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Elia S, Loprete S, De Stefano A, Hardavella G. Does aggressive management of solitary pulmonary nodules pay off? Breathe (Sheff) 2019; 15:15-23. [PMID: 30838056 PMCID: PMC6395991 DOI: 10.1183/20734735.0275-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Indeterminate solitary pulmonary nodules (SPNs), measuring up to 3 cm in diameter, are incidental radiological findings. The ever-growing use of modern imaging has increased their detection. The majority of those nodules are benign; however, the possibility of diagnosing early-stage lung cancer still stands. Guidelines for the management of SPNs have never been validated in prospective comparative studies. Positron emission tomography (PET) is a useful tool to provide functional information on SPNs. However, overall sensitivity and specificity of PET in detecting malignant SPNs of at least 10 mm in diameter are about 90% and false-negative results are reported. The development of video-assisted thoracic surgery has provided minimally invasive diagnosis and treatment of SPNs. In our series, 105 patients underwent surgery based on combined increased 18F-labelled 2-fluoro-2-deoxy-d-glucose (FDG) uptake on PET computed tomography and radiological features (morphology and density) without prior histological confirmation. We detected 26 false negatives (24.8%) and only nine false positives (8.57%). Therefore, our minimally invasive surgical approach prevented 25% of patients with lung cancer from a delayed treatment versus only 9% undergoing “overtreatment”. In our monocentric cohort, patients with SPNs with large diameter, irregular outline, no calcifications, central location, increased FDG uptake and/or subsolid aspect benefited from a primary surgical resection. There is much debate on the best management of solitary pulmonary nodules. Even if they are mostly benign, they may represent an early-stage lung cancer. Minimally invasive surgical removal is probably the best approach to this insidious disease.http://ow.ly/wMKz30nemjR
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Affiliation(s)
- Stefano Elia
- Dept of Surgical Sciences, Thoracic Surgery Unit, Tor Vergata University, Rome, Italy
| | - Serafina Loprete
- Dept of Biomedicine and prevention, Tor Vergata University, Rome, Italy
| | | | - Georgia Hardavella
- Dept of Respiratory Medicine and Allergy, Medical School, King's College London, London, UK.,10th Dept of Respiratory Medicine, Athens' Chest Diseases Hospital "Sotiria", Athens, Greece
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52
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Coonar A, Aresu G, Peryt A, Ali J. Thoracic surgery for lung cancer: current practice and future directions. J R Soc Med 2019; 112:136-139. [PMID: 30698492 DOI: 10.1177/0141076818818710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Aman Coonar
- Royal Papworth Hospital Cambridge, Cambridgeshire CB23 3RE, UK
| | - Giuseppe Aresu
- Royal Papworth Hospital Cambridge, Cambridgeshire CB23 3RE, UK
| | - Adam Peryt
- Royal Papworth Hospital Cambridge, Cambridgeshire CB23 3RE, UK
| | - Jason Ali
- Royal Papworth Hospital Cambridge, Cambridgeshire CB23 3RE, UK
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53
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Moulla Y, Gradistanac T, Wittekind C, Eichfeld U, Gockel I, Dietrich A. Predictive risk factors for lymph node metastasis in patients with resected non-small cell lung cancer: a case control study. J Cardiothorac Surg 2019; 14:11. [PMID: 30651112 PMCID: PMC6335711 DOI: 10.1186/s13019-019-0831-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Estimation of lymph node status is essential in order to determine precise therapy for patients with non-small cell lung cancer (NSCLC). Furthermore, lymph node involvement is a very powerful prognostic factor in these patients. In this analysis, we aim to evaluate the predictive factors for lymph node metastasis in NSCLC-patients. Methods In a prospectively-established database, we analyzed all data of patients with NSCLC, who underwent oncological surgical resections from 01/2007 to 12/2016, retrospectively. The correlation between clinicopathological parameters and lymph node metastasis was investigated by using univariate and binary logistic regression analysis. Results In this study, we operated on 204 consecutive patients, 142 men (71.7%) and 56 women (28.3%). Lymph node metastases were detected in 38.2% (78/204). Preoperatively, central tumor localization (OR = 2.6, 95% CI = 1.3–5.1, P = 0.005) and tumor size > 3 cm (OR = 2.5, 95% CI = 1.3–4.4, P = 0.005) were found to be significant predictive factors for lymph node metastasis. Postoperatively, multivariate analysis showed that intratumoral lymph vessel invasion (L1-status) (OR = 17.3, 95% CI = 5.1–58.4, P < 0.001) along with the central tumor localization (OR = 2.8, 95% CI = 1.4–5.8, P = 0.004) were significantly associated with lymph node metastasis. In small size tumors (≤3 cm), two predictive factors for lymph node metastasis were found: central tumor localization (OR = 19.4, 95% = 2.1–186.4, P = 0.01) and L1-status (OR = 43.9, 95% CI = 3.6–529.4, P = 0.003). Conclusions A precise pre- and intraoperative assessment of the lymph node status is essential in patients with larger sized tumors and central localization. Furthermore, L1-status is a highly significant risk factor for lymph node metastasis in NSCLC-Patients. Therefore, an adjuvant therapy in patients with L1-status and pNX category should be considered.
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Affiliation(s)
- Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Tanja Gradistanac
- Institute of Pathology, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Christian Wittekind
- Institute of Pathology, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Uwe Eichfeld
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Arne Dietrich
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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54
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Karenovics W, Gonzalez M. How to decrease technical obstacles to difficult video-assisted thoracoscopic surgery segmentectomy? J Thorac Dis 2019; 11:53-56. [PMID: 30863570 DOI: 10.21037/jtd.2018.12.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Wolfram Karenovics
- Service of Thoracic Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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55
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Xue L, Fan H, Shi W, Ge D, Zhang Y, Wang Q, Yuan Y. Preoperative 3-dimensional computed tomography lung simulation before video-assisted thoracoscopic anatomic segmentectomy for ground glass opacity in lung. J Thorac Dis 2018; 10:6598-6605. [PMID: 30746205 DOI: 10.21037/jtd.2018.10.126] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Three-dimensional (3D) simulation of pulmonary vessels and the space between the lesion and adjacent tissues may improve the safety and accuracy of video-assisted thoracoscopic surgery (VATS) for lung. The aim of this study was to evaluate the effect of 3D simulation on the outcome of VATS segmentectomy for ground glass opacity (GGO) in lung. Methods We retrospectively analyzed 68 cases of small (≤2 cm) GGO, which were diagnosed as cT1aN0M0 lung cancer, from May 1, 2016 to February 28, 2017 in our institute. All the patients underwent VATS segmentectomy. The patients were divided into "3D" group, 3D preoperative reconstruction simulation in 36 patients and "non-3D" group, 32 patients with only computed tomography (CT). Operation plans were firstly made by CT in all patients, then by 3D simulation only in 3D group. The clinical outcomes, including operation time, blood loss, resection margin distance, length of postoperative stay and postoperative complications were compared between the two groups. Results There were 21 male and 47 female analyzed, aging from 34 to 72 years (median 57). In 3D group, pathological result showed 8 cases of adenocarcinoma, 23 cases of microinvasive adenocarcinoma (MIA), 5 cases of adenocarcinoma in situ (AIS). In non-3D group, 18 cases of MIA, 9 cases of adenocarcinoma and 5 cases of AIS were diagnosed pathologically. The blood loss, postoperative hospital stay and the incidence of the postoperative complications were similar in both of the groups. There was no 30-day postoperative mortality in either group. The median operation time for the 3D group (111 minute) was shorter than non-3D group (139 minute) (P=0.03). Seven cases (19%) in 3D group changed the original operation plan according to the simulation result with the consideration of adequate resection margin distance. All cases in 3D group had adequate resection margin distance. Four cases (13%) in non-3D group got inadequate resection margin distance, and more lung tissues than the original plan were then resected in these patients (P=0.04). Conclusions 3D preoperative simulation may be more precise in operation plan than CT scan and can significantly shorten the operation time in VATS segmentectomy for GGO in lung.
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Affiliation(s)
- Liang Xue
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hong Fan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Woda Shi
- Department of Cardio-Thoracic Surgery, the Third People's Hospital of Yancheng City, Yancheng 224001, China
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yi Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yunfeng Yuan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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56
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Uniportal Subxiphoid Video-Assisted Thoracoscopic Anatomical Segmentectomy: Technique and Results. Ann Thorac Surg 2018; 106:1519-1524. [DOI: 10.1016/j.athoracsur.2018.06.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/31/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
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57
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Needlescopic-assisted thoracoscopic pulmonary anatomical lobectomy and segmentectomy for lung cancer: a bridge between multiportal and uniportal thoracoscopic surgery. Surg Today 2018; 49:49-55. [DOI: 10.1007/s00595-018-1707-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/19/2018] [Indexed: 12/15/2022]
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58
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Lv X, Cao J, Dai X, Rusidanmu A. Survival rates after lobectomy versus sublobar resection for early-stage right middle lobe non-small cell lung cancer. Thorac Cancer 2018; 9:1026-1031. [PMID: 29927089 PMCID: PMC6068437 DOI: 10.1111/1759-7714.12782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/13/2018] [Accepted: 05/14/2018] [Indexed: 01/22/2023] Open
Abstract
Background Lung cancer in the right middle lobe has a poorer prognosis than tumors located in other lobes. The optimal surgical procedure for early‐stage non‐small cell lung cancer (NSCLC) in the right middle lobe has not yet been elucidated. The aim of this study was to compare survival rates after lobectomy and sublobar resection for early‐stage right middle lobe NSCLC. Methods Patients who underwent lobectomy or sublobar resection for stage IA right middle lobe NSCLC tumors ≤ 2 cm between 2004 and 2014 were identified from the Surveillance, Epidemiology and End Results database of 18 registries. Cox regression model analysis was used to evaluate the prognostic factors. The lung cancer‐specific survival (LCSS) and overall survival (OS) rates between the two groups were compared. Results A total of 861 patients met our criteria, including 662 (76.9%) patients who underwent lobectomy and 199 (23.1%) patients who underwent sublobar resection. No statistical differences in LCSS and OS rates were identified between the groups of patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1–2 cm, lobectomy was associated with more favorable LCSS and OS rates compared to sublobar resection. Conclusion Lobectomy and sublobar resection deliver a comparable prognosis for patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1–2 cm, lobectomy showed better survival rates than sublobar resection.
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Affiliation(s)
- Xiayi Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinlin Cao
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaona Dai
- Quality Management Department, Second Affiliated Hospital of Zhejiang University , School of Medicine, Hangzhou, China
| | - Aizemaiti Rusidanmu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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59
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Dziedzic R, Zurek W, Marjanski T, Rudzinski P, Orlowski TM, Sawicka W, Marczyk M, Polanska J, Rzyman W. Stage I non-small-cell lung cancer: long-term results of lobectomy versus sublobar resection from the Polish National Lung Cancer Registry. Eur J Cardiothorac Surg 2018; 52:363-369. [PMID: 28402455 DOI: 10.1093/ejcts/ezx092] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/07/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Anatomical lobar resection and mediastinal lymphadenectomy remain the standard for the treatment of early stage non-small-cell lung cancer (NSCLC) and are preferred over procedures such as segmentectomy or wedge resection. However, there is an ongoing debate concerning the influence of the extent of the resection on overall survival. The aim of this article was to assess the overall survival for different types of resection for Stage I NSCLC. METHODS We performed a retrospective analysis of the results of the surgical treatment of Stage I NSCLC. Between 1 January 2007 and 31 December 2013, the data from 6905 patients who underwent Stage I NSCLC operations were collected in the Polish National Lung Cancer Registry (PNLCR) and overall survival was assessed. A propensity score-matched analysis was used to compare 3 groups of patients, each consisting of 231 patients who underwent lobectomy, segmentectomy, or wedge resection. RESULTS In the unmatched and matched patient groups, lobectomy and segmentectomy were associated with a significant benefit compared to wedge resection regarding overall survival (log-rank P < 0.001 and P = 0.001). The Cox proportional hazard ratio comparing segmentectomy and lobectomy to wedge resection was 0.54 [95% confidence interval (CI): 0.37-0.77) and 0.44 (95% CI: 0.38-0.50), respectively, indicating a significant improvement in survival. There was no difference in the 5-year survival of patients after lobectomy (79.1%; 95% CI: 77.7-80.4%) or segmentectomy (78.3%; 95% CI: 70.6-86.0%). The 30-day mortality rate was 1.6, 2.6 and 1.4% for lobectomy, segmentectomy and wedge resection, respectively. Wedge resection was associated with a significantly lower 5-year survival rate (58.1%; 95% CI: 53.6-62.5%) compared to segmentectomy (78.3%; 95% CI: 70.6-86.0%) and lobectomy (79.1%; 95% CI: 77.7-80.5%). The propensity score matched analysis confirmed most of the results of the comparisons of unmatched study groups. CONCLUSIONS Wedge resection was associated with significantly lower 3-year and 5-year survival rates compared to the other methods of resection. There was no significant difference in 3-year or 5-year survival rates between lobectomy and segmentectomy. Segmentectomy, but not wedge resection, could be considered an alternative to lobectomy in the treatment of patients with Stage I NSCLC.
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Affiliation(s)
- Robert Dziedzic
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Wojciech Zurek
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Marjanski
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Piotr Rudzinski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Tadeusz M Orlowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Wioletta Sawicka
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland
| | - Michal Marczyk
- Data Mining Group, Institute of Automatic Control, Silesian University of Technology, Gliwice, Poland
| | - Joanna Polanska
- Data Mining Group, Institute of Automatic Control, Silesian University of Technology, Gliwice, Poland
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
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60
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Harrison S, Stiles B, Altorki N. What is the role of wedge resection for T1a lung cancer? J Thorac Dis 2018; 10:S1157-S1162. [PMID: 29785289 DOI: 10.21037/jtd.2018.03.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Since 1995, lobar resection became the standard of care for medically fit patients with early stage lung cancer. This was based on the results of a single randomized trial comparing lobectomy and sublobar resection (SLR) in stage I lung cancer conducted by the lung cancer study group between 1982 and 1988. The conclusions of the study included a statistically significant tripling in loco-regional recurrence (LR) after limited resection but no difference between the two arms of the trial in systemic recurrence. Although both overall survival and cancer specific survival favored lobectomy, neither achieved statistical significance. Regardless, this landmark trial established lobectomy as the preferred oncological resection for early stage lung cancer. The practice of thoracic surgery has evolved significantly since the study period of the Lung Cancer Study Group, and this has led some surgeons to question its relevance to contemporary practice. The increased detection of smaller more precisely staged tumors combined with the rising segment of the population that is elderly with limited cardiopulmonary reserve has renewed interest in sub-lobar resection including wedge resection as either a definitive therapeutic strategy or as a compromise approach in patients with poor performance status. The interest in wedge resections is also to some extent further fueled by the emergence and increased utilization of competing technologies of local control such as stereotactic radiation or percutaneous and trans-bronchial ablative techniques. Although the results of the LCSG still cast a long shadow over the soundness of wedge resection as a cancer operation, much literature has been published in the subsequent years on this topic. We present in this review an overview of the conflicting data and offer our perspective on the role of wedge resection in early stage lung cancer.
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Affiliation(s)
- Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.,Department of Cardiothoracic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
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61
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Cao J, Yuan P, Wang Y, Xu J, Yuan X, Wang Z, Lv W, Hu J. Survival Rates After Lobectomy, Segmentectomy, and Wedge Resection for Non-Small Cell Lung Cancer. Ann Thorac Surg 2018; 105:1483-1491. [PMID: 29462591 DOI: 10.1016/j.athoracsur.2018.01.032] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/30/2017] [Accepted: 01/08/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND This study aimed to compare the survival rates after lobectomy, segmentectomy, and wedge resection for the eighth edition of the tumor, node, metastasis classification for stage IA non-small cell lung cancer (NSCLC). METHODS Patients who underwent lobectomy, segmentectomy, or wedge resection for stage IA NSCLC were identified from the Surveillance, Epidemiology, and End Results database. A Cox regression model and propensity-matched analysis were used. The overall survival (OS) rates and lung cancer-specific survival (LCSS) rates among the three groups were compared by tumor size. RESULTS A total of 16,819 patients met our criteria. Although the OS rate was better for lobectomy than for wedge resection, no statistical differences in the LCSS rate were identified among the three treatment groups of patients with tumors that were 1.0 cm or smaller. For tumors from 1.1 to 2.0 cm, lobectomy and segmentectomy showed no statistical differences in the LCSS rate, but both conferred better OS and LCSS rates than wedge resection. For tumors from 2.1 to 3.0 cm, the OS and LCSS rates were better for lobectomy than for segmentectomy or wedge resection, but similar for segmentectomy and wedge resection. CONCLUSIONS Lobectomy, segmentectomy, and wedge resection are comparable oncologic procedures for patients with stage IA NSCLC that is 1.0 cm or smaller. For tumors from 1.1 to 2.0 cm, lobectomy and segmentectomy could lead to equivalent survival rates but showed better survival rates than that observed with wedge resection. For tumors from 2.1 to 3.0 cm, lobectomy is still the standard surgical procedure; for patients who are unsuitable candidates for lobectomy, segmentectomy and wedge resection show similar survival rates.
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Affiliation(s)
- Jinlin Cao
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ping Yuan
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yiqing Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinming Xu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoshuai Yuan
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhitian Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wang Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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62
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Fiorelli A, Loizzi D, Santini M. Lobar or sublobar resection for stage I lung cancer: that is (still) the question! J Thorac Dis 2018; 10:38-41. [PMID: 29600017 DOI: 10.21037/jtd.2017.11.127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Domenico Loizzi
- Thoracic Surgery Unit, Università degli Studi di Foggia, Foggia, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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63
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O'Shea C, Khan KA, Tugwell J, Cantillon-Murphy P, Kennedy MP. Loss of flexion during bronchoscopy: a physical experiment and case study of commercially available systems. Lung Cancer Manag 2017; 6:109-118. [PMID: 30643576 DOI: 10.2217/lmt-2017-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/22/2017] [Indexed: 12/25/2022] Open
Abstract
During routine endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedures, especially with biopsy of lymph nodes in or around the left upper lobe, frequent reports have noted the loss of ultrasound image and needle angulation leading to an inability to biopsy nodes visualised by EBUS. The aim of this research was to investigate and compare this loss of angulation with commercially available scopes. Bench-top experiments and a clinical case study demonstrated the varying loss of scope angulation, flexibility and manoeuvrability with different scopes and biopsy instruments leading to procedural implications. Improvements in both the EBUS scope and needle characteristics are required to overcome this limitation which has implications in bronchoscope navigation and the diagnostic yield of EBUS-TBNA.
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Affiliation(s)
- Conor O'Shea
- School of Engineering, University College Cork, Ireland.,School of Engineering, University College Cork, Ireland
| | - Kashif Ali Khan
- Respiratory Medicine, Cork University Hospital, Ireland.,Respiratory Medicine, Cork University Hospital, Ireland
| | - Josef Tugwell
- School of Engineering, University College Cork, Ireland.,School of Engineering, University College Cork, Ireland
| | - Pádraig Cantillon-Murphy
- School of Engineering, University College Cork, Ireland.,School of Engineering, University College Cork, Ireland
| | - Marcus P Kennedy
- Respiratory Medicine, Cork University Hospital, Ireland.,Respiratory Medicine, Cork University Hospital, Ireland
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64
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D'Andrilli A, Rendina EA. POINT: Should Segmentectomy Rather Than Lobectomy Be the Operation of Choice for Early-Stage Non-small Cell Lung Cancer? Yes. Chest 2017; 153:590-592. [PMID: 29146405 DOI: 10.1016/j.chest.2017.10.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, "Sapienza" University of Rome-"Sant'Andrea" Hospital, Rome, Italy.
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, "Sapienza" University of Rome-"Sant'Andrea" Hospital, Rome, Italy
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65
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Yang SM, Wu WT, Liu YH, Ko HJ. Needlescopic-assisted uniportal video-assisted thoracoscopic pulmonary anatomical segmentectomy. J Vis Surg 2017; 3:138. [PMID: 29078698 DOI: 10.21037/jovs.2017.08.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/22/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pulmonary segmentectomy can be an oncologic equivalent of lobectomy for small non-small cell lung cancer. Uniportal video-assisted thoracoscopic surgery (VATS) has recently showed favorable surgical outcomes, but remains technical demanding, especially in a complex procedure like anatomic segmentectomy. This manuscript demonstrates the surgical techniques for uniportal VATS segmentectomies with the assistance of additional needlescopic instruments. METHODS Data of 22 consecutive patients who underwent 24 needlescopic-assisted uniportal VATS segmentectomies between December 2016 and June 2017 was analyzed. RESULTS There were 12 uni-segmentectomies, 10 bi-segmentectomies, and 2 tri-segmentectomies. The mean operation time was 178.3 minutes. The mean duration of chest tube drainage was 5.2 days, and the mean duration of hospital stay was 7.4 days. There were two episodes of major bleeding and one case that required conversion to lobectomy. CONCLUSIONS Under the assistance of additional needlescopic instruments, segmentectomy can be performed more easily and safely with uniportal VATS.
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Affiliation(s)
- Shun-Mao Yang
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Wen-Ting Wu
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Yu-Hsuan Liu
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Huan-Jang Ko
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu City, Taiwan
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Mendogni P, Tosi D, Rosso L, Palleschi A, Cattaneo M, Mazzucco A, Nosotti M. VATS segmentectomy: an underused option? J Vis Surg 2017; 3:136. [PMID: 29078696 DOI: 10.21037/jovs.2017.09.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/31/2017] [Indexed: 11/06/2022]
Abstract
It is well known that the "gold standard" procedure for surgically resectable early-stage non-small cell lung cancer (NSCLC), is pulmonary lobectomy. Even though sublobar resections (SLR), particularly segmentectomy, seem attractive as an alternative to lobectomy in early stage lung cancers, they are still debated procedures. The aim of this study is to answer to the question: "Is VATS lung segmentectomy an underused option?" To obtain an answer to this query, the authors carried out a review of the "state of the art" as follows: (I) performing a non-systematic review of the literature; (II) analyzing the review articles published; (III) looking at the ongoing studies, the results of which have not yet published; (IV) scanning the technical aspect of lung segmentectomy. After completing the multi-step revision, we can conclude that there is a lack of evidence about the oncological value of segmentectomy in early stage NSCLC. Although VATS segmentectomy is feasible and performed by many thoracic surgeons, it's currently not yet world-wide adopted. Among the trials now being recruited in some countries and, aimed to clarify the role of SLR in the treatment of early stage lung cancer, a European prospective randomized study is advocated to implement the scientific knowledge on this issue.
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Affiliation(s)
- Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Davide Tosi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alessandro Palleschi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Margherita Cattaneo
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alessandra Mazzucco
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Ghanem S, El Bitar S, Hossri S, Weerasinghe C, Atallah JP. What we know about surgical therapy in early-stage non-small-cell lung cancer: a guide for the medical oncologist. Cancer Manag Res 2017; 9:267-278. [PMID: 28740431 PMCID: PMC5505543 DOI: 10.2147/cmar.s139253] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Lung cancer remains the leading cause of death in cancer patients. The gold standard for the treatment of early-stage non-small-cell lung cancer is lobectomy with mediastinal lymph-node dissection or systematic lymph-node sampling. The evidence behind this recommendation is based on the sole randomized controlled trial conducted to date, done by the Lung Cancer Study Group and published in 1995, which found a superiority for lobectomy over sublobar resection with regard to local recurrence rate and improved survival. The population studied at that time were medically fit patients at low risk for surgery with a stage IA non-small-cell lung carcinoma, ie, a solitary tumor less than 3 cm in size. In practice, however, thoracic surgeons have continued to push the limit of a more conservative surgical resection in this patient population. Since then, several retrospective studies have attempted to identify the ideal population to benefit from sublobar resection without it affecting survival or local recurrence. Several variables have been studied, including tumor size, patient age, surgical approach, histological and radiological properties, and optimal surgical resection margin, as well as promising prognostic biomarkers. In this review, we summarize the data available in the literature regarding the surgical approach to patients with stage IA non-small-cell lung cancer studying all the aforementioned variables.
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Affiliation(s)
| | | | | | - Chanudi Weerasinghe
- Department of Hematology and Oncology, Staten Island University Hospital - Northwell Health, New York, NY, USA
| | - Jean Paul Atallah
- Department of Hematology and Oncology, Staten Island University Hospital - Northwell Health, New York, NY, USA
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Bedetti B, Bertolaccini L, Solli P, Schmidt J, Rocco R, Scarci M. Intentional Segmentectomies for Stage I Lung Cancer: An Up-to-Date Systematic Review. CURRENT SURGERY REPORTS 2017. [DOI: 10.1007/s40137-017-0177-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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69
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Bedetti B, Bertolaccini L, Rocco R, Schmidt J, Solli P, Scarci M. Segmentectomy versus lobectomy for stage I non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis 2017; 9:1615-1623. [PMID: 28740676 DOI: 10.21037/jtd.2017.05.79] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND In recent years, many factors have revamped the interest in segmentectomies as preferred procedure for stage I non-small cell lung cancer (NSCLC). The aim of this systematic review and meta-analysis is to compare the outcomes of segmentectomy versus lobectomy regarding overall survival (OS) in the surgical treatment of stage I NSCLC, as stated in the conclusions of the largest studies conducted in this field and reported to date. METHODS The searching strategy was developed in EMBASE, MEDLINE and Cochrane CENTRAL from 1990 until December 2016. The meta-analysis was performed with the combination of the reported survival outcomes of the individual studies using a random effect model. The OS of the lobectomy group was compared with the segmentectomy group alone. The hazard ratio (HR) and standard error were extracted or calculated for each study using the Kaplan-Meier method. RESULTS Regarding the results, most of these studies were based on the retrospective data. The size of the cohorts varied from 17 to 11,520, with a total number of 24,542 patients. The pooled HR was 1.04 [95% confidence interval (CI), 0.92-1.18; P=0.50]. CONCLUSIONS The survival in the segmentectomy group was not inferior to patients treated with lobectomy. In conclusion, the current meta-analysis disclosed that segmentectomies produce similar survival compared to lobectomy for patients with stage I NSCLC. To establish the role of segmentectomy in early NSCLC, more evidence is needed, in particular, a large numbered, prospective, randomised trials, which should dissolve the uncertainties and the questions raised by retrospective data.
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Affiliation(s)
| | | | - Raffaele Rocco
- Section of Thoracic Surgery, Department of Vascular Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Joachim Schmidt
- Department of Thoracic Surgery, Malteser Hospital, Bonn, Germany
| | | | - Marco Scarci
- Department of Thoracic Surgery, University College of London Hospitals, London, UK
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刘 洋, 钟 声, 何 绮, 张 剑, 陈 学, 郭 敏, 何 建. [Propensity Score Matching Analysis of VATS Lobectomy and Sublobar Resection for Stage I Lung Adenocarcinoma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:47-54. [PMID: 28103973 PMCID: PMC5973294 DOI: 10.3779/j.issn.1009-3419.2017.01.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/13/2016] [Accepted: 08/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND National Comprehensive Cancer Network (NCCN) guidelines recommend video-assisted thoracoscopic surgery (VATS) anatomical lobectomy as the first choice for the treatment of resectable lung cancer. However, sublobar resection offers significantly better functional preservation compared with lobectomy for stage I lung cancer. At present, the inferiority of sublobar resection to lobectomy is still uncertain. Herein, we compared the prognoses of these two types of surgical treatment for stage I lung adenocarcinoma. METHODS Retrospective research was conducted on 258 patients with stage I lung adenocarcinomas who underwent VATS lobectomy and sublobar resection at the First Affiliated Hospital of Guangzhou Medical University between January 2009 and December 2011. VATS lobectomy was performed on 222 patients, and VATS sublobe resection was performed on 36 patients. Propensity score matching analyses were conducted on the two groups. RESULTS A total of 70 patients were matched in the two groups. No significant difference was observed between the lobectomy and sublobar resection groups after matching (P=0.137). The disease-free survival (DFS) of the two groups were 49.3 and 42.7 months, and their overall survival (OS) were 50.3 and 49.0 months (P=0.122). Further, stratified analysis showed no significant differences in DFS and OS between the two groups with stage Ia lung adenocarcinoma. Nevertheless, the DFS and OS of the two groups significantly differed in matched patients with stage Ib lung adenocarcinomas. CONCLUSIONS Sublobar resection could achieve a similar prognosis to VATS lobectomy for stage Ia lung adenocarcinoma. Lobectomy should still be the first choice for the treatment of stage Ib lung adenocarcinoma.
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Affiliation(s)
- 洋 刘
- 510515 广州,南方医科大学研究生院Southern Medical University, Guangzhou 510515, China
- 510120 广州,广州医科大学附属第一医院胸外科Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - 声逸 钟
- 510120 广州,广州医科大学附属第一医院胸外科Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - 绮华 何
- 510120 广州,广州医科大学附属第一医院胸外科Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - 剑嵘 张
- 510120 广州,广州医科大学附属第一医院胸外科Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - 学炜 陈
- 510120 广州,广州医科大学附属第一医院胸外科Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - 敏章 郭
- 510120 广州,广州医科大学附属第一医院胸外科Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - 建行 何
- 510515 广州,南方医科大学研究生院Southern Medical University, Guangzhou 510515, China
- 510120 广州,广州医科大学附属第一医院胸外科Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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71
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Zhang T, Gao B, Zhou Z, Chang Y. The movement and deposition of PM2.5 in the upper respiratory tract for the patients with heart failure: an elementary CFD study. Biomed Eng Online 2016; 15:138. [PMID: 28155704 PMCID: PMC5260007 DOI: 10.1186/s12938-016-0281-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND PM2.5 is an important factor to affect the patients with respiratory and cardiovascular diseases. Clinical studies have found that the morbidity and mortality of patients with heart failure (HF) have a close relationship with the movement and deposition state of PM2.5. One reason is that the breathing pattern of patients with HF has obvious difference with healthy people, however the effect caused by these differences on the distribution regularity of PM2.5 in the respiratory tract is still unclear. Hence, a computational fluid dynamics simulation was conducted to clarify the aerodynamic effect of breathing pattern of patients with HF on respiratory system. METHODS Ideal upper respiratory tract geometric model was established based on standardized aerosol research laboratory of Alberta and Weibel A dimension. The discrete phase method is used to calculate the movement of the airflow and particles. The flow rate were chosen as the inlet boundary conditions, and the outlets are set at a constant pressure. The rate of particle deposition, distribution location, wall pressure, flow velocity and wall shear stress are obtained, and compared to the normal control. RESULTS The results demonstrated that the rate of escaped particles in every bronchial outlet of the patients with HF was more than the normal controls, meanwhile the trapped was less (1024 < 1160). There was higher by 12.9% possibility that the PM2.5 entered the lungs than the normal control. CONCLUSION The aerodynamic performances of HF patients are different from normal control. Compared to the normal control, under similar environment, there is higher possibility of PM2.5 moving into lungs, and these particles could affect the function of the respiratory system, resulting in the deterioration of the state of cardiovascular system. In short, it's necessary to pay more attention to the living environment of HF patients, to reduce the content of PM2.5 particles in the air, and reduce the damage of PM2.5 particles caused by breathing patterns.
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Affiliation(s)
- Tiantian Zhang
- School of Life Science and Bioengineering, Beijing University of Technology, Beijing, 100124, People's Republic of China
| | - Bin Gao
- School of Life Science and Bioengineering, Beijing University of Technology, Beijing, 100124, People's Republic of China
| | - Zhixiang Zhou
- School of Life Science and Bioengineering, Beijing University of Technology, Beijing, 100124, People's Republic of China
| | - Yu Chang
- School of Life Science and Bioengineering, Beijing University of Technology, Beijing, 100124, People's Republic of China.
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72
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Aresu G, Weaver H, Wu L, Lin L, Jiang G, Jiang L. The Shanghai Pulmonary Hospital uniportal subxiphoid approach for lung segmentectomies. J Vis Surg 2016; 2:172. [PMID: 29078557 DOI: 10.21037/jovs.2016.11.07] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 10/18/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lung segmentectomy may be considered an oncologic equivalent treatment to lobectomy for non-small cell lung cancer (NSCLC) sized 20 mm or smaller. Subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) could further improve the surgical outcome reducing the surgical stress and completely avoiding the intercostal nerve injury. The aim of this manuscript is to illustrate the Shanghai Pulmonary Hospital surgical techniques for uniportal subxiphoid VATS (SVATS) segmentectomies. METHODS A total of 79 consecutive patients underwent 84 subxiphoid segmentectomies for malignant or benign pulmonary diseases between September 2014 and January 2016. We here illustrate the surgical techniques and the early results. RESULTS There were 45 segmentectomies in right-side group and 39 segmentectomies left-side group. The mean operation time was 2.38±0.77 hours, and mean operative blood loss was 126.09±136.17 mL. Nine segmentectomies (10.7%) had an intra-operative change of procedure and four were converted to thoracotomy, one had a lobectomy rather than a segmentectomy and four were converted to conventional VATS lobectomy. A total of 12 patients (15.1%) had postoperative complications, including 1 hematoma, 4 prolonged air-leaks and 8 arrhythmias. CONCLUSIONS In the presented series that included our learning curve period we have experienced relative low conversion rates and few post-operatively complications showing that, SVATS segmentectomy can be considered a safe procedure with a relative low rate early post-operative complication.
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Affiliation(s)
- Giuseppe Aresu
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.,Department of Cardiothoracic Surgery, Santa Maria della Misericordia University Hospital, Udine 33100, Italy
| | - Helen Weaver
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Liang Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Lei Lin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
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73
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Aresu G, Weaver H, Wu L, Lin L, Sponga S, Jiang G, Jiang L. Uniportal subxiphoid video-assisted thoracoscopic bilateral segmentectomy for synchronous bilateral lung adenocarcinomas. J Vis Surg 2016; 2:170. [PMID: 29078555 DOI: 10.21037/jovs.2016.11.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/01/2016] [Indexed: 11/06/2022]
Abstract
Uniportal subxiphoid video assisted bilateral segmentectomy is a minimally invasive option for the treatment of synchronous bilateral lung lesions. Its advantages over conventional multiportal or uniportal video assisted thoracoscopic surgery include avoidance of damage to the intercostal neurovascular bundle and allowance of bilateral lesion resection as a combined procedure via a single incision. This article presents a case from our centre to describe our surgical technique for this procedure.
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Affiliation(s)
- Giuseppe Aresu
- Department of Thoracic Surgery, Santa Maria della Misericordia University Hospital, Udine 33100, Italy.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.,Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Helen Weaver
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridgeshire, UK
| | - Liang Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Lei Lin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Sandro Sponga
- Department of Thoracic Surgery, Santa Maria della Misericordia University Hospital, Udine 33100, Italy
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
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74
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Liu QX, Deng XF, Zhou D, Li JM, Min JX, Dai JG. Visceral pleural invasion impacts the prognosis of non-small cell lung cancer: A meta-analysis. Eur J Surg Oncol 2016; 42:1707-1713. [DOI: 10.1016/j.ejso.2016.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/26/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022] Open
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75
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Hou B, Deng XF, Zhou D, Liu QX, Dai JG. Segmentectomy versus wedge resection for the treatment of high-risk operable patients with stage I non-small cell lung cancer: a meta-analysis. Ther Adv Respir Dis 2016; 10:435-43. [PMID: 27585599 PMCID: PMC5933623 DOI: 10.1177/1753465816667121] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although lobectomy is still the preferred treatment for patients with stage I non-small cell lung cancer (NSCLC), segmentectomy or wedge resection is frequently performed on patients who cannot withstand the physiological rigors of lobectomy. The objective of this study was to compare the overall survival (OS), cancer-specific survival (CSS), and disease-free survival outcomes among patients with stage I NSCLC who have undergone these procedures. METHODS A systematic electronic search in three online databases was conducted from their earliest publication dates to June 2015. The studies were evaluated according to rigorous, predefined inclusion criteria. The hazard ratio (HR) was used as the outcome measure for data combining. RESULTS There were nine eligible studies. These studies included 1181 patients who underwent segmentectomy and 2003 patients who underwent wedge resection. Stage I NSCLC patients who underwent segmentectomy had significantly better OS (HR 0.80; 95% confidence interval [CI], 0.68-0.93; p = 0.004) and CSS (HR 0.42; 95% CI, 0.20-0.88; p = 0.02) rates than those who underwent wedge resection. However, there were no significant differences in OS (HR 0.39; 95% CI, 0.15-1.02; p = 0.06) and CSS (HR 1.87; 95% CI, 0.29-12.06; p = 0.51) rates between segmentectomy and wedge resection in patients with stage Ia NSCLC with tumor size ⩽ 2 cm. CONCLUSIONS For patients with stage I NSCLC, segmentectomy results in higher survival rates than wedge resection, whereas the outcomes of wedge resection are comparable to those of segmentectomy for patients with stage Ia NSCLC with tumor size ⩽ 2 cm. Considering the limitations and heterogeneity of the included studies, this conclusion should be further confirmed by rigorous randomized clinical trials.
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Affiliation(s)
- Bing Hou
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing China
| | - Xu-Feng Deng
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing China
| | - Dong Zhou
- Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing China
| | - Quan-Xing Liu
- Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Ji-Gang Dai
- Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
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Villar Álvarez F, Muguruza Trueba I, Belda Sanchis J, Molins López-Rodó L, Rodríguez Suárez PM, Sánchez de Cos Escuín J, Barreiro E, Borrego Pintado MH, Disdier Vicente C, Flandes Aldeyturriaga J, Gámez García P, Garrido López P, León Atance P, Izquierdo Elena JM, Novoa Valentín NM, Rivas de Andrés JJ, Royo Crespo Í, Salvatierra Velázquez Á, Seijo Maceiras LM, Solano Reina S, Aguiar Bujanda D, Avila Martínez RJ, de Granda Orive JI, de Higes Martinez E, Diaz-Hellín Gude V, Embún Flor R, Freixinet Gilart JL, García Jiménez MD, Hermoso Alarza F, Hernández Sarmiento S, Honguero Martínez AF, Jimenez Ruiz CA, López Sanz I, Mariscal de Alba A, Martínez Vallina P, Menal Muñoz P, Mezquita Pérez L, Olmedo García ME, Rombolá CA, San Miguel Arregui I, de Valle Somiedo Gutiérrez M, Triviño Ramírez AI, Trujillo Reyes JC, Vallejo C, Vaquero Lozano P, Varela Simó G, Zulueta JJ. Executive Summary of the SEPAR Recommendations for the Diagnosis and Treatment of Non-small Cell Lung Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2016.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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77
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Hu J, Bao F. [Advances in Surgical Treatment of Early Stage Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:399-402. [PMID: 27335305 PMCID: PMC6015207 DOI: 10.3779/j.issn.1009-3419.2016.06.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
肺癌是恶性肿瘤患者首位的死亡原因,随着计算机断层扫描(computed tomography, CT)等影像筛查的普及,肺癌的疾病谱正在发生变化,以往以中央型局部晚期肺鳞癌为主,而目前肺癌疾病谱主要为以孤立性肺结节、磨玻璃结节、亚厘米结节等为影像学表现的早期肺腺癌。早期肺癌是目前临床研究的热点,本文将就早期肺癌外科治疗的多个方面进展进行述评。
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Affiliation(s)
- Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University Medical College, Hangzhou 310003, China
| | - Feichao Bao
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University Medical College, Hangzhou 310003, China
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78
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Therapeutic strategy for small-sized lung cancer. Gen Thorac Cardiovasc Surg 2016; 64:450-6. [PMID: 27300350 DOI: 10.1007/s11748-016-0676-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/03/2016] [Indexed: 12/19/2022]
Abstract
Minimizing the volume of lung resection without diminishing curability has recently become an important issue in primary lung cancer. In this review, we will discuss the current state of the feasibility of sublobar resection and specific issues for a segmentectomy procedure. A previous randomized controlled trial showed that lobectomy must still be considered the standard surgical procedure compared with sublobar resection for T1N0 non-small cell lung cancer with a tumor less than 3 cm in size. Since then, supporting studies for segmentectomy of lung cancer with a tumor less than 2 cm in size were reported. In addition, segmentectomy seems to be feasible for clinical stage I adenocarcinoma less than 2 cm in size, in women younger than 70 years old, with a low tumor 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) standardized uptake value (SUV) from propensity-matching studies. In a meta-analysis of sublobar resection vs. lobectomy, intentionally performed sublobar resection showed equivalent outcomes to lobectomy. In the near future, two ongoing prospective, randomized trials will report results. As specific issues for the surgical procedure of segmentectomy, achieving a sufficient surgical margin is an important issue for preventing loco-regional recurrence. More studies regarding the regional lymph node dissection area for segmentectomy are needed. Sublobar resection has the potential to become the standard procedure for peripheral small-sized lung cancer less than 2 cm. However, more information is needed about the characteristics of this cancer and the surgical procedure, including nodal dissection.
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79
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Villar Álvarez F, Muguruza Trueba I, Belda Sanchis J, Molins López-Rodó L, Rodríguez Suárez PM, Sánchez de Cos Escuín J, Barreiro E, Borrego Pintado MH, Disdier Vicente C, Flandes Aldeyturriaga J, Gámez García P, Garrido López P, León Atance P, Izquierdo Elena JM, Novoa Valentín NM, Rivas de Andrés JJ, Royo Crespo Í, Salvatierra Velázquez Á, Seijo Maceiras LM, Solano Reina S, Aguiar Bujanda D, Avila Martínez RJ, de Granda Orive JI, de Higes Martinez E, Diaz-Hellín Gude V, Embún Flor R, Freixinet Gilart JL, García Jiménez MD, Hermoso Alarza F, Hernández Sarmiento S, Honguero Martínez AF, Jimenez Ruiz CA, López Sanz I, Mariscal de Alba A, Martínez Vallina P, Menal Muñoz P, Mezquita Pérez L, Olmedo García ME, Rombolá CA, San Miguel Arregui I, de Valle Somiedo Gutiérrez M, Triviño Ramírez AI, Trujillo Reyes JC, Vallejo C, Vaquero Lozano P, Varela Simó G, Zulueta JJ. Executive summary of the SEPAR recommendations for the diagnosis and treatment of non-small cell lung cancer. Arch Bronconeumol 2016; 52:378-88. [PMID: 27237592 DOI: 10.1016/j.arbres.2016.02.016] [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: 11/22/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 02/07/2023]
Abstract
The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.
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Affiliation(s)
| | | | - José Belda Sanchis
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrassa, España
| | | | | | | | - Esther Barreiro
- Grupo de Investigación en Desgaste Muscular y Caquexia en Enfermedades Crónicas Respiratorias y Cáncer de Pulmón, Instituto de Investigación del Hospital del Mar (IMIM)-Hospital del Mar, Departamento de Ciencias Experimentales y de la Salud (CEXS), Universidad Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona (PRBB); Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Barcelona. España
| | | | | | - Javier Flandes Aldeyturriaga
- Unidad de Broncoscopias y Neumología Intervencionista, Servicio de Neumología, ISS Fundación Jiménez Díaz, UAM, CIBERES, Madrid, España
| | - Pablo Gámez García
- Servicio de Cirugía Torácica, Hospital Universitario 12 de Octubre, Madrid, España
| | - Pilar Garrido López
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Pablo León Atance
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, España
| | | | | | - Juan José Rivas de Andrés
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | - Íñigo Royo Crespo
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | | | | | | | - David Aguiar Bujanda
- Servicio de Oncología Médica, Hospital Universitario de Gran Canaria «Dr. Negrín», España
| | | | | | | | | | - Raúl Embún Flor
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | | | | | | | | | | | | | - Iker López Sanz
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, España
| | | | - Primitivo Martínez Vallina
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | - Patricia Menal Muñoz
- Servicio de Radiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Laura Mezquita Pérez
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Carlos A Rombolá
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, España
| | - Iñigo San Miguel Arregui
- Servicio de Oncología Radioterápica, Hospital Universitario de Gran Canaria «Dr. Negrín», España
| | - María de Valle Somiedo Gutiérrez
- Unidad de Broncoscopias y Neumología Intervencionista, Servicio de Neumología, ISS Fundación Jiménez Díaz, UAM, CIBERES, Madrid, España
| | | | | | - Carmen Vallejo
- Servicio de Oncología Radioterápica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Paz Vaquero Lozano
- Unidad de Tabaquismo, Servicio de Neumología H.G.U. Gregorio Marañón, Madrid, España
| | - Gonzalo Varela Simó
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, España
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Oncologic Outcomes of Segmentectomy Versus Lobectomy for Clinical T1a N0 M0 Non-Small Cell Lung Cancer. Ann Thorac Surg 2016; 101:504-11. [DOI: 10.1016/j.athoracsur.2015.08.063] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/08/2015] [Accepted: 08/26/2015] [Indexed: 11/23/2022]
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81
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Rinieri P, Peillon C, Salaün M, Mahieu J, Bubenheim M, Baste JM. Perioperative outcomes of video- and robot-assisted segmentectomies. Asian Cardiovasc Thorac Ann 2016; 24:145-51. [PMID: 26764198 DOI: 10.1177/0218492315627556] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Video-assisted thoracic surgery appears to be technically difficult for segmentectomy. Conversely, robotic surgery could facilitate the performance of segmentectomy. The aim of this study was to compare the early results of video- and robot-assisted segmentectomies. METHODS Data were collected prospectively on videothoracoscopy from 2010 and on robotic procedures from 2013. Fifty-one patients who were candidates for minimally invasive segmentectomy were included in the study. Perioperative outcomes of video-assisted and robotic segmentectomies were compared. RESULTS The minimally invasive segmentectomies included 32 video- and 16 robot-assisted procedures; 3 segmentectomies (2 video-assisted and 1 robot-assisted) were converted to lobectomies. Four conversions to thoracotomy were necessary for anatomical reason or arterial injury, with no uncontrolled bleeding in the robotic arm. There were 7 benign or infectious lesions, 9 pre-invasive lesions, 25 lung cancers, and 10 metastatic diseases. Patient characteristics, type of segment, conversion to thoracotomy, conversion to lobectomy, operative time, postoperative complications, chest tube duration, postoperative stay, and histology were similar in the video and robot groups. Estimated blood loss was significantly higher in the video group (100 vs. 50 mL, p = 0.028). CONCLUSIONS The morbidity rate of minimally invasive segmentectomy was low. The short-term results of video-assisted and robot-assisted segmentectomies were similar, and more data are required to show any advantages between the two techniques. Long-term oncologic outcomes are necessary to evaluate these new surgical practices.
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Affiliation(s)
- Philippe Rinieri
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Christophe Peillon
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Mathieu Salaün
- Department of Pneumology, Rouen University Hospital, Rouen, France
| | - Julien Mahieu
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Michael Bubenheim
- Department of Epidemiology and Public Health, Unit of Biostatistics, Rouen University Hospital, Rouen, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
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82
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Baldwin DR, Callister ME, Graham R, Gleeson F. Pulmonary nodules again? The 2015 British Thoracic Society guidelines on the investigation and management of pulmonary nodules. Clin Radiol 2016; 71:18-22. [DOI: 10.1016/j.crad.2015.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/09/2015] [Accepted: 10/14/2015] [Indexed: 12/21/2022]
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83
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How should pulmonary nodules be optimally investigated and managed? Lung Cancer 2016; 91:48-55. [DOI: 10.1016/j.lungcan.2015.10.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/12/2015] [Indexed: 12/21/2022]
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84
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Taioli E, Yip R, Olkin I, Wolf A, Nicastri D, Henschke C, Yankelevitz D, Pass H, Flores RM. Survival after Sublobar Resection for Early-Stage Lung Cancer: Methodological Obstacles in Comparing the Efficacy to Lobectomy. J Thorac Oncol 2015; 11:400-6. [PMID: 26749486 DOI: 10.1016/j.jtho.2015.10.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/23/2015] [Accepted: 10/28/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Surgery is the treatment of choice for early-stage lung cancer (LC). Although lobectomy (L) is the historic standard treatment, the issue of whether long-term outcomes of sublobar resection (SL) are comparable is still under debate. The objective of this study was to perform a review of the literature on 5-year survival rates after SL compared to L for patients with early-stage LC. METHODS A priori inclusion criteria were as follows: (1) observational studies, (2) L compared to SL for early-stage LC, (3) radiographic staging by computed tomography scan, and (4) 5-year survival reported. A Medline search through January 2015 resulted in 31 studies representing 23 distinct datasets. The absolute difference in 5-year survival was calculated and plotted for each study. RESULTS L was performed in 4564 patients and SL in 2287 patients. Of 19 studies reporting the reason for SL, 11 indicated that SL was performed because of comorbidities or impaired cardiopulmonary function. Four studies showed no difference in 5-year survival, 13 favored L, and six favored SL. One propensity score study favored L and the other favored SL. Of 20 studies reporting recurrence rate, 11 favored L and nine favored SL. CONCLUSIONS Studies comparing 5-year survival rates of SL to L are sufficiently heterogeneous to prevent carrying out traditional meta-analysis. SL survival is often similar to L when adjustments are made for age, comorbidities, or impaired cardiopulmonary function. New approaches are needed for the comparison of L to SL.
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Affiliation(s)
- Emanuela Taioli
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, New York, NY; Population Health Science and Policy Department, Icahn School of Medicine at Mount Sinai, New York, NY; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rowena Yip
- Radiology Department, Mount Sinai Health System, Icahn School of Medicine, New York, NY
| | - Ingram Olkin
- Department of Statistics, Stanford University, Stanford, CA
| | - Andrea Wolf
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Nicastri
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Claudia Henschke
- Radiology Department, Mount Sinai Health System, Icahn School of Medicine, New York, NY
| | - David Yankelevitz
- Radiology Department, Mount Sinai Health System, Icahn School of Medicine, New York, NY
| | - Harvey Pass
- General Thoracic Surgery Division, General Thoracic Surgery Department, New York University Langone Medical Center, New York University School of Medicine, New York, NY
| | - Raja M Flores
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, New York, NY.
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85
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Field JK, Devaraj A, Duffy SW, Baldwin DR. CT screening for lung cancer: Is the evidence strong enough? Lung Cancer 2015; 91:29-35. [PMID: 26711931 DOI: 10.1016/j.lungcan.2015.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
The prevailing questions at this time in both the public mind and the clinical establishment is, do we have sufficient evidence to implement lung cancer Computed Tomography (CT) screening in Europe? If not, what is outstanding? This review addresses the twelve major areas, which are critical to any decision to implement CT screening and where we need to assess whether we have sufficient evidence to proceed to a recommendation for implementation in Europe. The readiness level of these twelve categories in 2015 have been with colour coded, where green indicates we have sufficient evidence, amber is borderline evidence and red requires further evidence. Recruitment from the 'Hard to Reach' community still remains at red, while mortality data, cost effectiveness and screening interval are all categorised as amber. The integration of smoking cessation into CT screening programmes is still considered to be category amber. The US Preventive Services Task Force have recommended that CT screening is implemented in the USA utilising the NLST criteria, apart from continuing screening to 80 years of age. The cost effectiveness of the NLST was calculated to be $81,000/QALY, however, its well recognised that the costs of medical care in the USA, is far higher than that of Europe. Medicare have agreed to cover the cost of screening but have stipulated a number of stringent requirements for inclusion. To date we do not have good CT screening mortality data available in Europe and eagerly await the publication of the NELSON trial data in 2016 and then the pooled UKLS and NELSON data thereafter. However in the meantime we should start planning for implementation in Europe, especially in the areas of the radiological service provision and accreditation, as well as identifying novel mechanisms to recruit from the hardest to reach communities.
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Affiliation(s)
- J K Field
- Roy Castle Lung Cancer Research Programme, The University of Liverpool, Department of Molecular and Clinical Cancer Medicine, The Apex Building 6 West Derby Street, Liverpool L7 8TX, UK.
| | - A Devaraj
- Department of Radiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
| | - S W Duffy
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
| | - D R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, City Campus, Hucknall Road, Nottingham NG5 1PB, UK.
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Assessment of the new thin convex probe endobronchial ultrasound bronchoscope and the dedicated aspiration needle: a preliminary study in the porcine lung. J Bronchology Interv Pulmonol 2015; 22:20-7. [PMID: 25590479 DOI: 10.1097/lbr.0000000000000123] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) allows for accurate minimally invasive mediastinal lymph node staging of lung cancer. The current convex probe EBUS (CP-EBUS) has limitations in the access to certain N1 lymph nodes (lobar and segmental) because of its size. The aim of this study was to assess the new thin CP-EBUS (TCP-EBUS) and an aspiration needle for sampling of N1 lymph nodes in a porcine model. METHODS The prototype TCP-EBUS (BF-Y0046, Olympus Medical Systems Corp.) with a thinner tip (5.9 mm) and larger bending angle (170 degrees upward) was used. Accessibility, operability, and TBNA capability of the TCP-EBUS were assessed and compared with the current CP-EBUS using porcine lungs. The endoscopic visibility range and the maximum reach were evaluated at the left upper lobe bronchus, tracheobronchus, and right lower lobe bronchus. The prototype aspiration needle (Olympus Medical Systems Corp.) was used for EBUS-TBNA. RESULTS In all of the evaluated bronchi (n=9), the TCP-EBUS had a greater reach (14.7 mm in the endoscopic visibility range, 16.0 mm in the maximum reach) than the current CP-EBUS. The TCP-EBUS was able to visualize 1 to 3 distal bifurcations farther compared with the current CP-EBUS. Adequate lymph node sampling from lobar and segmental lymph nodes was possible using the aspiration needle. CONCLUSIONS The TCP-EBUS has improved accessibility to peripheral bronchi with excellent operability and is capable of sampling lobar and segmental lymph nodes using the dedicated aspiration needle.
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87
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Thomas PA. [Use of minimally invasive approaches for stage I non-small cell lung cancer: A surgeon's point of view]. Cancer Radiother 2015; 19:365-70. [PMID: 26344441 DOI: 10.1016/j.canrad.2015.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
Abstract
Lobectomy with lymphadenectomy is the standard of care of patients with early stage non-small cell lung cancer, and the use of minimally invasive approaches is associated with reduced morbidity when compared with thoracotomy. Segmentectomy with lymphadenectomy seems to provide a curative effect equivalent to that of lobectomy for stage IA tumours of 2 cm or smaller, and for pure or predominant ground glass opacities. The combination of lung-sparing resections with minimally invasive approaches results in preserved pulmonary function, improved quality of life and very low morbidity. This benefit persists in so-called high-risk patients. Among patients with clinical stage IA managed with sublobar resections, more than 25% are proved to have a more advanced pathologic stage at surgery, suggesting that alternative ablative therapies would result in an incomplete resection in a similar proportion. Moreover, resection samples tumour tissue that is adequate in quantity and quality, and provides material for "research biopsies" to consolidate tissue availability for clinical trials, translational research, and in biobanks.
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Affiliation(s)
- P-A Thomas
- Service de chirurgie thoracique, Aix-Marseille université, hôpital Nord, AP-HM, chemin des Bourrely, 13915 Marseille, France.
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88
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Callister MEJ, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, Franks K, Gleeson F, Graham R, Malhotra P, Prokop M, Rodger K, Subesinghe M, Waller D, Woolhouse I. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 Suppl 2:ii1-ii54. [PMID: 26082159 DOI: 10.1136/thoraxjnl-2015-207168] [Citation(s) in RCA: 570] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - D R Baldwin
- Nottingham University Hospitals, Nottingham, UK
| | - A R Akram
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Barnard
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, UK
| | - P Cane
- Department of Histopathology, St Thomas' Hospital, London, UK
| | - J Draffan
- University Hospital of North Tees, Stockton on Tees, UK
| | - K Franks
- Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - P Malhotra
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - M Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - K Rodger
- Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - M Subesinghe
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - D Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - I Woolhouse
- Department of Respiratory Medicine, University Hospitals of Birmingham, Birmingham, UK
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89
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Thomas PA. Management of early stage lung cancer: a surgeon's perspective. Lung Cancer 2015. [DOI: 10.1183/2312508x.10010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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90
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Witte B, Stenz C, Vahl CF, Huertgen M. Comparative intention-to-treat analysis of the video-assisted thoracoscopic surgery approach to pulmonary segmentectomy for lung carcinoma. Interact Cardiovasc Thorac Surg 2015; 21:276-83. [DOI: 10.1093/icvts/ivv143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/08/2015] [Indexed: 11/12/2022] Open
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Wada H, Hirohashi K, Anayama T, Nakajima T, Kato T, Chan HHL, Qiu J, Daly M, Weersink R, Jaffray DA, Irish JC, Waddell TK, Keshavjee S, Yoshino I, Yasufuku K. Minimally invasive electro-magnetic navigational bronchoscopy-integrated near-infrared-guided sentinel lymph node mapping in the porcine lung. PLoS One 2015; 10:e0126945. [PMID: 25993006 PMCID: PMC4438870 DOI: 10.1371/journal.pone.0126945] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 04/09/2015] [Indexed: 02/05/2023] Open
Abstract
Background The use of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) for sentinel lymph node (SN) mapping has been investigated in lung cancer; however, this has not been fully adapted for minimally invasive surgery (MIS). The aim of our study was to develop a minimally invasive SN mapping integrating pre-operative electro-magnetic navigational bronchoscopy (ENB)-guided transbronchial ICG injection and intraoperative NIR thoracoscopic imaging. Methods A NIR thoracoscope was used to visualize ICG fluorescence. ICG solutions in a 96-well plate and ex vivo porcine lungs were examined to optimize ICG concentrations and injection volumes. Transbronchial ICG injection (n=4) was assessed in comparison to a traditional transpleural approach (n=3), where after thoracotomy an ICG solution (100μL at 100μg/mL) was injected into the porcine right upper lobe for SN identification. For further translation into clinical use, transbronchial ICG injection prior to thoracotomy followed by NIR thoracoscopic imaging was validated (n=3). ENB was used for accurate targeting in two pigs with a pseudo-tumor. Results The ICG fluorescence at 10 μg/mL was the brightest among various concentrations, unchanged by the distance between the thoracoscope and ICG solutions. Injected ICG of no more than 500μL showed a localized fluorescence area. All 7 pigs showed a bright paratracheal lymph node within 15 minutes post-injection, with persistent fluorescence for 60 minutes. The antecedent transbronchial ICG injection succeeded in SN identification in all 3 cases at the first thoracoscopic inspection within 20 minutes post-injection. The ENB system allowed accurate ICG injection surrounding the pseudo-tumors. Conclusions ENB-guided ICG injection followed by NIR thoracoscopy was technically feasible for SN mapping in the porcine lung. This promising platform may be translated into human clinical trials and is suited for MIS.
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Affiliation(s)
- Hironobu Wada
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kentaro Hirohashi
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Takashi Anayama
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Takahiro Nakajima
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuya Kato
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Harley H. L. Chan
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael Daly
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Robert Weersink
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - David A. Jaffray
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery/Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K. Waddell
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Guided Therapeutics, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- * E-mail:
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Hwang Y, Kang CH, Kim HS, Jeon JH, Park IK, Kim YT. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy on the patients with non-small cell lung cancer: a propensity score matching study. Eur J Cardiothorac Surg 2014; 48:273-8. [PMID: 25406426 DOI: 10.1093/ejcts/ezu422] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 09/30/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Thoracoscopic lobectomy has been widely performed on patients with early-stage lung cancer; meanwhile indications of thoracoscopic segmentectomy have not been clearly defined due to technical difficulties and unclear oncological outcomes. The aim of this study was to compare early and late outcomes between thoracoscopic segmentectomy and thoracoscopic lobectomy. METHODS Between January 2005 and December 2013, 100 thoracoscopic segmentectomies and 1049 thoracoscopic lobectomies were performed on patients with lung cancer in our institute. Preoperative clinical parameters including gender, age, tumour size, pathological stage, histology and forced expiratory volume in 1 s (FEV1) were used for propensity score matching. After propensity score matching, 94 thoracoscopic segmentectomies and 94 lobectomies were selected and compared. RESULTS Thoracoscopic segmentectomies were performed on patients with normal lung function (mean FEV1 = 101.6 ± 24.1%), small-sized tumour (mean diameter 1.7 ± 1.0 cm), early-stage cancer (Stage I 93.7%) and predominant adenocarcinoma (81.9%). The lobectomy group had similar clinical features with the segmentectomy group. Most commonly performed procedures were left upper lobe upper division segmentectomy (19%) and right lower lobe superior segmentectomy (17%). Segmentectomies were performed in all lobes except the right middle lobe. There were no differences between segmentectomy and lobectomy in terms of operation time (166.3 ± 54.7 min vs 181.1 ± 85.2 min, P = 0.47) and hospital stay (6.2 ± 5.2 days vs 7.1 ± 7.1 days, P = 0.31). Incidence of postoperative complications was non-significantly higher in the lobectomy group (17.2 vs 10.6%, P = 0.1), and postoperative mortality rates were also non-significantly higher in the segmentectomy group (1.1 vs 2.1%, P = 0.56). Postoperative FEV1 decrease was non-significantly lower in the segmentectomy group (8.9 ± 10.8 vs 11.0 ± 13.1, P = 0.36). The 3-year overall survival and recurrence-free survival was not different between the two groups (94 and 87% in the segmentectomy group and 96 and 94% in the lobectomy group, P = 0.62 and P = 0.69, respectively). CONCLUSIONS Thoracoscopic segmentectomy could achieve equal short-term surgical results and long-term oncological outcomes compared with thoracoscopic lobectomy.
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Affiliation(s)
- Yoohwa Hwang
- Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Seon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, National Cancer Center, Gyeonggi-do, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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93
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Wang Z, Zhang J, Cheng Z, Li X, Wang Z, Liu C, Xie Z. Factors affecting major morbidity after video-assisted thoracic surgery for lung cancer. J Surg Res 2014; 192:628-34. [PMID: 25167779 DOI: 10.1016/j.jss.2014.07.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/05/2014] [Accepted: 07/23/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) has been widely applied in the treatment of lung cancer. However, few studies have focused on the clinical factors predicting the major postoperative complications. METHODS Clinical data from 525 patients who underwent resection of primary lung cancer with VATS from January 2007-August 2011 were retrospectively analyzed. Risk factors related to major postoperative complications were assessed by univariate and multivariate analyses with logistic regression. RESULTS Major complications occurred in 36 (6.86%) patients, of which seven died (1.33%) within 30 d, postoperatively. Major complications included respiratory failure, hemothorax, myocardial infarction, heart failure, bronchial fistula, cerebral infarction, and pulmonary embolism. Univariate and multivariate logistic regression analyses demonstrated that age >70 y (odds ratio [OR], 2.105; 95% confidence interval [CI] 1.205-3.865), forced expiratory volume during the first second expressed as a percentage of predicted ≤70% (OR, 2.106; 95% CI 1.147-3.982) combined with coronary heart disease (OR, 2.257; 95% CI 1.209-4.123) were independent prognostic factors for major complications. CONCLUSIONS Age >70 and forced expiratory volume during the first second expressed as a percentage of predicted ≤70% combined with coronary heart disease are independent prognostic factors for postoperative major complications. Patients in these groups should undergo careful preoperative evaluation and perioperative management.
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Affiliation(s)
- Zhiqiang Wang
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Jiru Zhang
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Zhou Cheng
- Department of Emergency Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Xianhua Li
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Zhenjun Wang
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Chuanxin Liu
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China
| | - Zongtao Xie
- Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, The Fourth People's Hospital of Wuxi City, Wuxi, People's Republic of China.
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94
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Cao C, Gupta S, Chandrakumar D, Tian DH, Black D, Yan TD. Meta-analysis of intentional sublobar resections versus lobectomy for early stage non-small cell lung cancer. Ann Cardiothorac Surg 2014; 3:134-41. [PMID: 24790836 DOI: 10.3978/j.issn.2225-319x.2014.03.08] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 03/24/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Surgical resection is the preferred treatment modality for eligible candidates with non-small cell lung cancer (NSCLC). However, the selection of sublobar resection versus lobectomy for early-stage NSCLC remains controversial. Previous meta-analyses comparing these two procedures presented data without considering the significant differences in the patient selection processes in individual studies. The present study aimed to compare the overall survival (OS) and disease-free survival (DFS) outcomes of patients who underwent sublobar resections who were also eligible for lobectomy procedures with those who underwent lobectomy. METHODS An electronic search was conducted using five online databases from their dates of inception to December 2013. Studies were selected according to predefined inclusion criteria and meta-analyzed using hazard ratio (HR) calculations. RESULTS Twelve studies met the selection criteria, including 1,078 patients who underwent sublobar resections and 1,667 patients who underwent lobectomies. From the available data, there was no significant differences in OS [HR 0.91; 95% confidence interval (CI) 0.64-1.29] or DFS (HR 0.82; 95% CI 0.60-1.12) between the two treatment arms. In addition, no significant OS difference was detected for patients who underwent segmentectomies compared to lobectomies (HR 1.04; 95% CI 0.66-1.63, P=0.86). CONCLUSIONS Using the available data in the current literature, patients who underwent sublobar resection for small, peripheral NSCLC after intentional selection rather than ineligibility for greater resections achieved similar long-term survival outcomes as those who underwent lobectomies. However, patients included for the present meta-analysis were a highly selected cohort and these results should be interpreted with caution. The importance of the patient selection process in individual studies must be acknowledged to avoid conflicting outcomes in future meta-analyses.
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Affiliation(s)
- Christopher Cao
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sunil Gupta
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - David Chandrakumar
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - David H Tian
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Deborah Black
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Tristan D Yan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
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95
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Ohtaki Y, Shimizu K. Anatomical thoracoscopic segmentectomy for lung cancer. Gen Thorac Cardiovasc Surg 2014; 62:586-93. [DOI: 10.1007/s11748-014-0409-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Indexed: 12/22/2022]
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96
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Cao C, Gupta S, Chandrakumar D, Yan TD. A critical analysis of segmentectomy versus lobectomy for non-small-cell lung cancer. Eur J Cardiothorac Surg 2014; 46:928-9. [PMID: 24713889 DOI: 10.1093/ejcts/ezu142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Christopher Cao
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Sunil Gupta
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - David Chandrakumar
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Tristan D Yan
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
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97
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Bao F, Ye P, Yang Y, Hu J. Reply to Cao et al. Eur J Cardiothorac Surg 2014; 46:929-30. [PMID: 24713890 DOI: 10.1093/ejcts/ezu143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Feichao Bao
- Department of Thoracic Surgery, First Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Peng Ye
- Department of Thoracic Surgery, First Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yunhai Yang
- Department of Thoracic Surgery, First Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Hu
- Department of Thoracic Surgery, First Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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