VATS lobectomy: the impact of pre-operative Aspirin use

Abstract

OBJECTIVE: Patients receiving lung cancer surgery often have risk factors for cardiovascular disease, and may be on anti-platelet therapy pre-operatively. Although Video Assisted Thoracic Surgery (VATS) may offer clinical advantages over open surgery, adequacy of hemostasis with VATS in patients on aspirin remains a concern for some. The impact of aspirin use on VATS lobectomy has rarely been studied. METHODS: Patients receiving lobectomy and lymph node dissection with curative intent for lung cancer by a single surgeon - and for whom a complete VATS approach was intended - were selected for study. The cohort included 105 patients, of whom 10 (9.5%) were taking aspirin. Aspirin was stopped 5-7 days before surgery in 4 of those patients. RESULTS: No mortality or major morbidity was encountered. One or more minor complications occurred in 18 patients (17.1%), including 16 with air leaks. Minor non-air leak complications were more common in patients previously taking aspirin (17% versus 1%, p=0.01). Stopping aspirin pre-operatively did not influence complication risks, but reduced the incidence of intra-operative blood loss of 200ml or more (67% versus 0%, p=0.04). Aspirin use up to the time of surgery showed a trend to be associated with a longer mean operation time (267 mins versus 175 mins, p=0.09). Aspirin use increased the incidence of chest drainage of over 250ml in the first 24 hours post-operatively (70% versus 32%, p=0.02). Excluding patients with prolonged air leaks, patients taking aspirin up to the time of surgery had longer mean chest drain durations (5 days versus 3 days, p=0.02). Compared to those who had stopped or never taken aspirin, patients taking aspirin up to the time of surgery had a higher risk of conversion to thoracotomy (33% versus 7%, p=0.03) and a higher incidence of prolonged chest drainage for 5 days or more (75% versus 22%, p=0.02). CONCLUSIONS: Aspirin use may adversely affect outcomes and recovery after VATS lobectomy for lung cancer. Surgical risks may be reduced by stopping aspirin pre-operatively. However, the absolute risks posed by aspirin are not prohibitively high, and failure to stop should not be considered a categorical contraindication for VATS lobectomy.