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Toker A. Robotic Versus Video-Assisted Thoracoscopic Lobectomy (VATS) for Lung Cancer. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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202
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Vannucci F, Gonzalez-Rivas D. Is VATS lobectomy standard of care for operable non-small cell lung cancer? Lung Cancer 2016; 100:114-119. [PMID: 27597290 DOI: 10.1016/j.lungcan.2016.08.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/04/2016] [Accepted: 08/10/2016] [Indexed: 11/26/2022]
Abstract
Video-Assisted Thoracic Surgery (VATS) for treatment of lung cancer is being increasingly applied worldwide in the last few years. Since its introduction, many publications have been providing strong evidences that this minimally invasive approach is feasible, safe and oncologically efficient; offering to patients several advantages over traditional open thoracotomy, particularly for early-stage disease (I and II). The application of VATS for locally advanced disease treatment has also been largely described, but probably requires a further level of experience, which is more likely to be found in reference centers, with skilled experts. Although a large multi-institutional prospective randomized-controlled trial is the best way to confirm the superiority of one technique over another, such study comparing VATS versus open lobectomy for lung cancer is unlikely to ever come out. And in this scenario, retrospective data remains as the most reliable source of scientific information. Based on a literature review, the main objective of this article is to discuss to what extent VATS lobectomy can be considered the gold standard in the surgical treatment of lung cancer, taking into account the most important comparison aspects between the minimally invasive approach and open thoracotomy technique. This review addresses questions regarding lymph node dissection, oncologic efficacy, extended resections beyond standard lobectomy, post-operative complications/pain/quality of life, survival rates and the present limits of indication (and contraindication) for VATS, in order to define the real role of this technique on the surgical treatment of lung cancer in a minimally invasive, but safe and effective manner.
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Affiliation(s)
- Fernando Vannucci
- Department of Thoracic Surgery, Hospital Federal do Andaraí, Rio de Janeiro, Brazil; Department of Thoracic Surgery, Hospital Central da Polícia Militar (HCPM), Rio de Janeiro, Brazil.
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, Coruña, Spain; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain; Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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203
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Gonfiotti A, Bongiolatti S, Borgianni S, Borrelli R, Jaus MO, Politi L, Tancredi G, Viggiano D, Voltolini L. Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve. J Cardiothorac Surg 2016; 11:130. [PMID: 27496022 PMCID: PMC4974708 DOI: 10.1186/s13019-016-0526-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/28/2016] [Indexed: 11/25/2022] Open
Abstract
Background The development of a video assisted thoracic surgery lobectomy (VATS-L) program provides a dedicated surgical team with a recognized learning curve (LC) of 50 procedures. We analyse the results of our program, comparing the LC with subsequent cases. Methods From June 2012 to March 2015, we performed n = 146 VATS major pulmonary resections: n = 50 (Group A: LC); n = 96 (Group B). Pre-operative mediastinal staging followed the National Comprehensive Cancer Network guidelines. All procedures were performed using a standard anterior approach to the hilum; lymphadenectomy followed the NCCN recommendations. During the LC, VATS-L indication was reserved to clinical stages I, therefore evaluated case by case. Results Mean operative time was 191 min (120-290) in Group A and 162 min (85-360) in Group B (p <0,01). Pathological T status was similar between two Groups. Lymphadenectomy included a mean of 5.8 stations in Group A and 6.6 in Group B resulting in: pN0 disease: Group A n = 44 (88 %), Group B n = 80 (83.4 %); pN1: Group A n = 3 (6 %), Group B n = 8 (8.3 %); pN2: Group A n = 3 (6 %), Group B n = 8 (8.3 %). Conversion rate was: 8 % in group A (n = 4 vascular injuries); 1.1 % in Group B (n = 1 hilar lymph node disease). We registered n = 6 (12 %) complications in Group A, n = 10 (10.6 %) in Group B. One case (1.1 %) of late post-operative mortality (90 days) was registered in Group B for liver failure. Mean hospital stay was 6.5 days in Group A and 5.9 days in Group B. Conclusions We confirm the effectiveness of a VATS-L program with a learning curve of 50 cases performed by a dedicated surgical team. Besides the LC, conversion rate falls down, lymphadenectomy become more efficient, indications can be extended to upper stages.
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Affiliation(s)
- Alessandro Gonfiotti
- Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy
| | - Stefano Bongiolatti
- Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy.
| | - Sara Borgianni
- Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy
| | - Roberto Borrelli
- Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy
| | - Massimo O Jaus
- Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy
| | - Leonardo Politi
- Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy
| | - Giorgia Tancredi
- Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy
| | - Domenico Viggiano
- Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy
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204
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Ma Q, Liu D. VATS right upper lobe bronchial sleeve resection. J Thorac Dis 2016; 8:2269-71. [PMID: 27621889 PMCID: PMC4999755 DOI: 10.21037/jtd.2016.04.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/31/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study is to discuss video-assisted thoracic surgery (VATS) sleeve bronchial lobectomy when handling the locally advanced central lung cancer (involving the trachea and/or main bronchus). METHODS A 2.5 cm × 1.0 cm mass was found in the right upper lobe. Bronchoscopy demonstrated the tumor obstructing the right upper lobe bronchus and involved the right main bronchus and bronchus intermedius. Interrupted sutures were chosen for bronchial anastomosis. Bronchial membrane was sutured first, and then circumference end-to-end anastomoses were carried out using 3-0 absorbable sutures. RESULTS There were no complications and the patient was discharged 8 days postoperatively. CONCLUSIONS The third intercostal space of the anterior axillary line was suggested for right upper lobe bronchial sleeve resection. This incision can reduce the distance and angle between the anastomosis to the incision, and facilitate anastomosis. This approach can also prevent operator from fatigue for keeping one posture for a long time. Clearance of the mediastinal lymph nodes before cutting the bronchus was helpful for exposing the right main bronchus, the upper lobe bronchus and bronchus intermedius satisfied. And this option would avoid pulling bronchial anastomosis during mediastinal lymph nodes clearance. Interrupted suture was safe and effective for VATS bronchial anastomosis.
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Affiliation(s)
- Qianli Ma
- Department of Thoracic Surgery, China Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of Thoracic Surgery, China Japan Friendship Hospital, Beijing 100029, China
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205
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Reichert M, Kerber S, Pösentrup B, Bender J, Schneck E, Augustin F, Öfner D, Padberg W, Bodner J. Anatomic lung resections for benign pulmonary diseases by video-assisted thoracoscopic surgery (VATS). Langenbecks Arch Surg 2016; 401:867-75. [PMID: 27456676 DOI: 10.1007/s00423-016-1478-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Based on increasing evidence of its benefits regarding perioperative and oncologic outcome, video-assisted thoracoscopic surgery (VATS) has gained increasing acceptance in the surgical treatment of early stage non-small cell lung cancer (NSCLC). However, the evidence for a VATS approach in anatomic lung resection for benign pulmonary diseases is still limited. METHODS Between March 2011 and May 2014, data from 33 and 63 patients who received VATS anatomic lung resection for benign diseases (VATS-B) and early stage NSCLC (VATS-N), respectively, were analyzed retrospectively. For subgroup analyses, VATS-B was subdivided by operation time and underlying diseases. Subgroups were compared to VATS-N. RESULTS Three patients from VATS-B and four from VATS-N experienced conversion to open surgery. Causes of conversion in VATS-B were intraoperative complications, whereas conversions in VATS-N were elective for oncological concerns (p < 0.05). Operation time and duration of postoperative mechanical ventilation were longer by tendency; postoperative stay on intensive care unit and chest tube duration were significantly longer in VATS-B. Subgroup analyses showed a longer operation time as a predictor for worse perioperative outcome regarding postoperative mechanical ventilation, postoperative stay on intensive care unit, chest tube duration, and length of hospital stay. Patients with longer operation time suffered from more postoperative complications. Differences in perioperative outcome data were not significantly dependent on the underlying benign diseases compared to VATS-N. CONCLUSIONS VATS is feasible and safe in anatomic lung resection for benign pulmonary diseases. Not the underlying disease, but a longer operation time is a factor for worse postoperative outcome.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.
| | - Stefanie Kerber
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Bernd Pösentrup
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Julia Bender
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Johannes Bodner
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.,Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.,Department of Thoracic Surgery, Klinikum Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany
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206
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Video-assisted thoracoscopic anatomic lung resections in Germany—a nationwide survey. Langenbecks Arch Surg 2016; 401:877-84. [DOI: 10.1007/s00423-016-1481-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/15/2016] [Indexed: 12/26/2022]
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207
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Liu CC, Shih CS, Liu YH, Cheng CT, Melis E, Liu ZY. Subxiphoid single-port video-assisted thoracoscopic surgery. J Vis Surg 2016; 2:112. [PMID: 29399498 DOI: 10.21037/jovs.2016.06.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/14/2016] [Indexed: 11/06/2022]
Abstract
Background We report the feasibility and safety of chest surgery through the subxiphoid single port approach based on our preliminary experience. Methods From December 2013 till January 2016, 39 patients underwent 40 thoracoscopic surgeries via a 3- to 4-cm subxiphoid single incision. A sternal lifter was applied for better entrance and working angle. A zero-degree deflectable scope was preferred. The technique for anatomic resection was similar to that in the traditional single-port approach. Patient characteristics and demographic data were analyzed. Results There were 29 females and 10 males, with a median age of 56 years. Indication for surgery included 24 patients with primary lung cancer, eight with lung metastases, two with benign lung lesions, one with bilateral pneumothorax, and five with mediastinal tumors. Surgeries included lobectomy in 21, segmentectomy in five, wedge resection in nine, and mediastinal surgery in five patients. There was no surgical mortality. Complications (10%, 4 in 40) included postoperative bleeding in one patient, chylothorax in one patient, and transient arrhythmia in the early learning curve in two patients. Conclusions Our results indicated that subxiphoid single-incision thoracoscopic pulmonary resection could be performed safely but under careful patient selection with modification of instruments. Moreover, having a previous single-port incision experience was crucial. Major limitations of this approach included more frequently encountered instrument fighting; interference of left-side procedure related to heartbeat and radical mediastinal lymph node (LN) dissection; and the ability to handle complex conditions, such as anthracotic LNs, diffuse adhesion, and major bleeding.
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Affiliation(s)
- Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.,National Defense University, Taoyuan, Taiwan
| | - Chih-Shiun Shih
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Yun-Hen Liu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Keelung, Taiwan
| | - Chih-Tao Cheng
- National Defense University, Taoyuan, Taiwan.,Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Enrico Melis
- Division of Thoracic Surgery, Department of Surgical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Zhen-Ying Liu
- Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
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208
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Wang BY, Huang JY, Lin CH, Ko JL, Chou CT, Wu YC, Lin SH, Liaw YP. Thoracoscopic Lobectomy Produces Long-Term Survival Similar to That with Open Lobectomy in Cases of Non-Small Cell Lung Carcinoma: A Propensity-Matched Analysis Using a Population-Based Cancer Registry. J Thorac Oncol 2016; 11:1326-1334. [PMID: 27257134 DOI: 10.1016/j.jtho.2016.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/11/2016] [Accepted: 04/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a lack of large, prospective, randomized studies comparing thoracoscopic and open lobectomy in terms of long-term survival in the setting of NSCLC. Additionally, large case series evaluating the issue are limited. Until now, whether thoracoscopic lobectomy entails a long-term survival benefit compared with open lobectomy not been determined. METHODS Data were obtained from the National Health Insurance Research Database published in Taiwan. We included patients treated with open lobectomy or thoracoscopic lobectomy. In this retrospective review, the clinicopathologic characteristics of 5222 patients with lung cancer during the period 2004-2010 were analyzed. Patients were stratified according to clinical stage. Overall survival (OS) was compared between patients treated with open and those treated with thoracoscopic lobectomy and was also compared between patients in the three different clinical stages. Propensity-matching analysis and multivariate analysis were performed. RESULTS Open lobectomy was performed on 3058 patients (58.6%) and thoracoscopic lobectomy on 2164 (41.4%). Propensity matching produced 1848 patients in each group. The 1-year, 3-year, and 5-year OS rates for propensity-matched patients treated with open lobectomy were 93.4%, 79.3%, and 65.5%, respectively. The 1-year, 3-year, and 5-year OS rates for propensity-matched patients treated with thoracoscopic lobectomy were 94.1%, 80.9%, and 68.7%, respectively. The difference was not statistically significant. In multivariate analysis, surgical resection (open versus thoracoscopic) was not an independent prognostic factor. CONCLUSIONS This propensity-matched study suggests that open and thoracoscopic lobectomy are associated with similar long-term survival in the setting of lung cancer. Thoracoscopic lobectomy is an acceptable surgical treatment of lung cancer.
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Affiliation(s)
- Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Republic of China; Chung Shan Medical University, Taichung, Republic of China; School of Medicine, Kaohsiung Medical University, Kaohsiung, Republic of China; Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Republic of China
| | - Jing-Yang Huang
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Republic of China
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Republic of China; Chung Shan Medical University, Taichung, Republic of China; Department of respiratory care, College of health sciences, Chang Jung Christian University, Tainan, Republic of China
| | - Jiunn-Liang Ko
- Institute of Medicine, Chung Shan Medical University, Taichung, Republic of China
| | - Chen-Te Chou
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Republic of China; Department of Radiology, Chang-Hua Christian Hospital, Changhua City, Republic of China
| | - Yu-Chung Wu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Republic of China
| | - Sheng-Hao Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Republic of China; Chung Shan Medical University, Taichung, Republic of China; Department of respiratory care, College of health sciences, Chang Jung Christian University, Tainan, Republic of China
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Republic of China; Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Republic of China.
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209
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Park BJ, Yang HX, Woo KM, Sima CS. Minimally invasive (robotic assisted thoracic surgery and video-assisted thoracic surgery) lobectomy for the treatment of locally advanced non-small cell lung cancer. J Thorac Dis 2016; 8:S406-13. [PMID: 27195138 DOI: 10.21037/jtd.2016.04.56] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Insufficient data exist on the results of minimally invasive surgery (MIS) for locally advanced non-small cell lung cancer (NSCLC) traditionally approached by thoracotomy. The use of telerobotic surgical systems may allow for greater utilization of MIS approaches to locally advanced disease. We will review the existing literature on MIS for locally advanced disease and briefly report on the results of a recent study conducted at our institution. METHODS We performed a retrospective review of a prospective single institution database to identify patients with clinical stage II and IIIA NSCLC who underwent lobectomy following induction chemotherapy. The patients were classified into two groups (MIS and thoracotomy) and were compared for differences in outcomes and survival. RESULTS From January 2002 to December 2013, 428 patients {397 thoracotomy, 31 MIS [17 robotic and 14 video-assisted thoracic surgery (VATS)]} underwent induction chemotherapy followed by lobectomy. The conversion rate in the MIS group was 26% (8/31) The R0 resection rate was similar between the groups (97% for MIS vs. 94% for thoracotomy; P=0.71), as was postoperative morbidity (32% for MIS vs. 33% for thoracotomy; P=0.99). The median length of hospital stay was shorter in the MIS group (4 vs. 5 days; P<0.001). The 3-year overall survival (OS) was 48.3% in the MIS group and 56.6% in the thoracotomy group (P=0.84); the corresponding 3-year DFS were 49.0% and 42.1% (P=0.19). CONCLUSIONS In appropriately selected patients with NSCLC, MIS approaches to lobectomy following induction therapy are feasible and associated with similar disease-free and OS to those following thoracotomy.
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Affiliation(s)
- Bernard J Park
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China ; 4 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hao-Xian Yang
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China ; 4 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaitlin M Woo
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China ; 4 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Camelia S Sima
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China ; 4 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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210
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White A, Swanson SJ. Surgery versus stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer: less is not more. J Thorac Dis 2016; 8:S399-405. [PMID: 27195137 DOI: 10.21037/jtd.2016.04.40] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
High level evidence from randomized studies comparing surgery to stereotactic ablative radiotherapy (SABR) is lacking and available retrospective cohort and case control studies are highly variable in how thoroughly they define and stage lung cancer, in how they determine operability, and in the offered surgical approaches to operable lung cancer (open vs. video-assisted). This makes it difficult to compare best radiotherapy and best surgery approaches to treatment and to be confident in conclusions of equipoise between the two modalities. What has become clear from the controversy surrounding surgery versus SABR for early stage lung cancer is the desire to optimize treatment efficacy while minimizing invasiveness and morbidity. This review highlights the ongoing debate in light of these goals.
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Affiliation(s)
- Abby White
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott J Swanson
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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211
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Qiu B, Yan W, Chen K, Fu X, Hu J, Gao S, Knippenberg S, Schwiers M, Kassis E, Yang T. A multi-center evaluation of a powered surgical stapler in video-assisted thoracoscopic lung resection procedures in China. J Thorac Dis 2016; 8:1007-13. [PMID: 27162678 DOI: 10.21037/jtd.2016.03.88] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lung cancer is one of the most prevalent malignancies worldwide. The number of anatomic lung cancer resections performed via video-assisted thoracoscopic surgery (VATS) is growing rapidly. Staplers are widely used in VATS procedures, but there is limited clinical data regarding how they might affect performance and postoperative outcomes, including air leak. This clinical trial assessed the use of a powered stapler in VATS lung resection, with a primary study endpoint being occurrence and duration of air leak and prolonged air leak (PAL). METHODS Data was collected from a single arm, multi-center study in Chinese patients receiving VATS wedge resection or lobectomy. Intra-operative data included surgery duration; cartridge selection for ligation/transection of bronchus, major vessels, and lung parenchyma; staple line interventions; blood loss; and device usage. Post-operative data included air leak assessments, chest tube duration, length of hospital stay, and adverse events (AEs). RESULTS A total of 94 procedures across four institutions in China were included in the final analysis: 15 wedge resections, 74 lobectomies, and five wedge resections followed by lobectomies. Post-operative air leak occurred in five (5.3%) patients who had lobectomy procedures, with PAL in one (1.1%) patient. Sites were generally consistent relative to cartridge use by tissue type. The incidence of stapler firings requiring surgical interventions was seven out of 550 (1.3%). Surgeons participating in the study were satisfied with the articulation and overall usability of the stapler. CONCLUSIONS The powered staplers make the VATS procedure easier for the surgeons and have achieved intra- and post-operative patient outcomes comparable to those previously reported.
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Affiliation(s)
- Bin Qiu
- 1 Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China ; 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China ; 4 Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China ; 5 Clinical R&D Center of Excellence, 6 Medical Affairs Center of Excellence, Ethicon, Cincinnati, Ohio, USA ; 7 Strategic Medical Affairs, Johnson & Johnson Medical (Shanghai) Ltd., Shanghai 200030, China
| | - Wanpu Yan
- 1 Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China ; 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China ; 4 Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China ; 5 Clinical R&D Center of Excellence, 6 Medical Affairs Center of Excellence, Ethicon, Cincinnati, Ohio, USA ; 7 Strategic Medical Affairs, Johnson & Johnson Medical (Shanghai) Ltd., Shanghai 200030, China
| | - Keneng Chen
- 1 Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China ; 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China ; 4 Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China ; 5 Clinical R&D Center of Excellence, 6 Medical Affairs Center of Excellence, Ethicon, Cincinnati, Ohio, USA ; 7 Strategic Medical Affairs, Johnson & Johnson Medical (Shanghai) Ltd., Shanghai 200030, China
| | - Xiangning Fu
- 1 Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China ; 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China ; 4 Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China ; 5 Clinical R&D Center of Excellence, 6 Medical Affairs Center of Excellence, Ethicon, Cincinnati, Ohio, USA ; 7 Strategic Medical Affairs, Johnson & Johnson Medical (Shanghai) Ltd., Shanghai 200030, China
| | - Jian Hu
- 1 Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China ; 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China ; 4 Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China ; 5 Clinical R&D Center of Excellence, 6 Medical Affairs Center of Excellence, Ethicon, Cincinnati, Ohio, USA ; 7 Strategic Medical Affairs, Johnson & Johnson Medical (Shanghai) Ltd., Shanghai 200030, China
| | - Shugeng Gao
- 1 Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China ; 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China ; 4 Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China ; 5 Clinical R&D Center of Excellence, 6 Medical Affairs Center of Excellence, Ethicon, Cincinnati, Ohio, USA ; 7 Strategic Medical Affairs, Johnson & Johnson Medical (Shanghai) Ltd., Shanghai 200030, China
| | - Susan Knippenberg
- 1 Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China ; 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China ; 4 Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China ; 5 Clinical R&D Center of Excellence, 6 Medical Affairs Center of Excellence, Ethicon, Cincinnati, Ohio, USA ; 7 Strategic Medical Affairs, Johnson & Johnson Medical (Shanghai) Ltd., Shanghai 200030, China
| | - Michael Schwiers
- 1 Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China ; 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China ; 4 Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China ; 5 Clinical R&D Center of Excellence, 6 Medical Affairs Center of Excellence, Ethicon, Cincinnati, Ohio, USA ; 7 Strategic Medical Affairs, Johnson & Johnson Medical (Shanghai) Ltd., Shanghai 200030, China
| | - Edmund Kassis
- 1 Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China ; 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China ; 4 Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China ; 5 Clinical R&D Center of Excellence, 6 Medical Affairs Center of Excellence, Ethicon, Cincinnati, Ohio, USA ; 7 Strategic Medical Affairs, Johnson & Johnson Medical (Shanghai) Ltd., Shanghai 200030, China
| | - Tengfei Yang
- 1 Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China ; 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 3 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, China ; 4 Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China ; 5 Clinical R&D Center of Excellence, 6 Medical Affairs Center of Excellence, Ethicon, Cincinnati, Ohio, USA ; 7 Strategic Medical Affairs, Johnson & Johnson Medical (Shanghai) Ltd., Shanghai 200030, China
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French DG, Thompson C, Gilbert S. Transition from multiple port to single port video-assisted thoracoscopic anatomic pulmonary resection: early experience and comparison of perioperative outcomes. Ann Cardiothorac Surg 2016; 5:92-9. [PMID: 27134834 DOI: 10.21037/acs.2016.03.03] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Single port thoracoscopy is an approach aimed at minimizing trauma to the chest wall during lung resection. The objectives of this study were to describe early experience in the transition from multiple port video-assisted thoracic surgery (VATS) to single port surgery (S-VATS) and to compare perioperative outcomes between approaches. METHODS Consecutive anatomic lung resections using S-VATS were reviewed and compared to a historical, prospective cohort of multiple port VATS cases. Outcomes analysis was focused on the use of operating room resources and postoperative recovery. RESULTS Over 12 months, 50 S-VATS procedures were completed by one surgeon and compared to an equal number of VATS patients. The groups were similar in age, gender, BMI, comorbidity, tumor size and pulmonary function. There was no statistically significant difference in operative time. All tumors were completely resected (R0) and the median number of lymph nodes evaluated pathologically was equivalent {S-VATS=7 [4-10]; VATS=7 [4-10]; P=0.92}. There was no significant difference in conversion rate {S-VATS=2 (4%); VATS=1 (2%); P=0.56}. The median length of stay was similar in both groups {S-VATS=4 [3-7]; VATS=4 [3-7]; P=0.99}. There was no mortality and no significant difference in the rate of major complications {S-VATS=10/50 [20%]; VATS=5/50 [10%]; P=0.26}. There was no difference in patient reported pain as measured by a visual analog scale at 24 hours {S-VATS=4 [2-5]; VATS=4 [3-5]; P=0.63}. CONCLUSIONS Early experience in the transition from multiple port VATS to S-VATS lung resection indicates that safety, efficiency and surgical quality are preserved. More long-term data are required. Alternative approaches to perform thoracoscopic lung resection should be carefully evaluated and compared to established minimally invasive techniques.
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Affiliation(s)
- Daniel G French
- 1 Division of Thoracic Surgery, 2 Department of Anesthesia, University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Calvin Thompson
- 1 Division of Thoracic Surgery, 2 Department of Anesthesia, University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Sebastien Gilbert
- 1 Division of Thoracic Surgery, 2 Department of Anesthesia, University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
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213
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Sihoe ADL, Yu PSY, Kam TH, Lee SY, Liu X. Adherence to a Clinical Pathway for Video-Assisted Thoracic Surgery: Predictors and Clinical Importance. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alan D. L. Sihoe
- Department of Surgery, The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Peter S. Y. Yu
- Department of Surgery, The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Timothy H. Kam
- Department of Surgery, The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - S. Y. Lee
- Department of Surgery, The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xuyuan Liu
- Department of Surgery, The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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214
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Peng J, An S, Wang HP, Chen XL, Ning XG, Liu J, Yu XY, Mao X, Xu TR. Video-assisted thoracoscopic surgery lobectomy for lung cancer versus thoracotomy: a less decrease in sVEGFR2 level after surgery. J Thorac Dis 2016; 8:323-8. [PMID: 27076926 DOI: 10.21037/jtd.2016.02.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Angiogenic and anti-angiogenic factors play an important role in tumor biology and tumor recurrence after surgical resection. Antiangiogenic factors such as vascular endothelial growth factor (VEGF)-receptor 1 (sVEGFR1) and sVEGFR2, two soluble form receptor proteins of VEGF, are critical for angiogenesis. VEGF can be sequestered by soluble forms of these receptors, which result in decreasing VEGF amount available to bind to its receptor on vascular endothelial cell surface. This study aimed to investigate the influences of video-assisted thoracoscopic surgery (VATS) lobectomy and open by thoracotomy for early stage non-small cell lung cancer (NSCLC) on postoperative circulating sVEGFR1 and sVEGFR2 levels. METHODS Forty-eight lung cancer patients underwent lobectomy through either VATS (n=26) or thoracotomy (n=22). Blood samples were collected from all patients preoperatively and postoperatively on days 1, 3 and 7. ELISA analysis was used to determine the plasma levels of sVEGFR1 and sVEGFR2. Data are reported as means and standard deviations, and were assessed with the Wilcoxon signed-Rank test (P<0.05). RESULTS For all patients undergoing lobectomy, postoperative sVEGFR1 levels on days 1 and 3 were markedly increased, while postoperative sVEGFR2 levels on days 1 and 3 were significantly decreased. Moreover, VATS group had significantly higher plasma level of sVEGFR2 postoperative in comparison with open thoracotomy (OT) on day 1 (VATS 6,953±1,535 pg/mL; OT 5,874±1,328 pg/mL, P<0.05). CONCLUSIONS Major pulmonary resection for early stage NSCLC resulted in the increased sVEGFR1 and decreased sVEGFR2 productions. VATS is associated with enhanced anti-angiogenic response with higher circulating sVEGFR2 levels compared with that with OT. Such differences in anti-angiogenic response may have an important effect on cancer biology and recurrence after surgery.
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Affiliation(s)
- Jun Peng
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Su An
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Hui-Ping Wang
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Xin-Long Chen
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Xian-Gu Ning
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Jun Liu
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Xu-Ya Yu
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Xin Mao
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Tian-Rui Xu
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
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215
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Huang J, Li S, Hao Z, Chen H, He J, Xu X, Qiu Y, Dong Q, Liang L, Pan H, He J. Complete video-assisted thoracoscopic surgery (VATS) bronchial sleeve lobectomy. J Thorac Dis 2016; 8:553-74. [PMID: 27076954 DOI: 10.21037/jtd.2016.01.63] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND To explore the effectiveness of video-assisted thoracoscopic surgery (VATS) bronchial sleeve resection and reconstruction. METHODS The clinical data of patients who had received VATS bronchial sleeve lobectomy in our center from January 2008 to February 2015 were retrospectively analyzed. RESULTS Totally 118 patients (105 men and 13 women) received the VATS bronchial sleeve lobectomy. The procedures included sleeve resection of right upper lobe (n=59), right middle lobe (n=7), right lower lobe (n=8), left upper lobe (n=34), and left lower lobe (n=10). The lesions were confirmed to be squamous cell carcinoma (n=68), adenocarcinoma (n=16), mucoepidermoid carcinoma (n=8), adenosquamous carcinoma (n=7), large cell carcinoma (n=1), carcinoids (n=5), and others (n=13; including small cell carcinoma, pleomorphic carcinoma, and inflammatory myofibroblastic tumor). Operations lasted 118-223 min [mean ± standard deviations (SD): 124.00±31.75 min]. The length of removed bronchus was 1.50-2.00 cm (mean ± SD: 1.75±0.26 cm). The duration of bronchial anastomosis (from the first puncture to the completion of knotting) was 15-42 min (mean ± SD: 30.20±7.97 min). The number of dissected lymph node stations (at least three mediastinal lymph node stations, including station 7) was 5-9 stations (mean ± SD: 6.50±1.18 min). The number of dissected lymph nodes was 10-46 (mean ± SD: 26.00±10.48). The intraoperative blood loss was 20-400 mL (mean ± SD: 71.00±43.95 mL), and no blood transfusion was performed. All patients were observed in intensive care unit (ICU) for 1 day. Postoperative drainage was performed for 3-8 days (mean ± SD: 5.00±1.49 days). Postoperative hospital stay was 3-8 days (mean ± SD: 5.10±2.07 days). CONCLUSIONS VATS bronchial sleeve resection and reconstruction is a safe and feasible technique.
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Affiliation(s)
- Jun Huang
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Shuben Li
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Zhexue Hao
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Hanzhang Chen
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jiaxi He
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xin Xu
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yuan Qiu
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Qinglong Dong
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Lixia Liang
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Hui Pan
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jianxing He
- 1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Veronesi G, Novellis P, Alloisio M. Virtual navigation to guide personalized treatment of small-size lung cancer using minimally invasive techniques. J Vis Surg 2016; 2:72. [PMID: 29078500 DOI: 10.21037/jovs.2016.03.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Giulia Veronesi
- Division of Thoracic Surgery, Istituto Clinico Humanitas, Rozzano, Milano, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, Istituto Clinico Humanitas, Rozzano, Milano, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, Istituto Clinico Humanitas, Rozzano, Milano, Italy
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217
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Hirai K, Takeuchi S, Usuda J. Single-port video-assisted thoracic surgery for early lung cancer: initial experience in Japan. J Thorac Dis 2016; 8:S344-50. [PMID: 27014483 DOI: 10.3978/j.issn.2072-1439.2016.02.26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Single-port video-assisted thoracic surgery (SPVATS) emerged several years ago as a new, minimally invasive surgery for diseases in the field of respiratory surgery, and is increasingly becoming a subject of interest for some thoracic surgeons in Europe and Asia. However, the adoption rate of this procedure in the United States and Japan remains low. We herein reviewed our experience of SPVATS for early lung cancer in our center, and evaluated the safety and minimal invasiveness of this technique. METHODS We retrospectively analyzed patients who had undergone SPVATS for pathological stage I lung cancer in Nippon Medical School Chiba Hokusoh Hospital between September 2012 and October 2015. In SPVATS, an approximately 4-cm incision was made at the 4(th) or 5(th) intercostal space between the anterior and posterior axillary lines. A rib spreader was not used at the incision site, and surgical manipulation was performed very carefully in order to avoid contact between surgical instruments and the intercostal nerves. The same surgeon performed surgery on all patients, and analyzed laboratory data before and after surgery. RESULTS Eighty-four patients underwent anatomical lung resection for postoperative pathological stage I lung cancer. The mean wound length was 4.2 cm. Eighty-four patients underwent lobectomy and segmentectomy, respectively. The mean preoperative forced expiratory volume in 1 second (FEV1%) was 1.85%±0.36%. Our patients consisted of 49 men (58.3%) and 35 women (41.7%), with 64, 18, 1, and 1 having adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma, and small-cell lung cancer, respectively. The mean operative time was 175±21 min, operative blood loss 92±18 mL, and duration of drain placement 1.9±0.6 days. The duration of the postoperative hospital stay was 7.1±1.7 days, numeric rating scale (NRS) 1 week after surgery 2.8±0.6, and occurrence rate of allodynia 1 month after surgery 10.7%. No patient developed serious complications, and no deaths occurred within 30 days of surgery. Two patients (2.4%) were converted to open thoracotomy. CONCLUSIONS SPVATS is a safe and feasible technique, and is promising for next-generation thoracoscopic surgery. It may also reduce postoperative wound pain and contribute to improvements in the activities of daily living of patients.
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Affiliation(s)
- Kyoji Hirai
- 1 Division of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan ; 2 Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Shingo Takeuchi
- 1 Division of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan ; 2 Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Jitsuo Usuda
- 1 Division of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan ; 2 Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
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218
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Abstract
The uniportal video assisted thoracic surgery (VATS) approach to lung lobectomy has generated phenomenal interest in recent years. It promises to offer patients less morbidity and faster recovery, even when compared to conventional multiportal VATS. However, critics of the uniportal VATS approach may raise concerns about whether this most minimally invasive surgical approach for lung surgery may compromise safety and treatment efficacy. This debate has great potential importance not only in determining how patients are operated on, but in understanding how 'success' is gauged in major pulmonary surgery. This article explores both sides of this debate, drawing on the experience of how clinical research in multiportal VATS evolved over the years. Systematic generation of clinical evidence with progressively increasing sophistication is required to fairly evaluate the uniportal VATS approach. A review of the current literature suggests that there remain many large gaps in the evidence surrounding uniportal VATS. Hence, at the present time, the reasons voiced by critics as to why uniportal VATS should not be performed should not be lightly dismissed. Instead, it behoves surgeons on both sides of the debate to continue to generate good clinical evidence to resolve it.
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Affiliation(s)
- Alan D L Sihoe
- 1 Department of Surgery, The University of Hong Kong, Hong Kong, China ; 2 Department of Thoracic Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China ; 3 Department of Thoracic Surgery, Tongji University, Shanghai Pulmonary Hospital, Shanghai 200030, China
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219
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Edwards JP, Balderson SS, D'Amico TA. Management of pulmonary arterial bleeding in the post induction setting. J Vis Surg 2016; 2:53. [PMID: 29078481 DOI: 10.21037/jovs.2016.03.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/26/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND A minimally invasive approach to lung cancer resection offers many benefits over traditional open surgery. Pulmonary arterial injury is a widely cited reason for conversion to open surgery. METHODS We present a case of pulmonary arterial injury complicating dissection of the pulmonary artery during thoracoscopic left upper lobectomy. Ethical approval was obtained from the institutional ethics board and written consent was obtained from the patient. RESULTS Thoracoscopic management of pulmonary arterial bleeding is demonstrated. We show maintenance of a thoracoscopic approach with establishment of proximal pulmonary arterial control, allowing suture repair of an injury to the ongoing pulmonary artery. CONCLUSIONS While pulmonary arterial injury may be a significant problem during thoracoscopic lobectomy, minimally invasive approaches to repair are safe and effective.
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Affiliation(s)
- Janet P Edwards
- Department of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Thomas A D'Amico
- Department of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
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220
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Gonzalez-Rivas D, Yang Y, Sekhniaidze D, Stupnik T, Fernandez R, Lei J, Zhu Y, Jiang G. Uniportal video-assisted thoracoscopic bronchoplastic and carinal sleeve procedures. J Thorac Dis 2016; 8:S210-22. [PMID: 26981273 DOI: 10.3978/j.issn.2072-1439.2016.01.76] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Despite of the recent advanced with the video-assisted thoracoscopic surgery (VATS), the most common approach for bronchial and carinal resection is still the open surgery. The technical difficulties, the steep learning curve and the concerns about performing an oncologic and safe reconstruction in advanced cases, are the main reasons for the low adoption of VATS for sleeve resections. Most of the authors use 3-4 incisions for thoracoscopic sleeve procedures. However these surgical techniques can be performed by a single incision approach by skilled uniportal VATS surgeons. The improvements of the surgical instruments, high definition cameras and recent 3D systems have greatly contributed to facilitate the adoption of uniportal VATS techniques for sleeve procedures. In this article we describe the technique of thoracoscopic bronchial sleeve, bronchovascular and carinal resections through a single incision approach.
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Affiliation(s)
- Diego Gonzalez-Rivas
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Yang Yang
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Dmitrii Sekhniaidze
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Tomaz Stupnik
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Ricardo Fernandez
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Jiang Lei
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Yuming Zhu
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Gening Jiang
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
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Edwards JP, Balderson SS, D'Amico TA. Division of the bronchus: an approach to the intraoperative management of difficult lymphadenopathy. J Vis Surg 2016; 2:30. [PMID: 29078458 DOI: 10.3978/j.issn.2221-2965.2016.02.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/27/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND A minimally invasive approach to lung cancer resection offers many benefits over traditional open surgery. Reasons for increased difficulty and conversion from thoracoscopic to open surgery have been studied and include abnormal hilar or interlobar lymphadenopathy. METHODS We present a case of adherent lymphadenopathy complicating dissection of the truncus anterior branch of the pulmonary artery during thoracoscopic left upper lobectomy. RESULTS We show one approach to the management of difficult lymphadenopathy and pulmonary arterial isolation, that of division without closure of the lobar bronchus to allow superior access to the branches of the pulmonary artery, followed by stapled closure of the bronchus. CONCLUSIONS While adherent lymphadenopathy is a vexing problem in thoracoscopic lobectomy, minimallyinvasive approaches are safe and effective. We show that division of the bronchus can improve exposure and allow safe dissection to proceed.
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Affiliation(s)
- Janet P Edwards
- Department of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Thomas A D'Amico
- Department of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
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Cao C, D'Amico T, Demmy T, Dunning J, Gossot D, Hansen H, He J, Jheon S, Petersen RH, Sihoe A, Swanson S, Walker W, Yan TD. Less is more: a shift in the surgical approach to non-small-cell lung cancer. THE LANCET RESPIRATORY MEDICINE 2016; 4:e11-2. [PMID: 26973162 DOI: 10.1016/s2213-2600(16)00024-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/14/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Christopher Cao
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Thomas D'Amico
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Todd Demmy
- Department of Surgery, Rutgers Cancer Institute of New Jersey, NJ, USA
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Dominique Gossot
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Henrik Hansen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea
| | - Rene H Petersen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Alan Sihoe
- Department of Surgery, University of Hong Kong, Hong Kong
| | - Scott Swanson
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - William Walker
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, UK
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
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Lee PC, Kamel M, Nasar A, Ghaly G, Port JL, Paul S, Stiles BM, Andrews WG, Altorki NK. Lobectomy for Non-Small Cell Lung Cancer by Video-Assisted Thoracic Surgery: Effects of Cumulative Institutional Experience on Adequacy of Lymphadenectomy. Ann Thorac Surg 2016; 101:1116-22. [DOI: 10.1016/j.athoracsur.2015.09.073] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/10/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
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Decaluwé H, Stanzi A, Dooms C, Fieuws S, Coosemans W, Depypere L, Deroose CM, Dewever W, Nafteux P, Peeters S, Van Veer H, Verbeken E, Van Raemdonck D, Moons J, De Leyn P. Central tumour location should be considered when comparing N1 upstaging between thoracoscopic and open surgery for clinical stage I non-small-cell lung cancer. Eur J Cardiothorac Surg 2016; 50:110-7. [DOI: 10.1093/ejcts/ezv489] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/22/2015] [Indexed: 11/13/2022] Open
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Ma Q, Liu D. Video-assisted thoracic surgery right upper lobe bronchial sleeve resection. J Vis Surg 2016; 2:18. [PMID: 29078446 PMCID: PMC5638291 DOI: 10.3978/j.issn.2221-2965.2016.01.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 01/03/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) is a new technology for nearly 30 years in the field of thoracic surgery most watched. However, there are still some controversy concerning the technical difficulties, operation duration, the extent of lymph node dissection and perioperative complications for VATS sleeve bronchial lobectomy when handling the locally advanced central lung cancer (involving the trachea and/or main bronchus). METHODS A 66 years old man was admitted for coughing for 2 months. He had smoked for 30 years, 20 packs a day. Chest computed tomography (CT) revealed a 2.5 cm × 4.5 cm mass in the right upper lobe. Bronchoscopy demonstrated the tumor obstructing the right upper lobe bronchus and involved the right main bronchus and bronchus intermedius. Pathology was squamous cell carcinoma. His pulmonary function result was forced expiratory volume in 1 second (FEV1): 1.91 L (64.7% predicted), forced vital capacity (FVC): 4.36 L. He received general anesthesia with double-lumen endotracheal intubation and left lung ventilation. Left lateral decubitus position was chosen. The first 1.5 cm incision was selected in the eighth intercostal space in the midaxillary line, and was used for the camera. A 4 cm long incision was made in the 3rd intercostal space in the preaxillary line. A third 1.5 cm incision was performed in the 9th intercostal space in the postaxillary line for assistant. Pulmonary ligament and the entire right hilum were mobilized. Pulmonary vein is the most forward hilar structure, sometimes immediately prior pulmonary trunk. The right upper lobe vein was transected with a vascular stapler. Truncus and posterior ascending pulmonary artery were then divided and transected with a vascular stapler. Major and minor fissures were stapled by 60 mm green linear stapler. Following clearance of the mediastinal lymph nodes of level 7, 4R and 2R, the bronchial sleeve resection and reconstruction began. The distal right main bronchus and bronchus intermedius were fully mobilized to ensure adequate surgical exposure. Traction sutures were routinely placed on the lateral walls and to reduce tension. Interrupted sutures were chosen for bronchial anastomosis. Bronchial membrane was sutured first, and then circumference end-to-end anastomoses were carried out using 3-0 absorbable sutures. RESULTS There were no complications and the patient was discharged 8 days postoperatively. CONCLUSIONS The 3rd intercostal space of the anterior axillary line was suggested for right upper lobe bronchial sleeve resection. This incision can reduce the distance and angle between the anastomosis to the incision, providing convenient conditions for easy anastomosis. And avoid the operator fatigue for keeping the posture for a long time. Clearance of the mediastinal lymph nodes before cutting the bronchus was helpful for satisfied explosion of the right main bronchus, the upper lobe bronchus and bronchus intermedius. And this would avoid pulling bronchial anastomosis for mediastinal lymph nodes clearance. Interrupted suture was safe and effective for VATS bronchial anastomosis.
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Affiliation(s)
- Qianli Ma
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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Medbery RL, Gillespie TW, Liu Y, Nickleach DC, Lipscomb J, Sancheti MS, Pickens A, Force SD, Fernandez FG. Nodal Upstaging Is More Common with Thoracotomy than with VATS During Lobectomy for Early-Stage Lung Cancer: An Analysis from the National Cancer Data Base. J Thorac Oncol 2016; 11:222-33. [PMID: 26792589 DOI: 10.1016/j.jtho.2015.10.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/22/2015] [Accepted: 10/13/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Questions remain regarding differences in nodal evaluation and upstaging between thoracotomy (open) and video-assisted thoracic surgery (VATS) approaches to lobectomy for early-stage lung cancer. Potential differences in nodal staging based on operative approach remain the final significant barrier to widespread adoption of VATS lobectomy. The current study examines differences in nodal staging between open and VATS lobectomy. METHODS The National Cancer Data Base was queried for patients with clinical stage T2N0M0 or lower lung cancer who underwent lobectomy in 2010-2011. Propensity score matching was performed to compare the rate of nodal upstaging in VATS with that in open approaches. Additional subgroup analysis was performed to assess whether rates of upstaging differed by specific clinical setting. RESULTS A total of 16,983 lobectomies were analyzed; 4935 (29.1%) were performed using VATS. Nodal upstaging was more frequent in the open group (12.8% versus 10.3%; p < 0.001). In 4437 matched pairs, nodal upstaging remained more common for open approaches. For a subgroup of patients who had seven lymph or more nodes examined, propensity matching revealed that nodal upstaging remained more common after an open approach than after VATS (14.0% versus 12.1%; p = 0.03). For patients who were treated in an academic/research facility, however, the difference in nodal upstaging between an open and VATS approach was no longer significant (12.2% versus 10.5%, p = 0.08). CONCLUSIONS For early-stage lung cancer, nodal upstaging was observed more frequently with thoracotomy than with VATS. However, nodal upstaging appears to be affected by facility type, which may be a surrogate for expertise in minimally invasive surgical procedures.
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Affiliation(s)
- Rachel L Medbery
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Theresa W Gillespie
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Dana C Nickleach
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Joseph Lipscomb
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA; Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Manu S Sancheti
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Allan Pickens
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Seth D Force
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Felix G Fernandez
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
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Holbek BL, Horsleben Petersen R, Kehlet H, Hansen HJ. Fast-track video-assisted thoracoscopic surgery: future challenges. SCAND CARDIOVASC J 2015; 50:78-82. [DOI: 10.3109/14017431.2015.1114665] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Migliore M, Criscione A, Calvo D, Borrata F, Gangemi M, Attinà G. Preliminary experience with video-assisted thoracic surgery lobectomy for lung malignancies: general considerations moving toward standard practice. Future Oncol 2015; 11:43-6. [DOI: 10.2217/fon.15.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
As part of the Second Catania Symposium on Thoracic Oncology, as we started the experience with video-assisted thoracic surgery (VATS) lobectomy for lung malignancies, we reviewed our data and argued some comments in a more general discussion. Operated patients with non-small-cell lung cancer were divided in two groups and compared: VATS (collected in a prospective database) and open (historical group). Out of 74 patients, 31 in group A and 44 in group B. The majority of patients in group A were stage I–II. Mean operative time was shorter in group A. Postoperative hospital stay was shorter in group A. There was no mortality. VATS is effective and safe to perform pulmonary lobectomy in our unit, and it represents our preferred approach for early-stage lung cancer.
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Alessandra Criscione
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Damiano Calvo
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Francesco Borrata
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Mariapia Gangemi
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Giorgio Attinà
- Section of Thoracic Surgery, Department of General surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
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Shen Y, Wang H, Feng M, Xi Y, Tan L, Wang Q. Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study†. Eur J Cardiothorac Surg 2015; 49 Suppl 1:i48-53. [PMID: 26464451 DOI: 10.1093/ejcts/ezv358] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/09/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In this retrospective study, we aimed to compare single-port (SP) and multiport (MP) video-assisted thoracoscopic surgery (VATS) for the surgical resection of non-small-cell lung cancer (NSCLC). METHODS Between October 2013 and October 2014, a total of 411 consecutive NSCLC patients who underwent VATS lobectomy in the Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, were enrolled. Propensity-matched analysis, incorporating preoperative clinical features, was used to compare the perioperative outcomes and analyse the safety and efficacy between SP and MP VATS lobectomies for NSCLCs. RESULTS There were 115 patients in the SP group, and 296 patients in the MP group from October 2013 to October 2014. Propensity matching produced 100 pairs in this retrospective study. During the operation, the lobectomy took less time in the SP than in the MP (65.7 ± 14.8 vs 81.3 ± 13.6, P < 0.001) group, while the duration of lymphadenectomy was longer in the SP group (29.6 ± 16.7 vs 17.4 ± 13.3, P < 0.001). The total operation duration, the volume of estimated blood loss (55.1 ± 9.0 ml vs 58.7 ± 7.1 ml, P = 0.22) and the length of postoperative hospital stay (4.7 ± 1.2 days vs 5.3 ± 1.4 days, P = 0.05) were similar between the two groups. Postoperatively, SP and MP groups showed similar results in terms of morbidity and mortality. CONCLUSIONS In comparison with conventional VATS, SP VATS lobectomy showed better safety and efficacy in the surgical resection of NSCLCs. Further studies based on larger populations and better methodology are required to determine its further benefits towards patients.
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Affiliation(s)
- Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yong Xi
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
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Extended minimally invasive lung resections: VATS bilobectomy, bronchoplasty, and pneumonectomy. Langenbecks Arch Surg 2015; 401:341-8. [DOI: 10.1007/s00423-015-1345-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 09/22/2015] [Indexed: 11/26/2022]
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231
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Causes, predictors and consequences of conversion from VATS to open lung lobectomy. Surg Endosc 2015; 30:2415-21. [DOI: 10.1007/s00464-015-4492-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/01/2015] [Indexed: 11/27/2022]
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233
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Iwata H, Shirahashi K, Yamamoto H, Marui T, Matsumoto S, Mizuno Y, Matsumoto M, Mitta S, Miyamoto Y, Komuro H. Propensity score-matching analysis of hybrid video-assisted thoracoscopic surgery and thoracoscopic lobectomy for clinical stage I lung cancer. Eur J Cardiothorac Surg 2015; 49:1063-7. [DOI: 10.1093/ejcts/ezv296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/22/2015] [Indexed: 11/13/2022] Open
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Wang X, Gu L, Zhang Y, Sargent DJ, Richards W, Ganti AK, Crawford J, Cohen HJ, Stinchcombe T, Vokes E, Pang H. Validation of survival prognostic models for non-small-cell lung cancer in stage- and age-specific groups. Lung Cancer 2015; 90:281-7. [PMID: 26319317 DOI: 10.1016/j.lungcan.2015.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/03/2015] [Accepted: 08/13/2015] [Indexed: 01/16/2023]
Abstract
PURPOSE Prognostic models have been proposed to predict survival for non-small-cell lung cancer (NSCLC). It is important to evaluate whether these models perform better than performance status (PS) alone in stage- and age-specific subgroups. PATIENTS AND METHODS The validation cohort included 2060 stage I and 1611 stage IV NSCLC patients from 23CALGB studies. For stage I, Blanchon (B), Chansky (C) and Gail (G) models were evaluated along with the PS only model. For stage IV, Blanchon (B) and Mandrekar (M) models were compared with the PS only model. The c-index was used to assess the concordance between survival and risk scores. The c-index difference (c-difference) and the integrated discrimination improvement (IDI) were used to determine the improvement of these models over the PS only model. RESULTS For stage I, B and PS have better survival separation. The c-index for B, PS, C and G are 0.61, 0.58, 0.57 and 0.52, respectively, and B performs significantly better than PS with c-difference=0.034. For stage IV, B, M and PS have c-index 0.61, 0.64 and 0.60, respectively; B and M perform significantly better than PS with c-difference=0.015 and 0.033, respectively. CONCLUSION Although some prognostic models have better concordance with survival than the PS only model, the absolute improvement is small. More accurate prognostic models should be developed; the inclusion of tumor genetic variants may improve prognostic models.
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Affiliation(s)
- Xiaofei Wang
- Department of Biostatistics & Bioinformatics and Alliance Statistics and Data Center, Duke University, Durham, NC, United States.
| | - Lin Gu
- Department of Biostatistics & Bioinformatics and Alliance Statistics and Data Center, Duke University, Durham, NC, United States
| | - Ying Zhang
- Department of Biostatistics & Bioinformatics and Alliance Statistics and Data Center, Duke University, Durham, NC, United States
| | - Daniel J Sargent
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, United States
| | | | - Apar Kishor Ganti
- Department of Internal Medicine, VA Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Lincoln, NE, United States
| | - Jeffery Crawford
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Harvey Jay Cohen
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Thomas Stinchcombe
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Everett Vokes
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Herbert Pang
- Department of Biostatistics & Bioinformatics and Alliance Statistics and Data Center, Duke University, Durham, NC, United States; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Cao C, D'Amico T, Demmy T, Dunning J, Gossot D, Hansen H, He J, Jheon S, Petersen RH, Sihoe A, Swanson S, Walker W, Yan TD. Surgery versus SABR for resectable non-small-cell lung cancer. Lancet Oncol 2015; 16:e370-1. [DOI: 10.1016/s1470-2045(15)00036-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 11/27/2022]
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Scarci M, Pardolesi A, Caruana EJ, Petrella F, Solli P. Video-assisted thoracoscopic lobectomy: operative technique. Multimed Man Cardiothorac Surg 2015; 2015:mmv014. [PMID: 26173800 DOI: 10.1093/mmcts/mmv014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/17/2015] [Indexed: 11/14/2022]
Abstract
In this study, we present our technique for performing video-assisted lobectomy. This is presented in clear, easy-to-follow, sequential steps, noting variations on the most established technique and the rationale for this divergence. We also provide an instrument preference card, some operative tips and high-quality videos.
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Affiliation(s)
- Marco Scarci
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Edward Joseph Caruana
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Francesco Petrella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Piergiorgio Solli
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
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237
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Berry MF. Pulmonary Artery Bleeding During Video-Assisted Thoracoscopic Surgery: Intraoperative Bleeding and Control. Thorac Surg Clin 2015. [PMID: 26210920 DOI: 10.1016/j.thorsurg.2015.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With appropriate planning and operative technique, the risk of pulmonary artery injury and bleeding during video-assisted thoracoscopic surgery (VATS) lobectomy can be minimized. However, the risk cannot be completely eliminated; surgeons should always ensure that they are prepared to manage this situation if it occurs. Although pulmonary artery bleeding can potentially lead to intraoperative disasters, appropriate judgment, management, and control via VATS or conversion to thoracotomy can avoid any impact on either short-term or long-term patient outcomes.
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Affiliation(s)
- Mark F Berry
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
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238
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Single-incision versus multiple-incision thoracoscopic lobectomy and segmentectomy: a propensity-matched analysis. Ann Surg 2015; 261:793-9. [PMID: 24836148 DOI: 10.1097/sla.0000000000000712] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To compare the perioperative outcomes of single-incision and multiple-incision thoracoscopic lobectomy and segmentectomy. BACKGROUND Reports of single-incision thoracoscopic lobectomy and segmentectomy for lung cancer are limited, and a comparison between single-incision and multiple-incision thoracoscopic lobectomy or segmentectomy for lung cancer has not been previously reported. METHODS From January 2005 to June 2013, a total of 233 patients with lung cancer underwent thoracoscopic lobectomy or segmentectomy via a single-incision or multiple-incision technique. A propensity-matched analysis, incorporating preoperative variables, was used to compare the short-term outcomes between single-incision and multiple-incision thoracoscopic lobectomy and segmentectomy. RESULTS Overall, 50 patients underwent single-incision thoracoscopic pulmonary resections, including 35 lobectomies and 15 segmentectomies, and 183 patients underwent multiple-incision thoracoscopic lobectomy or segmentectomy between January 2005 and December 2011. Propensity matching produced 46 patients in each group. The length of hospital stay and the complication rate were not significantly different between the 2 groups. Single-incision thoracoscopic lobectomy and segmentectomy were associated with shorter operative time (P = 0.029), more numbers of lymph nodes (P = 0.032), and less intraoperative blood loss (P = 0.017) than with the multiple-incision approach. No in-hospital mortality occurred in either group. CONCLUSIONS Single-incision thoracoscopic lobectomy and segmentectomy are feasible, and perioperative outcomes are comparable with those of the multiple-incision approach.
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239
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Hsu PK, Lin WC, Chang YC, Chan ML, Wang BY, Liu CY, Huang WC, Shih CH, Liu CC. Multiinstitutional analysis of single-port video-assisted thoracoscopic anatomical resection for primary lung cancer. Ann Thorac Surg 2015; 99:1739-44. [PMID: 25827674 DOI: 10.1016/j.athoracsur.2015.01.041] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/09/2015] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiinstitutional analysis of single-port video-assisted thoracic surgery (VATS) for anatomic pulmonary resection is rare. This study aimed to address the technical feasibility and applicability of single-port video-assisted anatomical resection for primary lung cancer. METHODS A total of 121 patients with primary lung cancer undergoing single-port video-assisted anatomical resection between 2011 and 2014 in 4 hospitals were included. The clinicopathologic variables and perioperative outcomes were collected and analyzed retrospectively. RESULTS Single-port VATS segmentectomies and lobectomies were performed in 24 (19.8%) and 97 (80.2%) patients, respectively. One hundred seven of 121 (88.4%) patients had adenocarcinoma and 93 of 121 (76.9%) had pathologic stage I lung cancer. The average operative time and estimated blood loss was 198.8 ± 65.4 minutes and 99.1 ± 147.6 mL, respectively. The conversion and complication rates were 2.5% (3 of 121 cases) and 14.0% (17 of 121 cases), respectively. There was no surgical mortality, and the average length of hospital stay was 6.6 ± 2.6 days. The mean resected lymph node was 22.6 ± 12.0. We also identified patient age of 60 years or more, male sex, and tumor size greater than 3 cm as unfavorable perioperative outcome predictors after single-port video-assisted anatomical pulmonary resection. CONCLUSIONS This first multiinstitutional single-port VATS study demonstrated that anatomical resection for primary lung cancer can be safely and effectively completed through a single-port VATS approach in hospitals experienced in VATS techniques.
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Affiliation(s)
- Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Wei-Cheng Lin
- Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yin-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mei-Lin Chan
- Division of Thoracic Surgery, Department of Surgery, Makay Memorial Hospital, Taipei, Taiwan
| | - Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Taichung, Taiwan
| | - Chao-Yu Liu
- Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wen-Chien Huang
- Division of Thoracic Surgery, Department of Surgery, Makay Memorial Hospital, Taipei, Taiwan
| | - Chih-Hsun Shih
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
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240
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Zhai H, Zhong W, Wu Y. Research, evidence, and ethics: new technology or grey medicine. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:15. [PMID: 25738135 DOI: 10.3978/j.issn.2305-5839.2015.01.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 11/22/2014] [Indexed: 11/14/2022]
Abstract
Major pioneering advances of medicine in history tend to manifest in two directions that seem divergent but actually unified with dialectics: one is the important biological principle revealed by in-depth studies from the clinic to the laboratory based on individual cases; the other is the colonial generality displayed by epidemiologic data from large-scale samples. Although advances predominated, we human beings were paying dearly for it due to serious incidents of endangering ourselves and defects of restrictions of laws and ethics. Subsequently, the Nuremberg Code, Declaration of Helsinki and Belmont Report came into light and constrained human experiments and clinical trials. However, the development of such laws and regulations in China is lagging behind and renders China as a breeding ground for gray medicine. There are three lessons we can learn from painful histories and apply to individualized treatment of lung cancer. Firstly, the abuse of Avastin beyond its indications reflected the similar situation of tyrosine kinase inhibitors in lung cancer due to different molecular types and stages of tumors; secondly, the black market of stem cell therapy in China reminds us how to identify the boundaries of clinical trials and clinical treatment, in similar to the cellular immunotherapy of tumors; thirdly, the theory of Xiao's Reflex Arc emerged us to rethink the level of the validity of clinical evidences, which can provide hints related to video-assisted thoracoscopic surgeries (VATSs). In conclusion, clinical applications of new techniques and treatment regimens should follow three points: identify indications and contraindications clearly, obtain informed consent and permission of patients and supervise effectively according to laws and ethics.
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Affiliation(s)
- Haoran Zhai
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yilong Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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241
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Chung JH, Choi YS, Cho JH, Kim HK, Kim J, Zo JI, Shim YM. Uniportal video-assisted thoracoscopic lobectomy: an alternative to conventional thoracoscopic lobectomy in lung cancer surgery? Interact Cardiovasc Thorac Surg 2015; 20:813-9. [PMID: 25736285 DOI: 10.1093/icvts/ivv034] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/05/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Although the standard video-assisted thoracoscopic surgery (VATS) approach is generally performed through two to four incisions, uniportal VATS pulmonary resection has recently been reported to be a promising, less invasive alternative. To evaluate the adequacy of uniportal VATS lobectomy as an alternative to conventional VATS lobectomy in lung cancer, we analysed and compared the outcomes of uniportal and conventional VATS lobectomies. METHODS Retrospective observational data for patients who underwent VATS lobectomy at Samsung Medical Center between January 2013 and February 2014 due to a diagnosis of lung cancer were collected. Perioperative factors such as operative time, postoperative chest tube duration, postoperative hospital stay, complication rate, conversion rate, reoperation rate and mortality were compared between the uniportal and conventional VATS groups. RESULTS A total of 90 uniportal VATS lobectomies and 60 conventional VATS lobectomies were attempted. Fifty-eight (64.5%) cases were completed as uniportal VATS lobectomies, and 51 (85%) cases as conventional VATS lobectomies. There were 32 (35.5%) conversions of uniportal VATS lobectomy cases, including four conversions to three-port VATS, 18 to two-port VATS and 10 to open thoracotomy. No differences in postoperative complications, postoperative 30-day mortality or reoperation rate were noted between the two groups. There was no difference in operative time, number of removed lymph nodes, chest tube duration or length of postoperative hospital stay between the uniportal VATS group and conventional VATS group. CONCLUSIONS The similar perioperative results of uniportal VATS lobectomy compared with conventional VATS lobectomy suggest that uniportal VATS is a viable alternative approach to the conventional VATS approach in selected patients, especially in patients with early peripheral lung cancer with good anatomy and in good general condition.
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Affiliation(s)
- Jae Ho Chung
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
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Feng M, Shen Y, Wang H, Tan L, Mao X, Liu Y, Wang Q. Uniportal video assisted thoracoscopic lobectomy: primary experience from an Eastern center. J Thorac Dis 2015; 6:1751-6. [PMID: 25589969 DOI: 10.3978/j.issn.2072-1439.2014.11.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/04/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy is an emerging technique for the surgical resection of non-small cell lung cancer (NSCLC). Besides its wide debates on safety and efficacy throughout the world, there were few report on uniportal VATS from the Eastern countries. In this article, we summarized our primary experience on uniportal VATS lobectomy in an Eastern center. METHODS From October 2013 till February 2014, 54 consecutive uniportal VATS lobectomy were performed in the Department of Thoracic Surgery, Zhongshan Hospital of Fudan University. Patients' clinical features and operative details were recorded. Post-operatively, the morbidity and mortality were recorded to analyze the safety and efficacy of uniportal VATS lobectomy for NSCLCs. RESULTS Among the 54 planned uniportal VATS lobectomy, there was one conversion to mini-thoracotomy due to lymph node sticking. Extra ports were required in two patients. The uniportal VATS lobectomy was achieved in 51 out of 54 patients (94.4%). The average operation duration was 122.2±37.5 min (90-160 min). The average volume of estimated blood loss during the operation was 88.8±47.1 mL (50-200 mL). The mean chest tube duration and hospital stay were 3.2±1.9 days and 4.6±2.0 days, respectively. There was no postoperative mortality in this study. Two patients suffered from prolonged air leakage (5 and 7 days), and one atrial fibrillation was observed in this cohort. CONCLUSIONS Based on our primary experience, uniportal VATS lobectomy is a safe and effective procedure for the surgical resection of NSCLCs. The surgical refinements and instrumental improvements would facilitate the technique. Further studies based on larger population are required to determine its benefits towards patients with NSCLCs.
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Affiliation(s)
- Mingxiang Feng
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Yaxing Shen
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Hao Wang
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Lijie Tan
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Xuping Mao
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Yi Liu
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Qun Wang
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
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Smith PK, Mulvihill MS, D׳Amico TA. The History of Duke Thoracic Surgery. Semin Thorac Cardiovasc Surg 2015; 27:360-9. [DOI: 10.1053/j.semtcvs.2015.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 11/11/2022]
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Abstract
Lung cancer accounts for more cancer deaths than breast, prostate, colorectal and pancreatic cancer combined. With an aging population, greater intensity of cancer care, and the need for care of the growing number of cancer survivors, comparative effectiveness research opportunities will continue to emerge for this disease. In this chapter, we focus on CER opportunities in lung cancer surgery from the vantage point of those factors directly influenced by the surgeon, patient and the healthcare system.
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245
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Liu C, Li Z, Bai C, Wang L, Shi X, Song Y. Video-assisted thoracoscopic surgery and thoracotomy during lobectomy for clinical stage I non-small-cell lung cancer have equivalent oncological outcomes: A single-center experience of 212 consecutive resections. Oncol Lett 2014; 9:1364-1372. [PMID: 25663914 PMCID: PMC4315067 DOI: 10.3892/ol.2014.2804] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 08/22/2014] [Indexed: 12/24/2022] Open
Abstract
The aim of the present study was to compare the oncological outcomes following lobectomy using either video-assisted thoracoscopic surgery (VATS) or thoracotomy in clinical stage I non-small cell lung cancer (NSCLC) patients. Short- and long-term data from 212 consecutive patients who underwent lobectomy for clinical stage I NSCLC via VATS or thoracotomy between February 2003 and July 2013 were retrospectively reviewed. The primary endpoints were mediastinal lymph node staging, disease-free survival time and overall survival time. A total of 212 lobectomies for clinical stage I NSCLC were performed, 123 by VATS and 89 by thoracotomy. Patients’ demographic data, pathological stage and residual tumor were similar in the two groups. Reduced blood loss, less post-operative analgesia required and earlier hospital discharge were recorded for the VATS group, as compared with the thoracotomy group. The overall morbidity was similar in the two groups. However, the rate of major complications was higher following thoracotomy than following VATS. No 30-day mortality occurred subsequent to either thoracotomy or VATS lobectomy. The overall survival and disease-free survival times were comparable between the two groups. In the univariate analysis, the treatment approach was not associated with the overall five-year survival or the disease-free survival times. Multivariate Cox regression analysis of survival times revealed that significant predictors of shorter survival times were advanced pathological T3 stage, pathological N1 or N2 disease and poor cancer differentiation. In conclusion, it is reasonable to conclude from the present study that VATS lobectomy performed by specialist thoracic surgeons is safe and may achieve similar long-term survival times to the open surgery approach. However, further prospective randomized multi-center trials are warranted prior to incorporating VATS into clinical routine.
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Affiliation(s)
- Chunhua Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, P.R. China
| | - Zhongdong Li
- Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, P.R. China
| | - Cuiqing Bai
- Department of Respiratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Li Wang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, P.R. China
| | - Xuefei Shi
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, P.R. China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, P.R. China
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246
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Nwogu CE, D'Cunha J, Pang H, Gu L, Wang X, Richards WG, Veit LJ, Demmy TL, Sugarbaker DJ, Kohman LJ, Swanson SJ. VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance). Ann Thorac Surg 2014; 99:399-405. [PMID: 25499481 DOI: 10.1016/j.athoracsur.2014.09.018] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 07/26/2014] [Accepted: 09/09/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND The short-term superiority of video-assisted thoracoscopic surgery lobectomy compared with open lobectomy for early-stage lung cancer has been suggested by single-institution studies. Lack of equipoise limits the feasibility of a randomized study to confirm this. The hypothesis of this study (CALGB 31001) was that VATS lobectomy results in shorter length of hospital stay and fewer complications compared with open lobectomy in stages I and II non-small cell lung cancer in a multi-institutional setting. METHODS Five hundred nineteen patients whose tumors had been collected as part of CALGB 140202 (lung cancer tissue bank) were eligible. Propensity-scoring using age, race, sex, performance status, comorbidities, histology, tumor stage, and size as independent variables was used to create a 1:1 matched group of 175 pairs of patients. McNemar's test for binary variables and Wilcoxon signed-rank test for continuous variables were used to assess differences in length of hospital stay, complications, and discharge dispositions between the groups. Comparison of disease-free and overall survival between the two approaches was done using the log-rank test. Probability values of less than 0.05 were considered significant. RESULTS The matched data on length of hospital stay, complications, and discharge dispositions significantly favored the video-assisted thoracoscopic surgery group. There was no statistically significant difference in survival between the two approaches. CONCLUSIONS This multi-institutional study supports the assertion that thoracoscopic lobectomy results in shorter hospital length of stay, fewer perioperative complications, and greater likelihood of independent home discharge compared with open lobectomy for early-stage lung cancer. Survival was comparable between the two groups.
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Affiliation(s)
- Chukwumere E Nwogu
- Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, New York.
| | - Jonathan D'Cunha
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Herbert Pang
- Alliance Statistics and Data Center, Duke University Medical Center, Durham, North Carolina
| | - Lin Gu
- Alliance Statistics and Data Center, Duke University Medical Center, Durham, North Carolina
| | - Xiaofei Wang
- Alliance Statistics and Data Center, Duke University Medical Center, Durham, North Carolina
| | - William G Richards
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Linda J Veit
- State University of New York Upstate Medical Center, Syracuse, New York
| | - Todd L Demmy
- Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, New York
| | - David J Sugarbaker
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leslie J Kohman
- State University of New York Upstate Medical Center, Syracuse, New York
| | - Scott J Swanson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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247
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Panditaratne N, Slater S, Robertson R. Lung cancer: from screening to post-radical treatment. IMAGING 2014. [DOI: 10.1259/img.20120005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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248
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Reichert M, Kerber S, Amati AL, Bodner J. Total video-assisted thoracoscopic (VATS) resection of a left-sided sulcus superior tumor after induction radiochemotherapy: video and review. Surg Endosc 2014; 29:2407-9. [PMID: 25424366 DOI: 10.1007/s00464-014-3952-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 10/01/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has gained increasing acceptance for surgical therapy of early stage non small cell lung cancer (NSCLC). Even for extended pulmonary resections in advanced tumor stages, increasing evidence suggests feasibility and safety of the VATS approach. However, so far very little experience has been reported on VATS management of sulcus superior tumors. METHODS We report on a 56-year-old female patient with a left-sided anterior sulcus superior adenocarcinoma (cT3 cN1 cM0), which was completely resected by VATS after induction radiochemotherapy. RESULTS The surgical procedure was performed completely minimally invasively via a three-incision anterior thoracoscopic approach. The total operating time was 285 min (composed of 116 min for hilar lobectomy, 103 min for sulcus superior preparation and chest wall resection, and 26 min for systematic en-bloc lymph node dissection). The single chest tube was removed on postoperative day two and the patient was discharged on postoperative day six. No intraoperative and no postoperative complications were observed. Histopathology confirmed a complete (R0) resection of an ypT2aN0M0 bronchogenic adenocarcinoma. CONCLUSION With increasing experience even extended pulmonary resections are safe and feasible by a video-assisted thoracoscopic approach. We propose that in sulcus superior tumors without tumor invasion of vascular structures VATS can be considered.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Street 7, 35392, Giessen, Germany,
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Xu X, Chen H, Yin W, Shao W, Wang W, Peng G, Huang J, He J. Initial experience of thoracoscopic lobectomy with partial removal of the superior vena cava for lung cancers. Eur J Cardiothorac Surg 2014; 47:e8-12. [PMID: 25404663 DOI: 10.1093/ejcts/ezu416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objectives of this study were to report the surgical techniques and clinical outcome of thoracoscopic lobectomy with partial removal of the superior vena cava for lung carcinomas. METHODS Between January 2010 and November 2013, 1132 patients with lung cancer underwent radical surgery by thoracoscopy; 5 (0.4%) underwent thoracoscopic lobectomy with partial removal of the superior vena cava. Perioperative variables and postoperative outcomes of these cases were analysed to evaluate the technical feasibility and safety of this operation. RESULTS For all cases, a right upper lobectomy was performed. The average time of surgery was 260 min (range, 170-380, 260±90 min).The intraoperative blood loss averaged 160 ml (range, 50-300, 160±90 ml). The median postoperative hospital stay was 11 days (interquartile range, 7-15 days). Postoperatively, tracheal extubation was achieved in the recovery room without further need for mechanical ventilation. In 1 case, the patient experienced postoperative superior vena cava thrombosis; he recovered after administration of anticoagulation drugs. None of the patients developed active blood leakage postoperatively. Perioperative mortality was not observed. CONCLUSION Thoracoscopic lobectomy with partial removal of the superior vena cava can be considered a feasible and safe operation for selected patients with lung cancer.
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Affiliation(s)
- Xin Xu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Hanzhang Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Weiqiang Yin
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Wenlong Shao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Wei Wang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Guilin Peng
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Jun Huang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, Guangzhou, China
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Pischik VG. Technical difficulties and extending the indications for VATS lobectomy. J Thorac Dis 2014; 6:S623-30. [PMID: 25379200 DOI: 10.3978/j.issn.2072-1439.2014.10.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/02/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Data on advantages of video-assisted thoracoscopic surgery (VATS) lobectomies has been accumulated during the last 10 years then number of thoracoscopic anatomic pulmonary resections rapidly increased. But still there is no agreement about limitations of the method. The most popular "technical contraindications" for VATS anatomic pulmonary resections are: dense pleural adhesions, incompleteness of interlobar fissure, previous chemo- or/and radiotherapy, perivascular or/and peribronchial fibrosis, tumor larger than 5 cm, chest wall involvement, centrally located tumor, severe comorbidity, advanced age, severe COPD and emphysema. Extending of indications for the VATS anatomic pulmonary resection and its influence on the immediate outcomes was investigated. METHODS Ninety two consecutive cases of VATS anatomic pulmonary resection performed by the single surgeon from January 2012 till December 2013 at the Federal University Hospital #122 in Saint Petersburg, Russia were retrospectively analyzed. Forty three males and 49 females at the age from 21 to 87 years old (mean age 59±7.2). The most of the cases were comprised by lung cancer of I-III stage together with bronchiectasis and tuberculomas. Conversion rate was 3.2% mostly due to perivascular calcification and/or fibrosis. There were no cases of 30-days mortality and readmission. All those patients retrospectively divided into two groups: with standard and extended indications for the VATS lobectomy. Inclusion in "extended" group was made if patients had one or more technical challenges among following: size of the lesion 5 cm and more; strong pleural adhesions and/or "bad fissure"; adjacent structures involvement; hilar or mediastinal lymph nodes enlargement or involvement; centrally located tumors; previous chemo- or chemoradiotherapy or previous thoracic surgery. RESULTS According to these criteria, 45 standard (S) and 47 extended (E) patients were pair-matched with no statistically significant differences between the groups in common patients' characteristics. Postoperative comparison of "standard" and "expanded" groups revealed some differences in average operation time (152 vs. 189 min), in number of resected mediastinal lymph nodes (10.2 vs. 13.1), and in the mean time before removal of the chest tube (3.9 vs. 5.2 days). But the blood loss, morbidity and the length of hospital stay were almost the same in the two groups. CONCLUSIONS Extension of indications to VATS lobectomy does not compromise the short-term results. Incompleteness of interlobar fissures, pleural adhesions, preoperative chemotherapy, big size of lesion, and some cases of centrally located tumors are not supposed to be the contraindications for VATS lobectomy. Peribronchial and perivascular lymph node calcification may complicate and even preclude lobectomy by VATS.
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Affiliation(s)
- Vadim G Pischik
- Thoracic Surgery Department, Federal Hospital #122, Saint Petersburg, Russia ; Faculty of Medicine, Saint Petersburg State University, Saint Petersburg, Russia
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