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Feasibility of Routine Ambulatory Lung Lobectomies and Pneumonectomies

University of California Irvine, Orange, CA

PURPOSE: The objective of this study is to establish whether it is possible to minimize the operative insult during lung lobectomies and pneumonectomies to such an extent that these operations can be safely performed as outpatient procedures.

METHODS: Between January of 2000 and October of 2001, 50 consecutive patients with tumors of the lung and negative metastatic work-up underwent major lung resections. Thirty-two were females and 18 males with a mean age of 68 years (34 to 88) and 7 patients were older than 80 years of age. No patients were excluded on the bases of poor pulmonary function, large tumor size, need for an extended resection, need for reoperation, presence of comorbidities, nor advance age. The operation was performed through a minimally invasive approach, the analgesic method was multimodal, a portable chest drainage system was used, and the anesthetic management was adjusted to perform these operations as ambulatory procedures.

RESULTS: There were 42 lobectomies, 2 bilobectomies, and 6 pnuemonectomies. The cumulative length of hospital stay (LOS) for the 50 patients was 50 days (mean LOS, 1 day). Forty-three patients (86%) met discharge criteria within 24 hours of admission, and 20 (40%) were managed as ambulatory procedures. One patient required readmission 7 days after surgery for deep vein thrombosis and expired due to a massive pulmonary embolism (2% mortality rate). There were 5 complications, none of which required readmission.

CONCLUSIONS: This study suggests that by adjusting surgical and anesthetic techniques, ambulatory major lung resections are feasible and safe procedures. Further studies are needed to confirm our findings.

CLINICAL IMPLICATIONS: The transformation of major lung resections into a purely ambulatory procedure may represent in itself a significant paradigm shift in thoracic surgery. In addition, it may extend the indications of these procedures to sicker and more compromised patients.

DISCLOSURE: E.A. Tovar, None.