comparing pain and quality of life measures after anatomic lung resection using thoracoscopy or thoracotomy..Ann Thorac Surg2014;98:1160-6 PMCID:PMC4307383

[21] Cerfolio RJ,Skylizard L.Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms..J Thorac Cardiovasc Surg2011;142:740-6

[22] Butland RJ,Gross ER,Geddes DM.Two-, six-, and 12-minutes walking tests in respiratory disease..Br Med J (Clin Res Ed)1982;284:1607-8 PMCID:PMC1498516

[23] Nakata M,Yokoyama N,Takiyama W.Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy..Ann Thorac Surg2000;70:938-41

[24] Nomori H,Horio H,Suemasu K.Difference in the impairment of vital capacity and 6-minute walking after a lobectomy performed by thoracoscopic surgery, an anterior limited thoracotomy, an anteroaxillary thoracotomy, and a posterolateral thoracotomy..Surg Today2003;33:7-12

[25] Black LF.Maximal respiratory pressures: normal values and relationship to age and sex..Am Rev Respir Dis1969;99:696-702

[26] Stephens N,Correa A,Mehran R.Thoracoscopic lobectomy is associated with improved short term and equivalent oncological outcomes compared with open lobectomy for clinical stage I non-small cell cancer: a propensity-matched analysis of 963 cases..Eur J Cardiothorac Surg2014;46:607-13