Patient characteristics
The clinicopathological characteristics of the 41 patients who received RPR in the present study are listed in Table 1. The median follow-up time was 1457 days (range: 162 to 5758 days). Thirty-one patients were men, and the median age at the first operation was 68 years old, while that at the second operation was 70 years old. The median Brinkman index was 160, and ipsilateral resection was performed in 13 patients. Primary lung tumor was found in 31 patients and metastatic lung tumor in 10 patients. The median %VC at the first operation was 102.9%, and that at the second operation was 87.4%. The median FEV1% at the first operation was 73.3%, and that at the second operation was 70.3%.
Perioperative factors
The first operative approach was C-VATS in 11 patients, H-VATS in 29, and thoracotomy in 1. The second operative approach was C-VATS in 14 patients, H-VATS in 23, and thoracotomy in 4. The median wound length of the first operation was 7 mm, and the median operation time was 166 minutes. The median wound length of the second operation was 6 mm, and the median operation time was 126 minutes. Sublobar resection in 18 patients and lobectomy in 23 was performed at the first operation. Sublobar resection in 34 patients and lobectomy in 7 was performed at the second operation. The postoperative complication rate of the first operation was 29%, and the postoperative complications were classified as Clavien–Dindo grade 0 in 29 patients, grade I in 1, grade II in 5, and grade IIIa in 6. All six patients with grade IIIa complications had prolonged air leakage and underwent pleurodesis. The postoperative complication rate of the second operation was 29%, and the postoperative complications were classified as Clavien–Dindo grade 0 in 29 patients, grade I in 0, grade II in 4, and grade IIIa in 8. All eight patients with grade IIIa complications had prolonged air leakage and underwent pleurodesis. The incidence of postoperative complications in the RPR and single pulmonary resection (SPR) groups was not significantly different (data not shown; RPR: SPR = 29%:26%, p=0.71). The median postoperative hospital stay after the first operation was 15 days, while that after the second operation was 12 days.
Bivariate analyses
The relationship between patients’ characteristics and perioperative factors and postoperative complications after RPR is shown in Table 2. Although the gender, age, smoking history, operative side, operative procedure, %VC, FEV1%, approach at the second operation, and duration of the second operation were analyzed, these factors did not significantly affect the incidence of postoperative complications.
Multivariate analyses
Our multivariate analysis of postoperative complications examined the joint effects of the gender, age, smoking history, operative side, procedure for the first operation, postoperative complications after the first operation, %VC at the second operation, FEV1% at the second operation, approach at the second operation, procedure for the second operation, and duration of the second operation. There were no significant factors affecting the incidence of postoperative complications (Table 3).
Sub-analyses
The relationship between the operative side (ipsilateral or contralateral) and perioperative factors was analyzed (Table 4). The operation time was significantly longer (p=0.02), and the wound length tended to be longer (p=0.07) in the ipsilateral group than in the contralateral group. The rate of postoperative complications and the length of the postoperative hospital stay were not significantly different between the two groups.
Survival analyses
The overall survival from the first operation is shown in Figure 1. The 10-year overall survival was 84%. The overall survival from the second operation is shown in Figure 2. The 8-year overall survival was 78%.