Non-serratus-sparing antero-axillary thoracotomy with disconnection of anterior rib cartilage - Improvement in postoperative pulmonary function and pain in comparison to posterolateral thoracotomy

To examine the usefulness of non-serratus-sparing antero-axillary thoracotomy (AAT) with disconnection of anterior rib cartilage for curative resection of lung cancer, we used retrospective analysis to compare mortality, morbidity, hospital stay, time for thoracic opening, postoperative pulmonary function, and chest pain between AAT and posterolateral thoracotomy (PLT). Subjects were 50 lung cancer patients who underwent lobectomy via AAT (n=25) or PLT (n=25), who were matched by sex and age. Chest pain was evaluated using a visual analog scale, a McGill pain questionnaire, and analgesic requirements up to 6 months after surgery. AAT offered adequate exposure for lobectomy and mediastinal lymph node dissection. No difference was observed between the AAT and PLT groups in postoperative mortality, morbidity, or hospital stay. Times for thoracic opening were significantly shorter in AAT than in PLT (p<0.001). FEV, and vital capacity 1 week after surgery were significantly preserved in patients with AAT compared with patients with PLT (p<0.05). Chest pain was significantly reduced in AAT patients compared with PLT patients on 1 day and from 14 days to 6 months after surgery (p<0.01 to p<0.001). We conclude that AAT is a reasonable thoracotomy alternative to standard PLT for curative lung cancer resection, because of its adequate exposure, shortened opening time, diminished impairment of postoperative pulmonary function, and reduced chronic postoperative pain.