Management of the pulmonary artery during video-assisted thoracoscopic left upper lobectomy

Safety and feasibility of preferential manual bronchoplasty in 2-3 cm single-port video-assisted thoracoscopic lobectomy

BACKGROUND

This retrospective study aimed to compare preferential manual bronchoplasty (PMB) and mechanical stapler closure (MSC) of the bronchial stump after 2-3 cm single-port (SP) video-assisted thoracoscopic surgery (VATS) lobectomy in patients with pathological T1 (pT1) stage lung cancer.

METHODS

Between January 2019 and March 2022, patients with pulmonary neoplasms who underwent 2-3 cm SP VATS lobectomy were retrospectively screened. After propensity-matched analysis, we compared perioperative outcomes and analyzed the safety and feasibility of PMB and MSC of the bronchial stump while performing VATS lobectomy.

RESULTS

In this study, 280 and 832 patients were enrolled in the PMB and MSC groups, respectively. Propensity score matching produced 280 pairs. The operation time was shorter in the PMB group, whereas the average number of lymph nodes dissected was higher in the PMB group. The conversion rate was significantly lower in the PMB group. The following were similar between the PMB and MSC groups, respectively: average blood loss volume, postoperative hospital stay, and chest tube removal time. Postoperatively, the incidence of atelectasis was significantly higher in the MSC group. As per subgroup analyses, PMB was associated with a shorter operation time in left and right upper lobectomies. Particularly in left upper lobectomy, PMB had more lymph node dissections and less conversion to open and postoperative atelectasis.

CONCLUSIONS

In comparison with MSC of the bronchial stump, PMB showed better safety and feasibility in 2-3 cm SP VATS left and right superior lobectomies in patients with pT1 stage lung cancer.

Left superior pulmonary venous thrombosis complicated with splenic infarction after video-assisted thoracoscopic left upper lobectomy

A 72-year-old man underwent video-assisted thoracoscopic left upper lobectomy for small cell lung cancer. After 16 days, he experienced epigastric abdominal pain and vomiting, and was taken by ambulance to our hospital. Contrast-enhanced computed tomography (CT) showed a propagation of thrombus in the stump of the left superior pulmonary vein (LSPV) complicated with splenic infarction. The patient received anticoagulation therapy with heparin and warfarin, and further progression of the thrombus or any systemic embolic event was not observed during hospitalization. Here, we report a patient presenting with LSPV thrombosis complicated with splenic infarction after video-assisted thoracoscopic surgery (VATS), and describe several months follow-up CT imaging results after administration of an oral anticoagulation therapy. <Learning objective: Pulmonary venous thrombosis after lung surgery is a rare, but critical, condition. Only few cases have been previously reported and all cases described LSPV thrombus. We also demonstrated LSPV thrombus after VATS lobectomy, and clearly showed follow-up results after anticoagulation therapy. Our case indicates the need for periodic CT imaging follow-up after left upper lobectomy and may call attention to thoracic surgeons, internal medicine, and cardiology physicians regarding this complication.>.

Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study†

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.