K. Ratnasamy4, M. R. Kuhns1, F. O. Velez-Cubian2, K. Rodriguez4, C. C. Moodie1, J. R. Garrett1, J. P. Fontaine1,2,3, E. M. Toloza1,2,3 1Moffitt Cancer Center,Thoracic Oncology,Tampa, FL, USA 2University Of South Florida Morsani College Of Medicine,Surgery,Tampa, FL, USA 3University Of South Florida Morsani College Of Medicine,Oncologic Sciences,Tampa, FL, USA 4University Of South Florida,Morsani College Of Medicine,Tampa, FL, USA
Introduction: During robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy, we observed that patients with small body habitus results in increased collisions between robotic arms and restricted robotic arm movement. We investigated whether smaller chest wall dimensions affected perioperative outcomes after RAVT pulmonary lobectomy.
Methods: We retrospectively studied all patients who underwent RAVT pulmonary lobectomy between September 2010 and July 2014 by one surgeon at our institution. Chest wall dimensions (transverse radius from carina to lateral chest wall; anterior-posterior [AP] chest wall diameter at level of carina; height from 1st rib to dome of diaphragm) ipsilateral to the lung tumor were measured from patients’ CT scans. Patients were grouped based on chest wall dimensions, and perioperative outcomes, including estimated blood loss (EBL), skin-to-skin operative time, conversion to open lobectomy, postoperative complications, chest tube duration, hospital length of stay (LOS), and in-hospital mortality were compared. Student’s t-test and Chi-square test were used, with p≤0.05 as significant.
Results: We identified 289 patients, who were grouped by chest wall dimensions. No differences were noted in EBL, operative times, intraoperative complications, conversion to open lobectomy, chest tube duration, or hospital LOS between groups. More patients (70.6%) with chest AP diameter ≥19cm experienced postoperative complications versus 35.8% of those with AP diameter <16cm (p<0.05). Patients with chest transverse diameter ≥25.9cm had more postoperative complications (68%) compared to 37.8% of patients with chest transverse diameter <25.9 cm (p<0.05). Complications did not differ by chest height. In-hospital mortality increased with increasing AP:transverse diameter ratio (p=0.02).
Conclusions: Smaller chest wall dimensions did not result in increased intraoperative or postoperative complications. On the contrary, patients with larger chest wall dimensions, specifically larger chest AP and transverse diameters, did have more postoperative complications than those with smaller chest wall dimensions. Higher AP:transverse diameter ratio, or “barrel chest”, correlated with higher mortality risk.