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Echavarria MF, Cheng AM, Velez-Cubian FO, Ng EP, Moodie CC, Garrett JR, Fontaine JP, Robinson LA, Toloza EM. Comparison of pulmonary function tests and perioperative outcomes after robotic-assisted pulmonary lobectomy vs segmentectomy. Am J Surg 2016; 212:1175-1182. [PMID: 27823756 DOI: 10.1016/j.amjsurg.2016.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/04/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lobectomy is standard treatment for early-stage lung cancer, but sublobar resection remains debated. We compared outcomes after robotic-assisted video-assisted thoracoscopic (R-VATS) segmentectomy vs lobectomy. METHODS We retrospectively analyzed data from 251 consecutive patients who underwent R-VATS lobectomy (n = 208) or segmentectomy (n = 43) by a single surgeon over 36 months. Pulmonary function tests and perioperative outcomes were compared using Chi-squared test, unpaired Student t test, or Kruskal-Wallis test, with significance at P ≤ .05. RESULTS Intraoperative complications were not significantly different, but median operative times were longer for R-VATS segmentectomies (P < .01). Postoperative complications were not significantly different, except for increased rates of pneumothorax after chest tube removal (P = .032) and of effusions or empyema (P = .011) after R-VATS segmentectomies. Predicted changes for forced expiratory volume in 1 second and diffusion constant of the lung for carbon monoxide are significantly less after R-VATS segmentectomy (P < .001). CONCLUSIONS R-VATS segmentectomy should be considered as an alternative to lobectomy for conserving lung function in respiratory-compromised lung cancer patients, although oncologic efficacy remains undetermined.
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Affiliation(s)
- Maria F Echavarria
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Anna M Cheng
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Frank O Velez-Cubian
- Department of Surgery, University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA
| | - Emily P Ng
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Carla C Moodie
- Department of Thoracic Oncology, Moffitt Cancer Center, 12902 USF Magnolia Dr., Suite FOB-1, Tampa, FL, USA
| | - Joseph R Garrett
- Department of Thoracic Oncology, Moffitt Cancer Center, 12902 USF Magnolia Dr., Suite FOB-1, Tampa, FL, USA
| | - Jacques P Fontaine
- Department of Surgery, University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA; Department of Thoracic Oncology, Moffitt Cancer Center, 12902 USF Magnolia Dr., Suite FOB-1, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA
| | - Lary A Robinson
- Department of Surgery, University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA; Department of Thoracic Oncology, Moffitt Cancer Center, 12902 USF Magnolia Dr., Suite FOB-1, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA
| | - Eric M Toloza
- Department of Surgery, University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA; Department of Thoracic Oncology, Moffitt Cancer Center, 12902 USF Magnolia Dr., Suite FOB-1, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, USA.
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Shih CS, Liu CC, Liu ZY, Pennarun N, Cheng CT. Comparing the postoperative outcomes of video-assisted thoracoscopic surgery (VATS) segmentectomy using a multi-port technique versus a single-port technique for primary lung cancer. J Thorac Dis 2016; 8:S287-94. [PMID: 27014476 PMCID: PMC4783730 DOI: 10.3978/j.issn.2072-1439.2016.01.78] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/29/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Single-port video-assisted thoracoscopic surgery (VATS) has attracted much attention recently; however, it is still very challenging to perform especially on more technically demanding sublobar anatomic resection procedures such as segmentectomy. Therefore we conducted a retrospective study on the perioperative results of single-port segmentectomy using a propensity-matched method for comparison with multi-port segmentectomy in patients with primary lung cancer. METHODS For procedures of anatomic segmentectomy performed between May 2006 and March 2014, we retrieved data on patients' demographic information, medical history, cancer information, and postoperative outcomes from our surgical database of thoracoscopic lung cancer surgery. Outcome variables included the number of lymph nodes retrieved during the surgery, the amount of blood loss, the duration of hospitalization, the length of the wound, the operation duration in minutes, and incidence and types of complication. The t-test and Chi-squared test were used to compare demographic and clinical variables between single- and multi-port approaches. RESULTS A total of 98 consecutive patients who underwent VATS segmentectomy for lung cancer treatment were identified in our database: 52 (53.1%) underwent a single-port segmentectomy and 46 (46.9%) had a multi-port segmentectomy. After propensity score matching, the differences in patients' age, pulmonary function tests, tumor size, and operating surgeons were no longer significant between the two sample groups. The length of the wound was the only surgical outcome for which single-port segmentectomy had a significantly better outcome than multi-port segmentectomy (P value <0.001). CONCLUSIONS This study showed that single-port VATS segmentectomy yielded comparable surgical outcomes to multi-port segmentectomy despite technique difficulties and smaller wound in our setting.
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Kim SJ, Ahn S, Lee YJ, Park JS, Cho YJ, Cho S, Yoon HI, Kim K, Lee JH, Jheon S, Lee CT. Factors associated with preserved pulmonary function in non-small-cell lung cancer patients after video-assisted thoracic surgery. Eur J Cardiothorac Surg 2015; 49:1084-90. [DOI: 10.1093/ejcts/ezv325] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/30/2015] [Indexed: 11/14/2022] Open
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Sakurai H, Asamura H. Sublobar resection for early-stage lung cancer. Transl Lung Cancer Res 2015; 3:164-72. [PMID: 25806296 DOI: 10.3978/j.issn.2218-6751.2014.06.11] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/14/2022]
Abstract
Since the 1995 report of the prospective randomized trial of lobectomy versus sublobar resection for stage I non-small cell lung cancer (NSCLC) performed by the the Lung Cancer Study Group, lobectomy remains the standard of care for the surgical management of stage I NSCLC. Sublobar resection has been typically used for high-risk patients who are operative candidates but for whom a lobectomy is contraindicated. Recent advances in imaging and staging modalities and improved spatial resolution of computed tomography (CT) scan have refined the presentation and diagnosis of early-stage NSCLC. The detection of small tumors and ground-glass opacity (GGO) appearance associated with a favorable histology have led to the increased use of sublobar resection in many institutes to include good-risk patients. There is an increasing body of evidence that sublobar resection may achieve oncological outcomes similar to those with lobectomy in early-stage NSCLC, especially that 2 cm or less in size. However, whether or not sublobar resection constitutes adequate treatment for small-sized lung cancer or for the radiographic "early" lung cancer such as a GGO-dominant lesion is still being prospectively investigated. Sublobar resection will be expected to play an important role as a primary treatment option for patients with small stage IA NSCLC, based on an anatomical functional advantage over lobectomy as well as comparable prognostic outcomes between sublobar resection and lobectomy.
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Affiliation(s)
- Hiroyuki Sakurai
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
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