POSTOPERATIVE ATRIAL FIBRILLATION - VIDEO-ASSISTED THORACOSCOPIC SURGERY VERSUS OPEN SURGERY
DOI:
https://doi.org/10.48729/pjctvs.192Keywords:
diffusing capacity for carbon monoxide, non-small-cell lung cancer, postoperative atrial fibrillation, standard deviation, video-assisted thoracoscopic surgeryAbstract
Objectives: Compare the incidence of Postoperative atrial fibrillation (PAF) after anatomical lung resection for Non- Small-Cell Lung Cancer (NSCLC) following open surgery versus VATS.
Methods: Single center retrospective study of all consecutive patients diagnosed with NSCLC submitted to anatomical lung resection from 2015 to 2019 (N=564). Exclusion criteria: prior atrial fibrillation, previous lung surgery, concomitant procedures, pneumectomy, non-pulmonary resections, urgency surgery. Study population of 439 patients. Primary end-point: incidence of PAF. Univariable analysis was used to compare the baseline characteristics of the 2 groups. Inverse probability of treatment weighting (IPTW) multivariable logistic regression was used including 23 clinical variables to analyze the effect of the approach. The balance was assessed by standardized mean differences.
Results: Thoracotomy was performed in 280 patients (63.8%) and 159 (36.2%) were submitted to VATS. Patients submitted to VATS were more likely to be females, had a lower prevalence of non-adenocarcinoma cancer, stage TNM IIIIV, Diabetes Mellitus, respiratory disease, and chronic heart failure. They were submitted less often to neoadjuvant therapy, bilobectomy and they presented higher levels of diffusing capacity for carbon monoxide. After IPTW adjustment, all clinical covariates were well balanced. PAF occurred in 8.6% of the patients undergoing thoracotomy and 3,8% of the patients after VATS. After IPTW adjustment, VATS was not associated with a lower incidence of PAF (OR 0.40; CI95%:0.140-1.171; p=0.095).
Conclusion: In this study, minimally invasive non–rib spreading VATS did not decrease the incidence of PAF when compared with standard thoracotomy regarding anatomical lung resection for NSCLC.
Downloads
References
Ivanovica J, Mazia DE, Ramzana S, McGuirec AL, Villeneuvec PJ, Gilbertc S, Sundaresanc RS, Shamjic FM, Seely A, Incidence, severity and perioperative risk factors for atrial fibrillation following pulmonary resection: Interactive CardioVascular and Thoracic Surgery. 2014;18(3):340–346
He G, Yao T, Zhao L, Geng H, Ji Q, Zuo K, Luo Y, Atrial fibrillation and alteration of heart rate variability after
video-assisted pulmonary lobectomy versus thoracotomy pulmonary lobectomy. Journal of Cardiothoracic Surgery. 2020;15:220
Neustein SM, Kahn P, Krellenstein DJ, Cohen E, Incidence of Arrhythmias After Thoracic Surgery: Thoracotomy
Versus Video-Assisted Thoracoscopy. Journal of Cardiothoracic and Vascular Anesthesia. 1998;12(6):659-661
Park BJ, Zhang H, Rusch VW, et al. Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy. J Thoracic Cardiovasc Surg. 2007;133(3):775–9.
Papiashvilli M, Stav D, Cyjon A, Haitov Z, Gofman V, Bar I, Lobectomy for NonYSmall Cell Lung Cancer - Differences in Morbidity and Mortality Between Thoracotomy and Thoracoscopy. Innovations 2012;7(1):15-22
Villamizar NR, Darrabie MD, Burfeind WR, Petersen RP, Onaitis MW, Toloza E, Harpole DH, D’Amico TA, Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg 2009;138(2):419-25
Falcoz PE, Puyraveau M, Thomas PA, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surgery. 2016;49(2):602–9.
Austin PC, Stuart EA, Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Statist. Med. 2015, 34:3661–3679
