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Brescia AA, Harrington CA, Mazurek AA, Ward ST, Lee JSJ, Hu HM, Brummett CM, Waljee JF, Lagisetty PA, Lagisetty KH. Factors Associated With New Persistent Opioid Usage After Lung Resection. Ann Thorac Surg 2019; 107:363-368. [PMID: 30316852 PMCID: PMC7136012 DOI: 10.1016/j.athoracsur.2018.08.057] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/24/2018] [Accepted: 08/22/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Opioid dependence, misuse, and abuse in the United States continue to rise. Prior studies indicate an important risk factor for persistent opioid use includes elective surgical procedures, though the probability following thoracic procedures remains unknown. We analyzed the incidence and factors associated with new persistent opioid use after lung resection. METHODS We evaluated data from opioid-naïve cancer patients undergoing lung resection between 2010 and 2014 using insurance claims from the Truven Health MarketScan Databases. New persistent opioid usage was defined as continued opioid prescription fills between 90 and 180 days following surgery. Variables with a p value less than 0.10 by univariate analysis were included in a multivariable logistic regression performed for risk adjustment. Multivariable results were each reported with odds ratio (OR) and confidence interval (CI). RESULTS A total of 3,026 patients (44.8% men, 55.2% women) were identified as opioid-naïve undergoing lung resection. Mean age was 64 ± 11 years and mean postoperative length of stay was 5.2 ± 3.3 days. A total of 6.5% underwent neoadjuvant therapy, while 21.7% underwent adjuvant therapy. Among opioid-naïve patients, 14% continued to fill opioid prescriptions following lung resection. Multivariable analysis showed that age less than or equal to 64 years (OR, 1.28; 95% CI, 1.03 to 1.59; p = 0.028), male sex (OR, 1.40; 95% CI, 1.13 to 1.73; p = 0.002), postoperative length of stay (OR, 1.32; 95% CI, 1.05 to 1.65; p = 0.016), thoracotomy (OR, 1.58; 95% CI, 1.24 to 2.02; p < 0.001), and adjuvant therapy (OR, 2.19; 95% CI, 1.75 to 2.75; p < 0.001) were independent risk factors for persistent opioid usage. CONCLUSIONS The greatest risk factors for persistent opioid use (14%) following lung resection were adjuvant therapy and thoracotomy. Future studies should focus on reducing excess prescribing, perioperative patient education, and safe opioid disposal.
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Affiliation(s)
- Alexander A Brescia
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Alyssa A Mazurek
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sarah T Ward
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jay S J Lee
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hsou Mei Hu
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Chad M Brummett
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jennifer F Waljee
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Pooja A Lagisetty
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kiran H Lagisetty
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Kneuertz PJ, Singer E, D'Souza DM, Moffatt-Bruce SD, Merritt RE. Postoperative complications decrease the cost-effectiveness of robotic-assisted lobectomy. Surgery 2019; 165:455-460. [DOI: 10.1016/j.surg.2018.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/07/2018] [Accepted: 08/30/2018] [Indexed: 12/17/2022]
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Zhao W, Chen T, Feng J, Gu Z, Wang Z, Ji C, Fang W. Comparison of lymph node dissection and lymph node sampling for non-small cell lung cancers by video-assisted thoracoscopic surgery. J Thorac Dis 2019; 11:505-513. [PMID: 30962994 DOI: 10.21037/jtd.2019.01.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) has been increasingly used in the treatment of lung cancers. But it is still unclear whether mediastinal lymph node dissection (LND) under VATS is safe and feasible. The aim of this study is to figure out whether LND by VATS is safe and feasible. Methods Consecutive patients with primary resectable lung cancers referred for lobectomy and LND or sampling by VATS between January 2012 and December 2016 were retrospectively reviewed. Clinicopathological characteristics and perioperative results were collected for statistical analysis. Results Seven-hundred and seventy-three VATS lobectomy patients were included in this study, 494 received LND and 279 received lymph node sampling (LNS). There were more male patients, higher pathological T and N stage in the LND group than in the LNS group. Multivariate analysis suggested that clinical N stage higher than cN0 category and LND were independent risk factors for finding pN2 diseases in all lung cancers, while higher than cN0 category, solid or micropapillary component, and LND were independently related to finding pN2 stage in adenocarcinomas. Propensity-score matching rendered 279 pairs of patients with no significant difference in age, gender, co-morbidity, tumor location, or T stage. Although the LND group had longer operation time (128 vs. 114 minutes, P<0.001), higher amount of postoperative drainage (920 vs. 720 mL, P<0.001), longer postoperative hospital stay (6 vs. 4 days, P<0.001) than the LNS group, no difference was observed in overall morbidity or mortality between the two groups. Conclusions LND by VATS has acceptable perioperative results but can provide more accurate nodal staging compared with LNS. LND by VATS is safe, feasible, and should be recommended in patients with tumors in clinical N stages higher cN0 category or with more invasive histology.
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Affiliation(s)
- Weigang Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Tangbing Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jian Feng
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Zhexin Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Chunyu Ji
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Video-Assisted Thoracoscopic Lobectomy for Lung Cancer. Ann Thorac Surg 2019; 107:603-609. [DOI: 10.1016/j.athoracsur.2018.07.088] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/26/2018] [Accepted: 07/29/2018] [Indexed: 12/31/2022]
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Nodal upstaging evaluation in NSCLC patients treated by robotic lobectomy. Surg Endosc 2019; 33:153-158. [PMID: 29943062 DOI: 10.1007/s00464-018-6288-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Open pulmonary resection is considered the gold standard treatment of early-stage non-small cell lung cancer (NSCLC). However, in the last decades, the use of minimal-invasive techniques has given promising results. Survival in lung cancer, after surgery, depends on the number of pathological nodes (pN), thus lymph nodal upstaging can be considered a surrogate for surgical quality of the procedure. Several studies have demonstrated a lower rate of upstaging in video-assisted thoracic surgery than in open surgery, suggesting an approach-related difference in lymphadenectomy. Features of robotic technique could consent a lymph nodal dissection similar to open surgery. The aim of the study is to compare nodal upstaging between thoracotomy and robotic approaches to evaluate the oncologic radicality. METHODS Between January 2013 and December 2016, 212 consecutive cN0 NSCLC patients underwent lobectomy and lymphadenectomy (N1 + N2 stations) by either thoracotomy (Open Group) or robotic surgery (Robotic Group). RESULTS Lobectomy and lymphadenectomy were performed in 106 cN0-cN1 NSCLC patients by robotic surgery and in 106 cN0-cN1 NSCLC patients by open surgery. A mean of 14.42 ± 6.99 lymph nodes was removed in the Robotic Group (RG) and a mean of 14.32 ± 7.34 nodes in the Open Group (OG). Nodal upstaging was observed in 22 (20.75%) RG patients and in 19 OG (17.92%) patients. CONCLUSIONS Robotic lobectomy for clinical N0-N1 NSCLC appears to be equivalent to thoracotomy in terms of efficacy of lymph node dissection and nodal upstaging. Given that the nodal upstaging is a surrogate of quality of surgery, we can consider robotic lobectomy an appropriate procedure which ensures similar result to the open approach.
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Duan X, Zhu Y, Cui Y, Yang Z, Zhou S, Han Y, Yu D, Xiao N, Cao X, Li Y, Liu S, Wang Z, Zhang W, Feng L, Zhang K, Shou J, Liu Z, Xu S. Circulating tumor cells in the pulmonary vein increase significantly after lobectomy: A prospective observational study. Thorac Cancer 2018; 10:163-169. [PMID: 30511800 PMCID: PMC6360218 DOI: 10.1111/1759-7714.12925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 12/20/2022] Open
Abstract
Background It has been reported that there are more circulating tumor cells (CTCs) in the pulmonary vein (PV) than in the peripheral blood; however, it is unclear whether the CTC count changes in the PV after resection of a lung lobe. Methods Thirty‐three lung cancer patients were recruited for the study, including 17 who underwent lobectomy via video‐assisted thoracoscopic surgery and 16 via open thoracotomy. Sixty‐six blood specimens were sampled from the PV before the PV was interrupted and after lobectomy. The CTCs were quantified using the oHSV1‐hTERT‐GFP method. Results Before PV interruption, the CTC (pre‐CTC) detection rate was 79.0% (26/33), the mean number of CTCs was 3.36 (median 2, range: 0–18), and there was no significant relationship between the pre‐CTC count and clinical factors, such as histologic findings and pathological T stage (P > 0.05). After lobectomy, the CTC (post‐CTC) detection rate was 100% (33/33), the average number of CTCs was 14.88 (median 11, range: 1–69), and the post‐CTC count was significantly higher in patients in whom the PV was interrupted prior to the pulmonary artery (PA) than in patients in whom the PA was interrupted before the PV (P = 0.016). Overall, the CTC count was significantly higher following surgery (P < 0.001). Conclusion Post‐CTC counts were significantly higher than pre‐CTC counts, suggesting that surgical manipulation may potentially dislodge tumor cells into the PV. Interrupting the PV prior to the PA during lobectomy may prevent partial CTC entry into the circulation.
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Affiliation(s)
- Xinchun Duan
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yujie Zhu
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenrong Yang
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shijie Zhou
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yi Han
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Daping Yu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Ning Xiao
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Xiaoqing Cao
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yunsong Li
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Shuku Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Zitong Wang
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Wen Zhang
- Department of Immunology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Feng
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kaitai Zhang
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhidong Liu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Shaofa Xu
- Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University, Beijing, China
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Tuminello S, Liu B, Wolf A, Alpert N, Taioli E, Flores RM. Comparison of In-Hospital and Long-term Outcomes of Sublobar Lung Cancer Surgery by VATS and Open Techniques. Am J Clin Oncol 2018; 41:1149-1153. [DOI: 10.1097/coc.0000000000000440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Giang NT, Van Nam N, Trung NN, Anh LV, Cuong NM, Van Dinh N, Pho DC, Geiger P, Kien NT. Patient-controlled paravertebral analgesia for video-assisted thoracoscopic surgery lobectomy. Local Reg Anesth 2018; 11:115-121. [PMID: 30538541 PMCID: PMC6255283 DOI: 10.2147/lra.s184589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Paravertebral block has been proven to be an efficient method to provide post-thoracotomy pain management. This study aimed to compare patient-controlled paravertebral analgesia (PCPA) and intravenous patient-controlled analgesia (IVPCA) in terms of analgesic efficiency, respiratory function, and adverse effects after video-assisted thoracoscopic surgery (VATS) lobectomy. Patients and methods The prospective randomized trial study was carried out on 60 patients who underwent VATS lobectomy (randomly allocated 30 patients in each group). In the PCPA group, an initial dose of 0.3 mL/kg of 0.125% bupivacaine with fentanyl 2 µg/mL was administered, followed by a 3 mL/h continuous infusion with patient-controlled analgesia (2 mL bolus, 10-minute lockout interval, 25 mL/4 h limit). In the IVPCA group with morphine 1 mg/mL solution, an infusion device was programmed to deliver a 1.0 mL demand bolus with no basal infusion rate, with a 10-minute lockout interval and a maximum of 20 mL/4 h period. Postoperative pain was assessed by visual analog scale at rest and on coughing. Arterial blood gas and spirometry were monitored and recorded for the first 3 postoperative days. Side effects to include were also recorded. Results The PCPA group had statistically significant lower pain scores (P<0.0001) at rest at all times. Lower pain scores on coughing were statistically significant in PCPA group in the first 4 hours. Postoperative spirometry showed that both the groups had comparable recovery trajectories for their pulmonary function. Arterial blood gas analysis showed pH and PaCO2 were in a normal range in both the groups. The incidence of headache was higher in the IVPCA group (13.3% vs 0%; P=0.038). Conclusion PCPA effectively managed pain after VATS lobectomy, with lower pain scores, similar respiratory function, and fewer side effects than standard IVPCA treatment.
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Affiliation(s)
- Nguyen Truong Giang
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Van Nam
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Ngoc Trung
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Le Viet Anh
- Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Manh Cuong
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
| | - Ngo Van Dinh
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
| | - Dinh Cong Pho
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
| | - Phillip Geiger
- Department of Anesthesiology, Perioperative, and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Nguyen Trung Kien
- Department of Anesthesia and Pain Medicine, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam,
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Dalwadi SM, Lewis GD, Bernicker EH, Butler EB, Teh BS, Farach AM. Disparities in the Treatment and Outcome of Stage I Non-Small-Cell Lung Cancer in the 21st Century. Clin Lung Cancer 2018; 20:194-200. [PMID: 30655194 DOI: 10.1016/j.cllc.2018.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/28/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND African American (AA) individuals are less likely to receive treatment and more likely to die from cancer compared with Caucasian (C) individuals. Recent advancements in surgery and radiation have improved outcomes in early stage non-small-cell lung cancer (ESNSCLC). We studied racial disparities in ESNSCLC in the past decade. PATIENTS AND METHODS The Surveillance, Epidemiology, and End Results database was used to retrieve data of 62,312 ESNSCLC patients age 60 years and older diagnosed between 2004 and 2012. Patients were divided into racial cohorts: C, AA, American Indian (AI), Asian/Pacific Islander (API), or unknown. Demographics characteristics, therapy, and survival were compared using χ2 test, Kaplan-Meier method, and Cox multivariate analysis. RESULTS AA and AI individuals were less likely to receive surgery than typical ESNSCLC patients (55.9% and 57.6% vs. 66.7%; P < .0001). Two-year overall survival (OS) for C individuals was 70%, for AA 65%, AI 60%, and API 76% (P < .0001). Two-year cancer-specific survival (CSS) for C individuals was 79%, AA 76%, AI 73%, and API 84% (P < .0001). Median CSS for AI and AA individuals was less than that of typical ESNSCLC patients (49 and 80 months vs. 107 months; P < .0001). This difference disappeared in multivariate analysis, accounted by sex, age, treatment, histology, and T stage (all P < .0001). CONCLUSION Despite treatment advancements in the past decade, AA and AI individuals continue to have worse OS and CSS from ESNSCLC. This might be because of the association with more adverse risk factors, including older age, squamous histology, male sex, T2 stage, and tendency to forgo treatment.
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Affiliation(s)
- Shraddha M Dalwadi
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX
| | - Gary D Lewis
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX
| | - Eric H Bernicker
- Institute for Academic Medicine, Research Institute, Houston Methodist Hospital, Houston, TX
| | - E Brian Butler
- Department of Radiation Oncology, Institute for Academic Medicine, Research Institute, Houston Methodist Hospital, Houston, TX
| | - Bin S Teh
- Department of Radiation Oncology, Institute for Academic Medicine, Research Institute, Houston Methodist Hospital, Houston, TX
| | - Andrew M Farach
- Department of Radiation Oncology, Institute for Academic Medicine, Research Institute, Houston Methodist Hospital, Houston, TX.
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Fourdrain A, De Dominicis F, Iquille J, Lafitte S, Merlusca G, Witte-Pfister A, Meynier J, Bagan P, Berna P. Intraoperative conversion during video-assisted thoracoscopy does not constitute a treatment failure†. Eur J Cardiothorac Surg 2018; 55:660-665. [DOI: 10.1093/ejcts/ezy343] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/05/2018] [Accepted: 09/13/2018] [Indexed: 01/23/2023] Open
Affiliation(s)
- Alex Fourdrain
- Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
| | | | - Jules Iquille
- Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
| | - Sophie Lafitte
- Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
| | - Geoni Merlusca
- Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
| | | | - Jonathan Meynier
- Department of Biostatistics, Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France
| | - Patrick Bagan
- Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
| | - Pascal Berna
- Department of Thoracic Surgery, Amiens University Hospital, Amiens, France
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Sihoe ADL. Uniportal Lung Cancer Surgery: State of the Evidence. Ann Thorac Surg 2018; 107:962-972. [PMID: 30300638 DOI: 10.1016/j.athoracsur.2018.08.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/21/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Uniportal video-assisted thoracic surgery (VATS) has generated much attention in recent years, but questions remain regarding the adequacy of evidence to support its use in lung cancer surgery. This review aims to explore what the currently published literature suggests the role of the uniportal approach may be and to critically appraise that literature. METHODS A systematic review was conducted using the Ovid Medline database to identify articles related to uniportal VATS. Articles were selected for review on the basis of ability to provide original clinical data on the role of uniportal VATS for lung cancer surgery. RESULTS The literature search revealed that only some publications on uniportal VATS provided original clinical data. Twenty-two articles were selected for review, including 9 case series and 13 comparative studies. No concerns about the safety of the uniportal VATS were noted. Some but not all comparative studies provided data suggesting that uniportal VATS may hold advantages over multiportal VATS in some simple clinical outcomes (such as reduced lengths of stay and postoperative pain). However, the quantity and quality of evidence thus far are limited. CONCLUSIONS It remains premature to declare superiority for uniportal VATS in lung cancer surgery. A higher level of evidence is needed, especially in investigating objective benefits and treatment efficacy of the single-incision approach.
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Affiliation(s)
- Alan D L Sihoe
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Division of Thoracic Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, China; Department of Thoracic Surgery, Tongji University Shanghai Pulmonary Hospital, Shanghai, China.
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Kumar A, Asaf BB, Puri HV, Sharma MK, Lingaraju VC, Rajput VS. Video-assisted thoracoscopic surgery lobectomy: The first Indian report. J Minim Access Surg 2018; 14:291-297. [PMID: 29319014 PMCID: PMC6130190 DOI: 10.4103/jmas.jmas_148_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/11/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The fear of pleural adhesions and densely stuck lymph nodes in India, a country where tuberculosis is endemic, is one major factor keeping our surgeons away from video-assisted thoracoscopic surgery (VATS) lobectomy. In this paper, we aim to report our experience with performing VATS lobectomy in 102 cases using a standardised three-port anterior approach. MATERIALS AND METHODS Between March 2012 and September 2016, we performed 102 VATS lobectomies. Sixty patients (58.8%) were males and 42 females (41.2%), with a mean age of 42.02 years. Diagnoses were as follows: benign disease (72), lung cancer (27) and pulmonary metastases (3). Among the cases with primary lung cancer, twenty out of 27 (74%) were adenocarcinoma and 7 cases of squamous carcinoma (25.92%). All patients underwent lobectomy by a standardised three-port anterior approach. RESULTS The overall conversion rate was 8.82% (n = 9). We observed no postoperative complications in 82 (80.4%) patients. The average blood loss was 211.37 ml. Mean operative time was 173 min. Median length of hospital stay was 5 with median chest tube duration of 4.9 days. There was no in hospital or 30-day mortality. The most common complication was prolonged air leak. CONCLUSION From this first Indian series, it is clear that VATS lobectomy is feasible in both benign and malignant cases. It also shows that the fear of adhesions is unwarranted and properly selected benign cases can also undergo VATS lobectomy safely.
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Affiliation(s)
- Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | | | - Vimesh S. Rajput
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Allakhverdiev A, Davydov M, Akhmedov P. Thoracoscopic lobectomy with mediastinal lymph node dissection as a standard surgery for T1-2N0M0 non-small cell lung cancer (>300 surgeries experience). Ann Med Surg (Lond) 2018; 35:169-172. [PMID: 30319774 PMCID: PMC6180294 DOI: 10.1016/j.amsu.2018.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/01/2018] [Accepted: 09/18/2018] [Indexed: 01/05/2023] Open
Abstract
Background A lot of clinics worldwide in recent years recommend the use of minimally invasive surgical procedures in the early stages of lung cancer claiming that this technique helps reduce the number of postoperative complications, shortens the period of social rehabilitation of patients, without significantly affecting the long-term results of treatment. In this study we evaluate immediate and long-term results of surgical treatment of patients with early stages of non-small cell lung cancer (NSCLC) after video-assisted thoracoscopic lobectomy (VATS) with mediastinal lymph node dissection. Materials and methods Since 2008 317 patients with T1-2N0M0 NSCLC over 20 (median age was 65.3 ± 2.5) years underwent VATS with mediastinal lymphadenectomy. Total number of men was 186 (58.7%), women - 131 (41.3%). Histologically verified adenocarcinoma was in 278 (87, 7%), Squamous cell carcinoma in 39 (12.3%). A group of patients who underwent thoracotomy lobectomy (n = 189) was taken to compare immediate and long-term results. Median age in this group was 66.5 ± 1.7. Total number of men was 115, women - 74. Histologically verified adenocarcinoma was in 154 (82.4%), Squamous cell carcinoma in 35 (17.6%). Results Conversion to thoracotomy during VATS was in 14.3% of surgeries. There was no postoperative mortality in VATS group, whereas in open surgeries this happened in 2.6%. The 3 and 5-year overall survival (OS) rate was 94.0% and 94.0% in the VATS group respectively, 83.0% and 78.0% in the thoracotomy group for clinical stage T1N0M0 NSCLC (p = 0.04554). Conclusion Considering the results of our research and the literature review we made sure that VATS lobectomy with mediastinal lymph node dissection is an alternative procedure to open approaches: it is much safer, reduce the frequency of post-operative complications and the rehabilitation period. We believe that complete VATS lobectomy with mediastinal lymph node dissection must be taken as a standard in surgical treatment of patients with early stages of non-small cell lung cancer.
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Affiliation(s)
- Arif Allakhverdiev
- Department of Thoracic Surgery, N.N. Blokhin Cancer Research Center, Kashirskoe Road 23, 115478, Moscow, Russian Federation
| | - Mikhail Davydov
- Department of Thoracic Surgery, N.N. Blokhin Cancer Research Center, Kashirskoe Road 23, 115478, Moscow, Russian Federation
| | - Parvin Akhmedov
- Department of Thoracic Surgery, N.N. Blokhin Cancer Research Center, Kashirskoe Road 23, 115478, Moscow, Russian Federation
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Odaka M, Noda Y, Tsukamoto Y, Kato D, Shibasaki T, Mori S, Asano H, Matsudaira H, Yamashita M, Morikawa T. Impact of the introduction of thoracoscopic lobectomy for non-small cell lung cancer: a propensity score-matched analysis. J Thorac Dis 2018; 10:4985-4993. [PMID: 30233873 DOI: 10.21037/jtd.2018.07.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The present study evaluated the impact of the introduction of thoracoscopic lung lobectomy (TL) for non-small cell lung cancer at our institution. Methods This study retrospectively compared surgical and oncological outcomes in the period before and after the introduction of TL for non-small cell lung cancer. Propensity score-matched analysis was performed with respect to baseline patient variables and tumor characteristics. Results Patients were divided into two groups: those who underwent lung lobectomy in the period before (BI group, n=261) and after (AI group, n=261) the introduction of TL. The proportion of TLs at our institution increased from 1.3% in the BI group to 93% in the AI group. The AI group experienced a longer duration of surgery, lesser intraoperative blood loss, and a significantly shorter postoperative hospital stay (POHS). There were no significant differences in postoperative complications between the two groups. The median follow-up period was 50 months in both groups. No significant differences were observed between the BI and AI groups with respect to 5-year overall survival (OS) (76.1% and 71.7%, respectively; P=0.1973) and disease-free survival (DFS) (67.6% and 66.1%, respectively; P=0.4071). On multivariate analysis, pathological N1-2 status was an independent predictor of survival. AI group and TL showed no independent association with survival. Conclusions The introduction of TL represented a positive change at our institution owing to decreased invasiveness and oncological equivalence of the surgical treatment for non-small cell lung cancer.
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Affiliation(s)
- Makoto Odaka
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Noda
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yo Tsukamoto
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Daiki Kato
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takamasa Shibasaki
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Shohei Mori
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hisatoshi Asano
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Matsudaira
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Yamashita
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Morikawa
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
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165
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Patient-Controlled Paravertebral Block for Video-Assisted Thoracic Surgery: A Randomized Trial. Ann Thorac Surg 2018; 106:888-894. [DOI: 10.1016/j.athoracsur.2018.04.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 11/22/2022]
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166
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Lin R, Che G. Risk factors of cough in non-small cell lung cancer patients after video-assisted thoracoscopic surgery. J Thorac Dis 2018; 10:5368-5375. [PMID: 30416784 DOI: 10.21037/jtd.2018.08.54] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Cough is a common respiratory complication in non-small cell lung cancer (NSCLC) patients after surgery. Previous studies have proposed a number of risk factors for postoperative cough; however, these studies are mainly based on traditional thoracotomies and tend to lack adequate objective assessment methods. The purpose of this study was to identify the risk factors of cough in NSCLC patients after video-assisted thoracoscopic surgery (VATS) using the Leicester Cough Questionnaire in Mandarin Chinese (LCQ-MC) to evaluate postoperative cough. Methods A total of 198 NSCLC patients were enrolled. Overall, 91 patients (46.0%) developed cough after VATS, and 73 patients remained cough after 1 month. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors of postoperative cough. Results The independent factors of postoperative cough included female sex [odds ratio (OR) 2.399, 95% confidence interval (CI): 1.260-4.565, P=0.008], duration of anesthesia (over 164 minutes; OR 2.810, 95% CI: 1.368-5.771, P=0.005), resection of the lower paratracheal nodes (OR 3.697, 95% CI: 1.439-9.499, P=0.007), and resection of the subcarinal nodes (OR 4.175, 95% CI: 1.203-14.495, P=0.024). The follow-up LCQ-MC total score after 1 month (18.00±1.80) was significantly higher than the postoperative total score (16.35±2.26; P=0.004). Conclusions Female sex, duration of anesthesia over 164 minutes, lower paratracheal node resection and subcarinal node resection were independent risk factors related to cough in NSCLC patients after VATS. In addition, the LCQ-MC performed satisfactorily in describing the longitudinal changes in cough symptoms.
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Affiliation(s)
- Rongjia Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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167
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Robotic versus Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:338-343. [PMID: 30394958 DOI: 10.1097/imi.0000000000000557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective Pulmonary segmentectomy using robotic assistance is often perceived as being more expensive than segmentectomy using video-assisted thoracic surgery. The robotic technique allows for meticulous dissection during segmentectomy, potentially leading to fewer parenchymal injuries, fewer air leaks, and shorter length of stay. This study compared pulmonary segmentectomy costs using video-assisted thoracic surgery versus robotic with manual staplers versus robotic with robotic staplers. Methods Retrospective analyses were performed evaluating our early experience with robotic pulmonary segmentectomy for 30 months compared with the video-assisted thoracic surgery approach. All 50 anatomical segmentectomies performed since introduction of robotic technique in the practice were included. Twenty-eight procedures were robotic-assisted and 22 were video-assisted thoracic surgery. Procedure-specific evaluation of direct costs was performed, including cost of robotic instruments, staplers, and average length of stay in the hospital. Results The mean ± SD age was 70 ± 10 years (range = 43–91 years). There were 12 males in the robotic group and eight in the video-assisted thoracic surgery group ( P = 0.642). The mean age was 69 years in the robotic group and 71 years in the video-assisted thoracic surgery group ( P = 0.367). The median length of stay was 2 (2–4) days in the robotic group (range = 1–9) and 4 (2–5) days in the video-assisted thoracic surgery group (range = 1–20, P = 0.089). The cost of robotic segmentectomy with manual staplers was less than that with robotic staplers. Both robotic techniques cost less than video-assisted thoracic surgery. Conclusions In this small series, cost and outcomes in our early experience with robotic-assisted segmentectomy were comparable with our video-assisted thoracic surgery approach with trends toward shorter length of stay and fewer complications. Larger series are needed to validate these results.
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168
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The Role of an Array of Routine Clinical Variables to the Occurrence and Severity of Postoperative Pneumonia in Non–Small Cell Lung Cancer Patients. Int Surg 2018. [DOI: 10.9738/intsurg-d-16-00193.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background and purpose:
Data of an array of preoperative/intraoperative clinical variables may carry significant information for predicting the probability of postoperative pneumonia or chest infection in non–small cell lung cancer (NSCLC) patients. We aimed to investigate the association between those variables and the occurrence of postoperative pneumonia (POP) as well as the severity of POP, based on routine laboratory tests, basic characteristics, and perioperative variables during the in-hospital period.
Methods:
A consecutive series of NSCLC patients undergoing lung cancer lobectomy at our department from January 2014 and December 2015 was used as the target patient group and stratified into 2 groups: pneumonia (POP) and non-pneumonia (N-POP), according to occurrence of pneumonia after lobectomy in 30 days. The POP was classified into 5 severity grades, based on the Clavien-Dindo complication classification system.
Results:
Regarding binary logistic regression analysis for risk factors of POP, the following were found to be the independent risk factors of the occurrence of POP: postoperative predicted forced expiratory volume in 1 second [ppoFEV1%; odds ratio (OR): 0.996, 95% confidence interval (CI): 0.993–0.999; P = 0.021]; Charlson comorbidity index (CCI) score >3 (OR: 2.694, 95% CI: 1.462–4.965; P = 0.001); American Society of Anesthesiologists (ASA)score >3 (OR: 2.066, 95% CI: 1.060–4.029; P = 0.033); postoperative predicted diffusion capacity for carbon monoxide of the lung (ppoDlco%; OR: 0.458, 95% CI: 0.090–0.809; P = 0.014); and neutrophil-lymphocyte ratio (NLR; OR: 2.171, 95% CI: 1.721–2.737; P < 0.001). With regard to risk factors analysis of pneumonia severity via ordinal polytomous logistic regression, the following were the independent risk factors: early stage (OR: 0.626, 95% CI: 0.422–0.929, P = 0.020); CCI score >3 (OR: 1.914, 95% CI: 1.058–3.459, P = 0.032); ppoDlco% (OR: 0.638, 95% CI: 0.445–0.914, P = 0.014); and NLR (OR: 1.218, 95% CI: 1.031–1.436, P = 0.020).
Conclusion:
Among an array of clinical variables in the hospital, major risk factors for POP following LC surgery were ppoFEV1%, ppoDlco%, NLR, ASA score >3, and CCI score>3; meanwhile, ppoDlco%, CCI score>3, NLR, and early tumor stage were the key predictors of POP severity.
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169
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Chen D, Mao R, Kadeer X, Sun W, Zhu E, Peng Q, Chen C. Video-assisted thoracic surgery is an optimal alternative to conventional thoracotomy for reoperations for ipsilateral pulmonary lesions. Thorac Cancer 2018; 9:1421-1428. [PMID: 30152592 PMCID: PMC6209788 DOI: 10.1111/1759-7714.12854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Ipsilateral pulmonary reoperation is empirically considered a contraindication of video-assisted thoracic surgery (VATS) because of intrapleural adhesion and the destruction of anatomical structures caused by previous surgery. The purpose of this study was to present our experience of the use of VATS for ipsilateral reoperations. METHODS The medical records of patients who underwent VATS reoperation or re-thoracotomy between January 2006 and March 2017 were retrospectively reviewed. Data were compared to assess the feasibility and safety of VATS for ipsilateral reoperations. RESULTS The study enrolled 64 patients, including 36 patients who underwent attempted ipsilateral VATS reoperations (VATS group) and 28 who underwent conventional re-thoracotomy as a control with clinicopathological characteristics similar to those in the VATS group. Intrapleural severe adhesions were detected in 28 (77.8%) and 22 (78.6%) patients in the VATS and re-thoracotomy groups, respectively (P = 0.906), and their dissection required a longer period in the VATS group (P = 0.014). VATS reoperations were converted to re-thoracotomy or video-assisted mini re-thoracotomy in three patients because of bleeding or difficulty in dissecting hilar structures. There were no significant differences in resection methods, time to reoperation, intraoperative blood loss, or drainage time between the two groups. However, patients in the VATS group had a shorter hospital stay (P < 0.01) and fewer complications (P = 0.042). CONCLUSION VATS is an optimal alternative to re-thoracotomy for ipsilateral pulmonary lesions, regardless of intrapleural adhesions and the destruction of anatomical structures caused by former operations in selected patients.
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Affiliation(s)
- Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rui Mao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiermaimaiti Kadeer
- Department of Thoracic Surgery, The Sixth People's Hospital of Nantong, Nantong, China
| | - Weiyan Sun
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Erjia Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiao Peng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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170
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Jiang G, Chen C, Zhu Y, Xie D, Dai J, Jin K, Shen Y, Wang H, Li H, Zhang L, Gao S, Chen K, Zhang L, Zhou X, Shi J, Wang H, Xie B, Jiang L, Fan J, Zhao D, Chen Q, Duan L, He W, Zhou Y, Liu H, Zhao X, Zhang P, Qin X. [Shanghai Pulmonary Hospital Experts Consensus on the Management of Ground-Glass Nodules Suspected as Lung Adenocarcinoma (Version 1)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:147-159. [PMID: 29587930 PMCID: PMC5973030 DOI: 10.3779/j.issn.1009-3419.2018.03.05] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
随着胸部计算机断层扫描(computed tomography, CT)检查,尤其是低剂量薄层CT筛查项目在中国的广泛开展,越来越多的无症状肺部磨玻璃结节(ground-glass nodules, GGNs)被发现。虽然国内及国际上已发布了一系列针对肺部GGNs的指南,但是这些指南的撰写者多来自呼吸、肿瘤及影像专业,可能缺乏对现代微创胸外科的充分认识,造成外科手术在肺部GGNs诊治中的作用不明确,甚至被低估;而且,肺部肿瘤相关的各学科对于早期肺癌,尤其是浸润前病变的处理也缺乏统一规范。因此,基于国内外现有文献及上海市肺科医院多年积累的经验,上海市肺科医院撰写了此诊疗共识。本共识推荐对于疑似肺腺癌的GGNs进行多学科评估,依据诊断,选择合理的处置方式。对于疑似原位腺癌,推荐进行胸部薄层CT随访,或在特定情况下进行不超过肺段切除的限制性肺切除;对于疑似微浸润腺癌,推荐进行限制性肺切除或肺叶切除;对于疑似浸润性腺癌,建议依据病灶是否含有磨玻璃成分、位置、大小、个数及患者躯体情况选择合理的手术方式;而肺多发结节的处理原则推荐为主病灶优先,兼顾次要病灶,综合选择治疗方案。
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Affiliation(s)
- Gening Jiang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Chang Chen
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Yuming Zhu
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Dong Xie
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Jie Dai
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Kaiqi Jin
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Yingran Shen
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Haifeng Wang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Hui Li
- Capital Medical University Affiliated Beijing Chao-Yang Hospital, Beijing 100020 , China
| | - Lanjun Zhang
- Sun Yat-sen University Cancer Center, Guangzhou 510060 , China
| | - Shugeng Gao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Keneng Chen
- Peking University Cancer Hospital and Institute, Beijing 100142 , China
| | - Lei Zhang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Xiao Zhou
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Jingyun Shi
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Hao Wang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Boxiong Xie
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Lei Jiang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Jiang Fan
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Deping Zhao
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Qiankun Chen
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Liang Duan
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Wenxin He
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Yiming Zhou
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Hongcheng Liu
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Xiaogang Zhao
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Peng Zhang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Xiong Qin
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
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171
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Guo H, Diao Y, Fan H, Luo Q. [Clinical Value of Four-hole Unilateral Dissecting Lobectomy and Mediastinal Lymph Node Dissection in the Treatment of Early Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:578-582. [PMID: 30172263 PMCID: PMC6105359 DOI: 10.3779/j.issn.1009-3419.2018.08.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thoracoscopic lobectomy combined with mediastinal lymph node dissection has been considered as one of the standard surgical procedures for early lung cancer. After 20 years of development, thoracoscopic lobectomy has reached a consensus on reliability and minimally invasive. At present, thoracoscopic lobectomy has a variety of incisions, which gradually evolve into four holes based on three holes, and two or one hole as the operative approach. The aim of this study was to evaluate the clinical value of four-hole unilateral dissecting lobectomy and mediastinal lymph node dissection in the treatment of non-small cell lung cancer (NSCLC). The aim of this study was to investigate the clinical value of anatomical lobectomy with mediastinal lymphadenectomy under four-hole completely video-assisted thoracoscopic surgery (C-VATS) in the treatment of non-small cell lung cancer. METHODS The patients undergoing lobectomy with mediastinal lymphadenectomy for NSCLC were identified in the Department of Thoracic Surgery, Yangzhou First People's Hospital, Yangzhou University from March 2015 to July 2016. Preoperative clinical diagnosis of peripheral-type early NSCLC. The patients were randomly divided into four-hole monophasic group (experimental group) and three-hole group (control group) according to the number of hospitalization before surgery. According to inclusion and exclusion criteria, the 39 cases assign in experimental group and 34 cases in the control group, including 36 males and 37 females; aged 38 to 84 years. The mean operation time, average blood loss, lymph node dissection group, average drainage, average extubation time and postoperative complications were compared between the two groups for statistical analysis. RESULTS The two groups of patients were successfully completed surgery, no death after surgery. Mean bleeding in the two groups, the number of lymph node dissection group, the average postoperative drainage, the average time of extubation, postoperative complications, with no significant difference. The average operation time of the four-hole unidirectional group was shorter than that of the three-hole group. The difference was statistically significant (P<0.05). CONCLUSIONS The safety and efficacy of a four-hole one-way operation under VATS are satisfactory. The operation is smooth during operation, which shortens the course of operation and deserves the clinical promotion.
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Affiliation(s)
- Hong Guo
- Department of Thoracic Surgery, Affiliated to Hospital of Yangzhou University, Yangzhou 225000, China
| | - Yali Diao
- Department of Thoracic Surgery, Affiliated to Hospital of Yangzhou University, Yangzhou 225000, China
| | - Huangxin Fan
- Department of Thoracic Surgery, Affiliated to Hospital of Yangzhou University, Yangzhou 225000, China
| | - Qingquan Luo
- Department of Thoracic Surgery, Affiliated to Hospital of Shanghai Jiao Tong University, Shanghai 200240, China
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172
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Dal Agnol G, Oliveira R, Ugalde PA. Video-assisted thoracoscopic surgery lobectomy with chest wall resection. J Thorac Dis 2018; 10:S2656-S2663. [PMID: 30345102 DOI: 10.21037/jtd.2018.04.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Lung cancer presents with chest wall invasion in 5-8% of patients, which imparts some treatment challenges. Surgical resection is currently the standard of care, and there are some controversies regarding the best approach. Published series and case reports confirm the safety and feasibility of video-assisted thoracoscopic surgery (VATS) in highly complex surgical cases including lobectomy with chest wall resection of locally advanced lung cancer. In this article, we present the clinical indications of locally advanced lung cancer that infiltrates the chest wall, the modalities for and importance of accurately staging lung cancers with chest wall invasion, and the technical aspects of accomplishing a safe and oncologically sound extended resection through VATS.
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Affiliation(s)
- Guilherme Dal Agnol
- Divison of Thoracic Surgery, Americas-Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - Ricardo Oliveira
- Division of Thoracic Surgery, Santa Casa de Misericórdia da Bahia, University-affiliated hospital, Quebec, Canada
| | - Paula A Ugalde
- Department of Respiratory Medicine and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
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Mun M, Nakao M, Matsuura Y, Ichinose J, Nakagawa K, Okumura S. Video-assisted thoracoscopic surgery lobectomy for non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2018; 66:626-631. [DOI: 10.1007/s11748-018-0979-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/25/2018] [Indexed: 12/19/2022]
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174
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LoMauro A, Aliverti A, Chiesa M, Cattaneo M, Privitera E, Tosi D, Nosotti M, Santambrogio L, Palleschi A. Ribcage kinematics during exercise justifies thoracoscopic versus postero-lateral thoracotomy lobectomy prompt recovery. Eur J Cardiothorac Surg 2018; 52:1197-1205. [PMID: 28977548 DOI: 10.1093/ejcts/ezx174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/09/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The video-assisted thoracic surgery (VATS) approach is encouraged over postero-lateral thoracotomy (PLT) for lobectomy in lung cancer. We compare the ribcage kinematics during exercise before and after both procedures, assuming that VATS, being minimally invasive, could better preserve ribcage expansion. METHODS Thirty-one patients undergoing lobectomy by means of VATS (n = 20) or PLT (n = 11) were compared presurgery, after chest drainage removal (T1) and 2 months post-surgery (T2) during quiet breathing and incremental exercise. Spirometry, chest pain, ventilatory pattern and expansions of the ribcage (ΔVRC) and abdomen were measured. Furthermore, the expansion of the ribcage and abdomen in the operated (ΔVRC-OP and ΔVAB-OP, respectively) and non-operated (ΔVRC-NO and ΔVAB-NO, respectively) sides was also considered. RESULTS At T1, in both groups, spirometry worsened and chest pain increased, being higher after PLT. Tidal volume (VT) decreased after PLT because the ribcage expanded less due to reduced ΔVRC-OP. Contrary to this, in VATS, there were no changes in VT and ΔVRC, although ΔVRC-OP was lower, because ΔVRC-NO increased at high level of exercise. At T2, ΔVRC-OP was completely restored after VATS. At high levels of exercise following PLT, although patients still showed reduced ΔVRC and ΔVRC-OP, VT was restored owing to increased ΔVAB-NO. CONCLUSIONS We demonstrate VATS to have a reduced impact on ribcage kinematics while PLT induced restriction more markedly during exercise and still present 2 months after surgery. Patients adopt 2 different compensatory mechanisms, by shifting the expansion toward the contralateral ribcage after VATS and toward the abdomen after PLT. Our study justifies thoracoscopic lobectomy prompt recovery. Clinical trial registration clinicaltrials.gov (NCT02910453).
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Affiliation(s)
- Antonella LoMauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Melania Chiesa
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Margherita Cattaneo
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emilia Privitera
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Tosi
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Santambrogio
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Palleschi
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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175
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Novel development of Spectra-A using indocyanine green for segmental boundary visibility in thoracoscopic segmentectomy. J Surg Res 2018; 227:228-233. [DOI: 10.1016/j.jss.2018.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/15/2018] [Accepted: 02/13/2018] [Indexed: 11/18/2022]
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Dunne EM, Fraser IM, Liu M. Stereotactic body radiation therapy for lung, spine and oligometastatic disease: current evidence and future directions. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:283. [PMID: 30105233 PMCID: PMC6068327 DOI: 10.21037/atm.2018.06.40] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/11/2018] [Indexed: 12/16/2022]
Abstract
Stereotactic body radiation therapy (SBRT) also referred to as stereotactic ablative radiotherapy (SABR), is a technique which has emerged over the past two decades due to improvements in radiation technology. Unlike conventional external beam radiotherapy (cEBRT) which traditionally delivers radiation in small doses [approximately 2 Gray (Gy) per fraction] over several weeks, SBRT, typically delivered in one to eight fractions, is a technique whereby potentially ablative doses of radiotherapy (usually 7.5-20 Gy per fraction) can be delivered with steeper dose gradients and sub millimetre precision, minimising risk to surrounding normal tissues. The potential benefits of excellent tumor control with low toxicity has led to the increasing use of SBRT in a number of clinical situations. Due to compelling evidence, SBRT is now the treatment of choice for medically inoperable patients with peripherally located stage I non-small cell lung cancer (NSCLC). Controversy remains however as to its efficacy and safety for central or ultra-central lung tumors. The evidence base supporting the use of SBRT as a novel treatment for spinal metastases and oligometastases is rapidly expanding but challenges remain in these difficult patient populations. In an era where targeted therapy and improved systemic treatments for stage IV cancer have resulted in increased disease-free survival, and our knowledge of the oligometastatic state is ever expanding, using SBRT to treat metastatic disease and gain durable local control is increasingly desirable. Several randomized trials are currently underway and are sure to provide valuable information on the benefit and utility of SBRT across many tumor sites including early-stage NSCLC, spinal metastases and oligometastatic disease. Recognizing the evolving role of SBRT in clinical practice, this paper provides a critical review of recent developments in each of these areas particularly highlighting the challenges facing clinicians and discusses potential areas for future research.
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Affiliation(s)
- Emma Maria Dunne
- Department of Radiation Oncology, British Columbia Cancer Agency (BCCA), Vancouver, Canada
| | - Ian Mark Fraser
- Department of Radiation Oncology, British Columbia Cancer Agency (BCCA), Vancouver, Canada
| | - Mitchell Liu
- Department of Radiation Oncology, British Columbia Cancer Agency (BCCA), Vancouver, Canada
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177
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Reichert M, Pösentrup B, Hecker A, Padberg W, Bodner J. Lung decortication in phase III pleural empyema by video-assisted thoracoscopic surgery (VATS)-results of a learning curve study. J Thorac Dis 2018; 10:4311-4320. [PMID: 30174878 DOI: 10.21037/jtd.2018.06.72] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Pleural empyema (PE) is a devastating disease with a high morbidity and mortality. According to the American Thoracic Society it is graduated into three phases and surgery is indicated in intermediate phase II and organized phase III. In the latter, open decortication of the lung via thoracotomy is the gold standard whereas the evidence for feasibility and safety of a minimally-invasive video-assisted thoracoscopic approach is still poor. Methods Retrospective single-center analysis of patients undergoing surgery for phase III PE from 02/2011 to 03/2015 [n=138, including n=130 VATS approach (n=3 of them with bilateral disease) and n=8 open approach]. The learning curve was assessed by grouping those 127 patients with unilateral disease who underwent a video-assisted thoracoscopic approach into two groups: VATS-1 (03/2011 to 06/2012, n=43) and VATS-2 (06/2012 to 03/2015, n=84). Results ASA-scores (P=0.0279) and rate of pre-operative drainage therapy (P=0.0534) were higher in VATS-2 patients. Operating times were longer in VATS-1 (P=0.0308), intra-operative complication as well as conversion to open surgery rates did both not differ. Rates of post-operative vasoconstrictive therapy (P=0.0191) and prolonged mechanical ventilation (P=0.0560) were both higher in VATS-2, however, post-operative length of stay (LOS) at intensive care unit, overall post-operative LOS and post-operative complication rate were similar in both groups. Conclusions Video-assisted thoracoscopic surgery is feasible for evacuation and decortication in late phase III PE. A learning curve of approximately 40 cases is sufficient to gain procedure-specific surgical skills and thus reduce the operating times sufficiently.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - Bernd Pösentrup
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - Andreas Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Giessen, Germany
| | - Johannes Bodner
- Department of Thoracic Surgery, Klinikum Bogenhausen, Munich, Germany.,Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Innsbruck, Austria
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178
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Petersen RH, Gjeraa K, Jensen K, Møller LB, Hansen HJ, Konge L. Assessment of competence in video-assisted thoracoscopic surgery lobectomy: A Danish nationwide study. J Thorac Cardiovasc Surg 2018; 156:1717-1722. [PMID: 29773444 DOI: 10.1016/j.jtcvs.2018.04.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/05/2018] [Accepted: 04/07/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Competence in video-assisted thoracoscopic surgery lobectomy has previously been established on the basis of numbers of procedures performed, but this approach does not ensure competence. Specific assessment tools, such as the newly developed video-assisted thoracoscopic surgery lobectomy assessment tool, allow for structured and objective assessment of competence. Our aim was to provide validity evidence for the video-assisted thoracoscopic surgery lobectomy assessment tool. METHODS Video recordings of 60 video-assisted thoracoscopic surgery lobectomies performed by 18 thoracic surgeons were rated using the video-assisted thoracoscopic surgery lobectomy assessment tool. All 4 centers of thoracic surgery in Denmark participated in the study. Two video-assisted thoracoscopic surgery experts rated the videos. They were blinded to surgeon and center. RESULTS The total internal consistency reliability Cronbach's alpha was 0.93. Inter-rater reliability between the 2 raters was Pearson's r = 0.71 (P < .001). The mean video-assisted thoracoscopic surgery lobectomy assessment tool scores for the 10 procedures performed by beginners were 22.1 (standard deviation [SD], 8.6) for the 28 procedures performed by the intermediate surgeons, 31.2 (SD, 4.4), and for the 20 procedures performed by experts 35.9 (SD, 2.9) (P < .001). Bonferroni post hoc tests showed that experts were significantly better than intermediates (P < .008) and beginners (P < .001). Intermediates' mean scores were significantly better than beginners (P < .001). The pass/fail standard calculated using the contrasting group's method was 31 points. One of the beginners passed, and 2 experts failed the test. CONCLUSIONS Validity evidence was provided for a newly developed assessment tool for video-assisted thoracoscopic surgery lobectomy (video-assisted thoracoscopic surgery lobectomy assessment tool) in a clinical setting. The discriminatory ability among expert surgeons, intermediate surgeons, and beginners proved highly significant. The video-assisted thoracoscopic surgery lobectomy assessment tool could be an important aid in the future training and certification of thoracic surgeons.
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Affiliation(s)
- René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Kirsten Gjeraa
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Katrine Jensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
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179
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Oncologic Equivalence of Minimally Invasive Lobectomy: The Scientific and Practical Arguments. Ann Thorac Surg 2018; 106:609-617. [PMID: 29678519 DOI: 10.1016/j.athoracsur.2018.02.089] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/11/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite the slow adoption of minimally invasive lobectomy (MIL), it is now a preferred approach for early lung cancer. Nevertheless, ongoing concerns about MIL oncologic effectiveness has led to calls for prospective, randomized trials. METHODS Retrospective analysis of on-line databases, collected readings, and other scholarly experiences of the experienced authors were used to construct this review. All available reports that contained long-term survival comparisons for open versus MIL were tabulated. RESULTS The preponderance of limited randomized and numerous large propensity-matched database analyses indicate equivalent or improved long-term MIL survival for early-stage disease. MIL lymph node dissection quality has been challenged; however, this was attributed to MIL avoidance of central tumors in early reports. Although technical inadequacies for MIL should be amplified for advanced cancer resections, early reports show no such concern. In fact, for special populations such as older, frail patients, evidence is much stronger that MIL confers a survival advantage. CONCLUSIONS MIL is an oncologically equivalent operation with substantially less morbidity, especially in frail populations. It is reasonable to suggest that MIL should be the technique of choice, even a quality indicator, for lobectomy.
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180
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Boisen ML, Sardesai MP, Kolarczyk L, Rao VK, Owsiak CP, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights From 2017. J Cardiothorac Vasc Anesth 2018; 32:1556-1569. [PMID: 29655515 DOI: 10.1053/j.jvca.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Michael L Boisen
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
| | - Mahesh P Sardesai
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
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181
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Sbrocchi AJ, Denlinger CE. Occam's razor: What is the best approach for a lobectomy? J Thorac Cardiovasc Surg 2018; 156:363-364. [PMID: 29655538 DOI: 10.1016/j.jtcvs.2018.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Alexander J Sbrocchi
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Chadrick E Denlinger
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
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182
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Abstract
Historically, the prognosis for individuals diagnosed with lung cancer has been bleak. However, the past 10 years have seen important advances in treatment and diagnosis which have translated into the first improvements seen in lung cancer survival. This review highlights the major advances in treatments with curative intent, systemic targeted therapies, palliative care and early diagnosis in lung cancer. We discuss the pivotal research that underpins these new technologies/strategies and their current position in clinical practice.
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Affiliation(s)
- Gavin S Jones
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - David R Baldwin
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
- Department of Respiratory Medicine, Nottingham University hospitals, Nottingham, UK
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183
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A novel assessment tool for evaluating competence in video-assisted thoracoscopic surgery lobectomy. Surg Endosc 2018; 32:4173-4182. [PMID: 29603007 DOI: 10.1007/s00464-018-6162-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Specific assessment tools can accelerate trainees' learning through structured feedback and ensure that trainees attain the knowledge and skills required to practice as competent, independent surgeons (competency-based surgical education). The objective was to develop an assessment tool for video-assisted thoracoscopic surgery (VATS) lobectomy by achieving consensus within an international group of VATS experts. METHOD The Delphi method was used as a structured process for collecting and distilling knowledge from a group of internationally recognized VATS experts. Opinions were obtained in an iterative process involving answering repeated rounds of questionnaires. Responses to one round were summarized and integrated into the next round of questionnaires until consensus was reached. RESULTS Thirty-one VATS experts were included and four Delphi rounds were conducted. The response rate for each round were 68.9% (31/45), 100% (31/31), 96.8% (30/31), and 93.3% (28/30) for the final round where consensus was reached. The first Delphi round contained 44 items and the final VATS lobectomy Assessment Tool (VATSAT) comprised eight items with rating anchors: (1) localization of tumor and other pathological tissue, (2) dissection of the hilum and veins, (3) dissection of the arteries, (4) dissection of the bronchus, (5) dissection of lymph nodes, (6) retrieval of lobe in bag, (7) respect for tissue and structures, and (8) technical skills in general. CONCLUSION A novel and dedicated assessment tool for VATS lobectomy was developed based on VATS experts' consensus. The VATSAT can support the learning of VATS lobectomy by providing structured feedback and help supervisors make the important decision of when trainees have acquired VATS lobectomy competencies for independent performance.
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184
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Arnold BN, Thomas DC, Narayan R, Blasberg JD, Detterbeck FC, Boffa DJ, Kim AW. Robotic-Assisted Lobectomies in the National Cancer Database. J Am Coll Surg 2018; 226:1052-1062.e15. [PMID: 29574177 DOI: 10.1016/j.jamcollsurg.2018.03.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Robotic-assisted thoracoscopic surgery (RobATS) lobectomy is becoming more common for the treatment of lung cancer. As with any relatively new technology, there is the assumption that greater experience leads to greater proficiency. The objective of this study was to analyze outcomes of patients undergoing RobATS lobectomy as hospitals gain experience, and to describe outcomes after conversion to open procedures. STUDY DESIGN The National Cancer Database (NCDB) was used to analyze robotic lobectomies for lung cancer from 2010 to 2014. Individual hospitals were categorized by the year they began reporting robotic lobectomies to the NCDB. Primary outcomes were perioperative morbidity and mortality and rate of conversion to open lobectomy. RESULTS There were 7,645 robotic lobectomies identified from 465 hospitals. The overall conversion rate was 9.2% (n = 702). A propensity-matched analysis showed no significant difference between experienced and inexperienced hospitals with respect to 30-day mortality (1.07% vs 2.03%, p = 0.092) or 90-day mortality (2.35% vs 3.63%, p = 0.104). Conversion to open was a predictor of 30-day mortality (odds ratio [OR] 2.54, CI 1.56 to 4.14) and 90-day mortality (OR 2.68, CI 1.83 to 3.91). Patients who underwent conversion had higher 90-day mortality compared with patients not undergoing conversion, in years of experience: 2 (p = 0.043), 3 (p = 0.002), and 4 (p = 0.003). CONCLUSIONS Mortality after RobATS lobectomy at experienced hospitals is not significantly different than at inexperienced hospitals. Though conversion rates decrease with experience, patients who undergo conversion have higher mortality than those who do not, particularly in hospitals with more experience. This suggests that a deliberate effort to increase experience with and improve patient selection for RobATS lobectomies may ameliorate the conversions and their attendant sequelae.
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Affiliation(s)
- Brian N Arnold
- Section of Thoracic Surgery, Yale School of Medicine, Yale University, New Haven CT
| | - Daniel C Thomas
- Section of Thoracic Surgery, Yale School of Medicine, Yale University, New Haven CT
| | | | - Justin D Blasberg
- Section of Thoracic Surgery, Yale School of Medicine, Yale University, New Haven CT
| | - Frank C Detterbeck
- Section of Thoracic Surgery, Yale School of Medicine, Yale University, New Haven CT
| | - Daniel J Boffa
- Section of Thoracic Surgery, Yale School of Medicine, Yale University, New Haven CT
| | - Anthony W Kim
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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185
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Murakawa T, Sato H, Okumura S, Nakajima J, Horio H, Ozeki Y, Asamura H, Ikeda N, Otsuka H, Matsuguma H, Yoshino I, Chida M, Nakayama M, Iizasa T, Okumura M, Shiono S, Kato R, Iida T, Matsutani N, Kawamura M, Sakao Y, Funai K, Furuyashiki G, Akiyama H, Sugiyama S, Kanauchi N, Shiraishi Y. Thoracoscopic surgery versus open surgery for lung metastases of colorectal cancer: a multi-institutional retrospective analysis using propensity score adjustment†. Eur J Cardiothorac Surg 2018; 51:1157-1163. [PMID: 28329272 DOI: 10.1093/ejcts/ezx020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/02/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Thoracoscopic surgery for lung metastasectomy remains controversial. The study aimed at determining the efficacy of thoracoscopic surgery for lung metastasectomy. METHODS This was a multi-institutional, retrospective study that included 1047 patients who underwent lung metastasectomy for colorectal cancer between 1999 and 2014. Prognostic factors of overall survival were compared between the thoracoscopic and open thoracotomy groups using the multivariate Cox proportional hazard model. The propensity score, calculated using the preoperative covariates, included the era of lung surgery as a covariate. A stepwise backward elimination method, with a probability level of 0.15, was used to select the most powerful sets of outcome predictors. The difference between the radiological tumour number and the resected tumour number (delta_num) was also evaluated. RESULTS The c -statistics and the P -value of the Hosmer-Lemeshow Chi-square of the propensity score model were 0.7149 and 0.1579, respectively. After adjusting for the propensity score, the thoracoscopy group had a better survival rate than the open group (stratified log-rank test: P = 0.0353). After adjusting for the propensity score, the most powerful predictive model for overall survival was that which combined thoracoscopy [hazard ratio (HR): 0.468, 95% CI: 0.262-0.838, P = 0.011] and anatomical resection (HR: 1.49, 95% CI: 1.134-1.953, P = 0.004). Before adjusting for the propensity score, the delta_num was significantly greater in the open group than in the thoracoscopy group (thoracoscopy: 0.06, open: 0.33, P = 0.001); however, after adjustment, there was no difference in the delta_num (thoracoscopy: 0.04, open: 0.19, P = 0.114). CONCLUSIONS Thoracoscopic metastasectomy showed better overall survival than the open approach in this analysis. The thoracoscopic approach may be an acceptable option for resection of pulmonary metastases in terms of tumour identification and survival outcome in the current era.
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Affiliation(s)
- Tomohiro Murakawa
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hajime Sato
- Department of Health Policy and Technology Assessment, National Institute of Public Health, Saitama, Japan
| | - Sakae Okumura
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hirotoshi Horio
- Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yuichi Ozeki
- Department of Thoracic Surgery, National Defense Medical College, Saitama, Japan
| | - Hisao Asamura
- Department of General Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Norihiko Ikeda
- First Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, Tokyo, Japan
| | | | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Mitsuo Nakayama
- Department of General Thoracic Surgery, Saitama Medical Center, Saitama, Japan
| | | | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Ryoichi Kato
- Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Tomohiko Iida
- Department of Thoracic Surgery, Kimitsu Central Hospital, Chiba, Japan
| | - Noriyuki Matsutani
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masafumi Kawamura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Go Furuyashiki
- Department of Thoracic Surgery, Nagaoka Chuo General Hospital, Niigata, Japan
| | - Hirohiko Akiyama
- Department of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan
| | | | - Naoki Kanauchi
- Department of General Thoracic Surgery, Nihonkai General Hospital, Yamagata, Japan
| | - Yuji Shiraishi
- Section of Chest Surgery, Fukujuji Hospital, Tokyo, Japan
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186
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Upham TC, Onaitis MW. Video-assisted thoracoscopic surgery versus robot-assisted thoracoscopic surgery versus thoracotomy for early-stage lung cancer. J Thorac Cardiovasc Surg 2018; 156:365-368. [PMID: 29921098 DOI: 10.1016/j.jtcvs.2018.02.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 02/07/2018] [Accepted: 02/17/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Trevor C Upham
- Division of Cardiovascular and Thoracic Surgery, University of California San Diego Medical Center, San Diego, Calif
| | - Mark W Onaitis
- Division of Cardiovascular and Thoracic Surgery, University of California San Diego Medical Center, San Diego, Calif.
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187
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Changes in Treatment Patterns and Overall Survival in Patients With Early-Stage Non–Small Cell Lung Cancer in the United States After the Incorporation of Stereotactic Ablative Radiation Therapy. Am J Clin Oncol 2018; 41:259-266. [DOI: 10.1097/coc.0000000000000265] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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188
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Wang S, Wang X, Zhou Q, Xu Y, Xia W, Xu W, Ma Z, Qiu M, You R, Xu L, Yin R. Stereotactic ablative radiotherapy versus lobectomy for stage I non-small cell lung cancer: A systematic review. Thorac Cancer 2018; 9:337-347. [PMID: 29322682 PMCID: PMC5832478 DOI: 10.1111/1759-7714.12574] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is debate regarding the use of stereotactic ablative radiotherapy (SABR) or surgery for patients with early stage non-small cell lung cancer (NSCLC). This meta-analysis compared the clinical efficacy of SABR and lobectomy in stage I NSCLC patients. METHODS An online search identified eight eligible articles (including 2 trials and 7 cohort studies) for inclusion. The odds ratio (OR) was used as a summary statistic. Overall survival (OS), cause-specific survival (CSS), and recurrence-free survival (RFS) were selected to calculate ORs with 95% confidence intervals (CI). Fixed-effects or random-effects models were conducted according to study heterogeneity. RESULTS There were no significant differences between SABR and lobectomy in terms of one-year OS or CSS. Significant benefits of surgery were observed in three-year OS (OR 2.11, 95% CI 1.55-2.86), three-year CSS (OR 1.94, 95% CI 1.05-3.57), three-year RFS (OR 1.63, 95% CI 1.12-2.36), and five-year OS (OR 2.40, 95% CI 1.71-3.36). In addition, lobectomy demonstrated a beneficial trend in one-year RFS, five-year RFS, and CSS. CONCLUSION Meta-analyses of current evidence suggested that lobectomy provides better long-term survival outcomes for stage I NSCLC patients.
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Affiliation(s)
- Siwei Wang
- Department of Thoracic Surgery, Jiangsu Key Laboratory of Molecular and Translational Cancer ResearchJiangsu Cancer Hospital, Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer HospitalNanjingChina
- The Fourth Clinical College of Nanjing Medical UniversityNanjingChina
| | - Xiaoxiao Wang
- GCP Research CenterAffiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
| | - Qing Zhou
- Department of Medical OncologyJiangsu Cancer Hospital, Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer HospitalNanjingChina
| | - Youtao Xu
- Department of Thoracic Surgery, Jiangsu Key Laboratory of Molecular and Translational Cancer ResearchJiangsu Cancer Hospital, Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer HospitalNanjingChina
| | - Wenjia Xia
- Department of Thoracic Surgery, Jiangsu Key Laboratory of Molecular and Translational Cancer ResearchJiangsu Cancer Hospital, Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer HospitalNanjingChina
| | - Weizhang Xu
- Department of Thoracic Surgery, Jiangsu Key Laboratory of Molecular and Translational Cancer ResearchJiangsu Cancer Hospital, Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer HospitalNanjingChina
- The Fourth Clinical College of Nanjing Medical UniversityNanjingChina
| | - ZhiFei Ma
- Department of Thoracic Surgery, Jiangsu Key Laboratory of Molecular and Translational Cancer ResearchJiangsu Cancer Hospital, Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer HospitalNanjingChina
- The Fourth Clinical College of Nanjing Medical UniversityNanjingChina
| | - Mantang Qiu
- Department of Thoracic SurgeryPeking University People's HospitalBeijingChina
| | - Ran You
- Department of Interventional Radiology, Medical School of Nantong UniversityNantong University Affiliated HospitalNantongChina
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Key Laboratory of Molecular and Translational Cancer ResearchJiangsu Cancer Hospital, Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer HospitalNanjingChina
| | - Rong Yin
- Department of Thoracic Surgery, Jiangsu Key Laboratory of Molecular and Translational Cancer ResearchJiangsu Cancer Hospital, Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer HospitalNanjingChina
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189
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Dinic VD, Stojanovic MD, Markovic D, Cvetanovic V, Vukovic AZ, Jankovic RJ. Enhanced Recovery in Thoracic Surgery: A Review. Front Med (Lausanne) 2018; 5:14. [PMID: 29459895 PMCID: PMC5807389 DOI: 10.3389/fmed.2018.00014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/17/2018] [Indexed: 12/28/2022] Open
Abstract
The main goal of enhanced recovery program after thoracic surgery is to minimize stress response, reduce postoperative pulmonary complications, and improve patient outcome, which will in addition decrease hospital stay and reduce hospital costs. As minimally invasive technique, video-assisted thoracoscopic surgery represents an important element of enhanced recovery program in thoracic surgery. Anesthetic management during preoperative, intraoperative and postoperative period is essential for the enhanced recovery. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key elements of the enhanced recovery program in thoracic surgery. Having reviewed recent literature, the authors highlight potential procedures and techniques that might be incorporated into the program.
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Affiliation(s)
- Vesna D Dinic
- Center for Anesthesiology and Reanimatology, Clinical Center of Niš, Niš, Serbia
| | | | - Danica Markovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Niš, Niš, Serbia
| | - Vladan Cvetanovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Niš, Niš, Serbia
| | - Anita Zoran Vukovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Niš, Niš, Serbia
| | - Radmilo J Jankovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Niš, Niš, Serbia.,School of Medicine, University of Niš, Niš, Serbia
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190
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Stereotactic Body Radiation Therapy Versus Surgery for Early Lung Cancer Among US Veterans. Ann Thorac Surg 2018; 105:425-431. [DOI: 10.1016/j.athoracsur.2017.07.048] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/16/2017] [Accepted: 07/19/2017] [Indexed: 11/21/2022]
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191
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First experiences and complications in video-assisted thoracoscopic surgery lobectomy at a thoracic surgery center. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:116-122. [PMID: 32082720 DOI: 10.5606/tgkdc.dergisi.2018.13641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 03/27/2017] [Indexed: 11/21/2022]
Abstract
Background This study aims to report the difficulties and complications we experienced in video-assisted thoracoscopic surgery lobectomies performed at our thoracic surgery center. Methods A total of 76 patients (54 males, 22 females; mean age 48.3 years; range 9 to 83 years) who underwent video-assisted thoracoscopic surgery lobectomy between January 2012 and June 2016 were retrospectively reviewed. Preoperative patient characteristics such as additional diseases or tuberculosis history, stage for malignant diseases, surgical characteristics such as port properties and amount of bleeding, postoperative characteristics such as amount, time and duration of drainage, air leakage, and discharge time, morbidity and mortality rates, and their causes were evaluated. Results Of the patients, 35 were evaluated due to benign pulmonary diseases and 41 due to malignant pulmonary diseases. Postoperative prolonged air leakage developed in 14 patients. Of these patients, one was administered thoracotomy and primary repair, three were administered pleurodesis, and three were administered secondary pleurocan catheter, while the air leakage ended spontaneously in seven patients. Due to bleeding, one patient was treated with revision video-assisted thoracoscopic surgery on the same day postoperatively. One patient developed chylothorax and one patient developed pneumonia, which caused respiratory failure. Conclusion Video-assisted thoracoscopic surgery lobectomy is a safe thoracic procedure, which is used for both oncologic and non-oncologic diseases of the lung. Video-assisted thoracoscopic surgery may be performed by all thoracic surgeons experienced in open thoracic surgery. Thanks to the gained experiences, the rates of video-assisted thoracoscopic surgery lobectomy may improve in all centers.
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192
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Refai M, Andolfi M, Sabbatini A. Physiopathology aspects of anatomical video-assisted thoracic surgery resections: current status and prospects of development. J Vis Surg 2018; 3:161. [PMID: 29302437 DOI: 10.21037/jovs.2017.09.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 11/06/2022]
Abstract
Pulmonary lobectomy remains the gold standard therapy for early-stage lung cancer. With the spread of video-assisted thoracic surgery (VATS), surgeons began using this approach also to perform lobectomies, becoming progressively widespread worldwide. However some early-stage lung cancer patients are of questionable eligibility for open lobectomy being considered at high-risk to develop postoperative complications due to compromised pulmonary function or cardiopulmonary reserve. Herein we evaluate pathophysiology of VATS, focusing on: the correlation between the traditional predictors of outcome and overall complications, the current status of different VATS approaches and the role of VATS segmentectomy in high-risk patients, unable to tolerate lobectomy for their compromised cardiopulmonary reserve.
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Affiliation(s)
- Majed Refai
- Unit of Thoracic Surgery, AOU Ospedali Riuniti, Ancona, Italy
| | - Marco Andolfi
- Unit of Thoracic Surgery, AOU Ospedali Riuniti, Ancona, Italy
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193
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Porkhanov VA, Zhikharev VA, Polyakov IS, Danilov VV, Kononenko VB. [Video-assisted thoracoscopic thymectomy in myasthenia gravis. New approach]. Khirurgiia (Mosk) 2018:15-21. [PMID: 29652317 DOI: 10.17116/hirurgia20183215-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To present possibility and technical aspects of anesthetic management during video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. MATERIAL AND METHODS The article describes the proposed modified anesthetic method that is suitable for video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. Nine patients with myasthenia underwent VATS-thymectomy. Anesthesia was performed with artificial airway and auxiliary ventilation without muscle relaxants administration.
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Affiliation(s)
- V A Porkhanov
- Research Institute - Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | - V A Zhikharev
- Research Institute - Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | - I S Polyakov
- Research Institute - Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | - V V Danilov
- Research Institute - Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | - V B Kononenko
- Research Institute - Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
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194
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Mehta H, Osasona A, Shan Y, Goodwin JS, Okereke IC. Trends and Outcomes of Thoracoscopic Lobectomy or Segmentectomy: A National Surgical Quality Improvement Project Analysis. Semin Thorac Cardiovasc Surg 2018; 30:350-359. [DOI: 10.1053/j.semtcvs.2018.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/11/2022]
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195
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Tirrell T, Onaitis M. Lymph node assessment and survival: we still have work to do. J Thorac Dis 2018; 10:15-16. [PMID: 29600011 DOI: 10.21037/jtd.2017.12.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Timothy Tirrell
- Department of Surgery, University of California, San Diego, CA, USA
| | - Mark Onaitis
- Department of Surgery, University of California, San Diego, CA, USA
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196
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Surendrakumar V, Martin-Ucar AE, Edwards JG, Rao J, Socci L. Evaluation of surgical approaches to anatomical segmentectomies: the transition to minimal invasive surgery improves hospital outcomes. J Thorac Dis 2017; 9:3896-3902. [PMID: 29268399 DOI: 10.21037/jtd.2017.09.91] [Citation(s) in RCA: 7] [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
Background We aim to evaluate the transition process from open to video-assisted thoracoscopic surgery (VATS) anatomical segmentectomies in a regional thoracic surgical unit. Methods In a retrospective study from January 2013 to December 2015, we identified all anatomical segmentectomies performed in our unit. Pre, peri and postoperative data were compared between the three years (2013, 2014 and 2015) and according to operative approach. Thoracotomy after VATS intraoperative biopsy was considered a conversion for the purposes of the study. Results A total of 86 consecutive cases [56 females and 30 males, median age 70 years (range, 43 to 83 years); median FEV1 of 78% predicted (range, 41% to 126%)] were included. There was a significant change in the surgical approach with time. Fifty-two cases underwent VATS (73% via single-port) and 34 open surgeries, including nine conversions. There were no postoperative deaths in the VATS group and one in the open group. Operative outcomes were similar over time with no haemorrhagic events, equivalent R1 resection and nodal stations explored in all lymph node positive patients. In node negative cases however, open surgery was associated with more extensive mediastinal exploration. Patients in 2015 had a shorter hospital stay in comparison to those in previous years [median 4 days (range, 1-15 days) vs. median 6 days (range, 3-27 days), P=0.01]. There were no differences in the incidence of complications or readmissions to hospital over time. Conclusions The transition over a short period of time from open to single-port VATS segmentectomy has allowed us to significantly reduce postoperative hospital stay without compromising operative or postoperative outcomes.
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Affiliation(s)
- Veena Surendrakumar
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - Antonio E Martin-Ucar
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - John G Edwards
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - Jagan Rao
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
| | - Laura Socci
- Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, UK
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197
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Tandberg DJ, Tong BC, Ackerson BG, Kelsey CR. Surgery versus stereotactic body radiation therapy for stage I non-small cell lung cancer: A comprehensive review. Cancer 2017; 124:667-678. [PMID: 29266226 DOI: 10.1002/cncr.31196] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/10/2017] [Accepted: 11/18/2017] [Indexed: 12/14/2022]
Abstract
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death in the United States. With the implementation of lung cancer screening, the number and proportion of patients diagnosed with early-stage disease are anticipated to increase. Surgery is currently the standard of care for patients with operable stage I NSCLC. However, promising outcomes with stereotactic body radiation therapy (SBRT) in patients with inoperable disease has led to interest in directly comparing SBRT and surgery in operable patients. Unfortunately, early randomized trials comparing surgery and SBRT closed early because of poor accrual. In this article, the nuances of surgery and SBRT for early-stage NSCLC are reviewed. Furthermore, retrospective and prospective analyses of SBRT in early-stage NSCLC are discussed, and active randomized trials comparing these 2 approaches are described. Cancer 2018;124:667-78. © 2017 American Cancer Society.
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Affiliation(s)
- Daniel J Tandberg
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Betty C Tong
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Bradley G Ackerson
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
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198
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Madhavan R, Renilmon PS, Nair HM, Lal A, Nair SS, Unnikrishnan UG, Makuny D. Stereotactic body radiation therapy for early-stage primary lung cancer, is an active breath coordinator necessary? An audit from a tertiary cancer care center. Indian J Cancer 2017; 54:301-304. [PMID: 29199709 DOI: 10.4103/ijc.ijc_230_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT The hypofractionated stereotactic body radiation therapy (SBRT) has emerged as a safe and effective treatment modality for early-stage nonsmall cell lung carcinoma. AIMS An audit SBRT in primary lung cancer treated in our center with and without an active breath coordinator (ABC) was undertaken to evaluate its impact on target volumes and clinical outcomes. SETTINGS AND DESIGN This was an observational study. MATERIALS AND METHODS Nine patients with lung carcinoma were treated from January 2014 to August 2016. Five patients were simulated using ABC and four patients with free breathing. Volumetric modulated arc therapy plans were generated using Monaco treatment planning software. Three patients were treated with a dose of 54 Gy in three fractions and six patients with a dose of 48 Gy in four fractions. STATISTICAL ANALYSIS USED The statistical analysis was performed using Kaplan-Meier survival. RESULTS The mean planning target volumes (PTV) in ABC and free breathing groups were 42.19cc and 60.17cc, respectively. The mean volume of lung receiving 20, 10, and 5 Gy (V20, V10and V5) in ABC group were 5.37cc, 10.49cc, and 18.45cc whereas in free breathing 6.63cc, 12.74cc, and 20.64cc, respectively. At a median follow-up of 18 months, there were three local recurrences. No significant toxicity occurred in our series. CONCLUSION Our initial results show that SBRT is well tolerated with good local control. Although the PTV volume and irradiated normal lung volume was higher in this group compared to ABC group, this did not translate to any added clinical toxicity.
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Affiliation(s)
- R Madhavan
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - P S Renilmon
- Department of Radiation Physics, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - H M Nair
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - A Lal
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - S S Nair
- Department of Radiation Physics, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - U G Unnikrishnan
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - D Makuny
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
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199
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Long H, Tan Q, Luo Q, Wang Z, Jiang G, Situ D, Lin Y, Su X, Liu Q, Rong T. Thoracoscopic Surgery Versus Thoracotomy for Lung Cancer: Short-Term Outcomes of a Randomized Trial. Ann Thorac Surg 2017; 105:386-392. [PMID: 29198623 DOI: 10.1016/j.athoracsur.2017.08.045] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 08/18/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Safety and short-term efficacy of video-assisted thoracoscopic surgery (VATS) for early-stage non-small lung cancer (NSCLC) has been demonstrated by observational studies previously. However, these outcomes have never been verified by a large randomized controlled trial (RCT). The aim of our RCT was to confirm that VATS is not inferior or even superior to open operation for early-stage NSCLC in terms of short-term and oncologic efficacy. METHODS The trial was undertaken at five tertiary hospitals. Patients aged between 18 and 75 years with clinically early-stage NSCLC were randomly assigned to the VATS and axillary thoracotomy groups. Lobectomy plus mediastinal lymph node dissection was standard surgical intervention. Because patients continue to be followed up for oncologic outcome, the short-term perioperative outcomes would be reported here. RESULTS Between 2008 and 2014, 508 patients were recruited and 425 were eligible for analyses (215 VATS and 210 axillary thoracotomy). Eight VATS procedures were converted to open operation intraoperatively (3.72%). Median operation time with VATS was significantly less than axillary thoracotomy (150 versus 166 minutes, p = 0.009). In addition, VATS was associated with less intraoperative blood loss (p = 0.001). There was no difference for postoperative pleural drainage, length of hospitalization, and rates of morbidity and mortality. Cancer residual margins were found in 1 patient with VATS and 5 with axillary thoracotomy (p = 0.128). The yield of lymph nodes from either surgical approach was similar (p = 0.389). CONCLUSIONS Our study demonstrates that VATS lobectomy is safe and reliable to treat NSCLCs, and it may be superior to axillary thoracotomy for operation time and intraoperative blood loss. ClinicalTrials.gov identifier: NCT01102517.
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Affiliation(s)
- Hao Long
- Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Qunyou Tan
- Department of Thoracic Surgery, Daping Hospital of the Third Military Medical University, Chongqing, China
| | - Qingquan Luo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zheng Wang
- Department of Thoracic Surgery, Shenzhen People's Hospital, Jinan University, Shenzhen, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Dongrong Situ
- Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yongbin Lin
- Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiaodong Su
- Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qing Liu
- Department of Preventive Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tiehua Rong
- Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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200
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Han KN, Kim HK, Choi YH. Midterm outcomes of single port thoracoscopic surgery for major pulmonary resection. PLoS One 2017; 12:e0186857. [PMID: 29136038 PMCID: PMC5685603 DOI: 10.1371/journal.pone.0186857] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/09/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Single-port thoracoscopic surgery has widened the current minimally invasive surgical techniques toward more less invasive procedures in terms of reducing the number of incisions. However, the current status of oncologic outcome with this technique is not well known for lung cancer surgery. The purpose of this study is to evaluate the oncologic outcomes in early stage lung cancer for impact of the survival outcomes with our experience of conversion to a single-port approach from the conventional three-port approach. MATERIALS AND METHODS Retrospective data of patients who underwent thoracoscopic major lung resection for non-small cell lung cancer between January 2006 and June 2015 were analyzed. Patients' characteristics, perioperative outcomes, pathologic result, and postoperative follow-up data of thoracoscopic surgery were reviewed and surgical outcomes were compared between conventional three-port (n = 168), two-port (n = 68), and single-port thoracoscopic surgery (n = 203). RESULTS Of the 203 single-port thoracoscopic surgeries, we performed 167 single-port thoracoscopic lobectomy and mediastinal lymph node dissections. During the learning period of each thoracoscopic approach, the mean operation time for single-port thoracoscopic surgery (189±62 min) was not significantly different from those of two-port (175±46 min) and three-port (195±75 min) thoracoscopic lobectomy (p = 0.165). Perioperative outcomes including drain indwelling time (p <0.001), complication (p = 0.185) and conversion event (p = 0.911) were not worsened during learning period with two-port. Midterm survival (p = 0.753) and recurrence free survival (p = 0.656) of single port thoracoscopic lobectomy showed acceptable results compared with two- and three-port approach. CONCLUSIONS Single-port thoracoscopic surgery is safe and a feasible option for major lung resection in lung malignancy and this approach following experiences of two-port approach may yield similar oncologic results to those of conventional multi-port approach during thoracoscopic lobectomy.
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Affiliation(s)
- Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Republic of Korea
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