Does muscle-sparing thoracotomy as opposed to posterolateral thoracotomy result in better recovery?

Abstract

A best evidence topic was written according to a structured protocol. The question addressed was whether muscle-sparing thoracotomy (MST), as opposed to posterolateral thoracotomy (PLT), results in better recovery. A total of 108 papers were found using the reported searches of which eight represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. A recent large prospective, randomized, double-blinded, controlled study demonstrated a shorter length of stay in patients undergoing MST. It failed to demonstrate any significant difference in pain reported or pulmonary function. A separate prospective randomized controlled trial focussed on pain, pulmonary function, late shoulder range of motion and late muscle strength. It failed to show any significant difference in these domains between PLT and MST. While the mean 'opening time' is greater when performing a MST, this is negated by a shorter mean 'closing time' when compared with PLT. Overall, the evidence suggests that MST results in greater early (1 week) preservation of skeletal muscle strength and range of motion over PLT. This difference has disappeared at 1 month. There is little evidence to suggest a difference in pulmonary function or pain dependent on the thoracotomy type. Moreover, analgesic consumption is similar. However, there is an inverse relationship between the incision length and the post-thoracotomy syndrome.

Meta-analysis of health-related quality of life after minimally invasive versus open oesophagectomy for oesophageal cancer

“…Patients want information about HRQoL outcomes after cancer surgery, but surgeons rarely inform the patients about such outcomes. Trauma related to thoracotomy is associated with postoperative pain. Pain and decreased exertion caused by open surgery may have a strong influence on respiratory function, pulmonary complication rate and postoperative HRQoL.…”

Quality of Life and Late Complications After Minimally Invasive Compared to Open Esophagectomy: Results of a Randomized Trial

“…It has been reported that up to 50 % of patients describe post-thoracotomy pain 1 year after the procedure [ 23 ]. A recent study on the type of thoracotomy found an inverse relationship between the incision length and post-thoracotomy pain [ 24 ]. With MIE both incision length and myofascial damage is limited.…”

Ultimate management of post thoracotomy morbidities: a set of surgical technique and peri-operative precautions

“…Anyway, Jiwnani's paper is not the first study comparing PLT versus NST. In 2014 Celikten (7) and co-workers presented a similar study with consistent conclusions and, in 2012, Elshiekh et al (8), presented a best evidence topic set as a protocol as reported in IVCTS (9). Conclusions were based on a selection of prospective randomized studies and suggested that MST better preserve muscle strength and arm motion but only in the first postoperative week.…”