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Hishida T, Okami J, Asamura H, Miyaoka E, Shintani Y, Kadokura M, Endo S, Chida M, Suzuki H, Yoshino I, Date H. Clinicopathological Features and Survival Outcomes of Resected Lung Adenosquamous Carcinoma: Results From a Nationwide Japanese Registry Data. Clin Lung Cancer 2024; 25:519-528.e3. [PMID: 38906754 DOI: 10.1016/j.cllc.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES The objective of this study was to clarify the clinicopathological features and prognostic factors of resected lung adenosquamous carcinoma (ASC) using a nationwide multi-institutional database. METHODS We retrospectively reviewed the records of 15,542 patients who underwent complete R0 resection for ASC (n = 326), adenocarcinoma (AC, n = 11,820), or squamous cell carcinoma (SC, n = 3396) from a Japanese lung cancer registry in 2010. To reduce the selection bias, an inverse probability of treatment weighting (IPTW) method using a propensity score was implemented. RESULTS The ASC group showed worse recurrence-free and overall survival (RFS and OS) than both the AC and SC groups (5-year OS: 57.5% in ASC, 83.9% in AC [< 0.001], and 62.3% in SC [P = .086]). In multivariate analyses, prognostic factors that affected OS for ASC included male, p-stage II-III, and postoperative complications within 30 days (grade ≥ 3 in the Clavien-Dindo classification). The sensitizing EGFR mutation was detected in 28 (21.5%) of 130 screened patients with ASC, but it did not affect either RFS, OS, or postrecurrence survival. Although more patients in the ASC group received adjuvant chemotherapy compared to the AC and SC groups, both multivariate and IPTW-adjusted analyses did not show positive impact of adjuvant chemotherapy on RFS and OS in ASC. CONCLUSIONS In this nationwide registry study, lung ASC was more aggressive than both AC and SC. No apparent survival impact of conventional adjuvant chemotherapy prompted us to investigate novel adjuvant strategies to optimize survival outcomes.
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Affiliation(s)
- Tomoyuki Hishida
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Jiro Okami
- Department of Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Etsuo Miyaoka
- Department of Mathematics, Tokyo University of Science, Tokyo, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsutaka Kadokura
- Department of Surgery, Division of Chest Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Shunsuke Endo
- Department of General Thoracic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Licker M, El Manser D, Bonnardel E, Massias S, Soualhi IM, Saint-Leger C, Koeltz A. Multi-Modal Prehabilitation in Thoracic Surgery: From Basic Concepts to Practical Modalities. J Clin Med 2024; 13:2765. [PMID: 38792307 PMCID: PMC11121931 DOI: 10.3390/jcm13102765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/23/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Over the last two decades, the invasiveness of thoracic surgery has decreased along with technological advances and better diagnostic tools, whereas the patient's comorbidities and frailty patterns have increased, as well as the number of early cancer stages that could benefit from curative resection. Poor aerobic fitness, nutritional defects, sarcopenia and "toxic" behaviors such as sedentary behavior, smoking and alcohol consumption are modifiable risk factors for major postoperative complications. The process of enhancing patients' physiological reserve in anticipation for surgery is referred to as prehabilitation. Components of prehabilitation programs include optimization of medical treatment, prescription of structured exercise program, correction of nutritional deficits and patient's education to adopt healthier behaviors. All patients may benefit from prehabilitation, which is part of the enhanced recovery after surgery (ERAS) programs. Faster functional recovery is expected in low-risk patients, whereas better clinical outcome and shorter hospital stay have been demonstrated in higher risk and physically unfit patients.
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Affiliation(s)
- Marc Licker
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
| | - Diae El Manser
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Eline Bonnardel
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Sylvain Massias
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Islem Mohamed Soualhi
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
| | - Charlotte Saint-Leger
- Department of Cardiovascular & Thoracic Surgery, University Hospital of Martinique, F-97200 Fort-de-France, France;
| | - Adrien Koeltz
- Department of Cardiovascular & Thoracic Anaesthesia and Critical Care, University Hospital of Martinique, F-97200 Fort-de-France, France; (D.E.M.); (E.B.); (S.M.); (I.M.S.); (A.K.)
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Roshanov PS, Chan MTV, Borges FK, Conen D, Wang CY, Xavier D, Berwanger O, Marcucci M, Sessler DI, Szczeklik W, Spence J, Alonso-Coello P, Fernández C, Pearse RM, Malaga G, Garg AX, Srinathan SK, Jacka MJ, Tandon V, McGillion M, Popova E, Sigamani A, Abraham V, Biccard BM, Villar JC, Chow CK, Polanczyk CA, Tiboni M, Whitlock R, Ackland GL, Panju M, Lamy A, Sapsford R, Williams C, Wu WKK, Cortés OL, MacNeil SD, Patel A, Belley-Côté EP, Ofori S, McIntyre WF, Leong DP, Heels-Ansdell D, Gregus K, Devereaux PJ. One-year Outcomes after Discharge from Noncardiac Surgery and Association between Predischarge Complications and Death after Discharge: Analysis of the VISION Prospective Cohort Study. Anesthesiology 2024; 140:8-24. [PMID: 37713506 DOI: 10.1097/aln.0000000000004763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
BACKGROUND In previous analyses, myocardial injury after noncardiac surgery, major bleeding, and sepsis were independently associated with most deaths in the 30 days after noncardiac surgery, but most of these deaths occurred during the index hospitalization for surgery. The authors set out to describe outcomes after discharge from hospital up to 1 yr after inpatient noncardiac surgery and associations between predischarge complications and postdischarge death up to 1 yr after surgery. METHODS This study was an analysis of patients discharged after inpatient noncardiac surgery in a large international prospective cohort study across 28 centers from 2007 to 2013 of patients aged 45 yr or older followed to 1 yr after surgery. The study estimated (1) the cumulative postdischarge incidence of death and other outcomes up to a year after surgery and (2) the adjusted time-varying associations between postdischarge death and predischarge complications including myocardial injury after noncardiac surgery, major bleeding, sepsis, infection without sepsis, stroke, congestive heart failure, clinically important atrial fibrillation or flutter, amputation, venous thromboembolism, and acute kidney injury managed with dialysis. RESULTS Among 38,898 patients discharged after surgery, the cumulative 1-yr incidence was 5.8% (95% CI, 5.5 to 6.0%) for all-cause death and 24.7% (95% CI, 24.2 to 25.1%) for all-cause hospital readmission. Predischarge complications were associated with 33.7% (95% CI, 27.2 to 40.2%) of deaths up to 30 days after discharge and 15.0% (95% CI, 12.0 to 17.9%) up to 1 yr. Most of the association with death was due to myocardial injury after noncardiac surgery (15.6% [95% CI, 9.3 to 21.9%] of deaths within 30 days, 6.4% [95% CI, 4.1 to 8.7%] within 1 yr), major bleeding (15.0% [95% CI, 8.3 to 21.7%] within 30 days, 4.7% [95% CI, 2.2 to 7.2%] within 1 yr), and sepsis (5.4% [95% CI, 2.2 to 8.6%] within 30 days, 2.1% [95% CI, 1.0 to 3.1%] within 1 yr). CONCLUSIONS One in 18 patients 45 yr old or older discharged after inpatient noncardiac surgery died within 1 yr, and one quarter were readmitted to the hospital. The risk of death associated with predischarge perioperative complications persists for weeks to months after discharge. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Pavel S Roshanov
- Department of Medicine, Western University, London, Canada; Population Health Research Institute, Hamilton, Canada
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Flavia K Borges
- Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - David Conen
- Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - C Y Wang
- Honorary Professor; Department of Anesthesiology, University of Malaya, Kuala Lumpur, Malaysia
| | - Denis Xavier
- St. John's Medical College Hospital, Bangalore, India
| | - Otavio Berwanger
- George Institute for Global Health, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Maura Marcucci
- Clinical Epidemiology and Research Centre (CERC), Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jessica Spence
- Anesthesia and Critical Care, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Hospital Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública, Madrid, Spain
| | - Carmen Fernández
- Department of Anesthesiology and Intensive Care Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rupert M Pearse
- Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - German Malaga
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Amit X Garg
- Department of Medicine, University of Western Ontario, London, Canada
| | | | - Michael J Jacka
- Department of Critical Care and Anesthesia, University of Alberta, Edmonton, Canada
| | - Vikas Tandon
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Michael McGillion
- School of Nursing, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - Ekaterine Popova
- IIB Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Centro Cochrane Iberoamericano, Barcelona, Spain
| | - Alben Sigamani
- Numen Health, Bangalore, India; Narayana Hrudayalaya Health City Bangalore, Bangalore, India
| | - Valsa Abraham
- Christian Medical College and Hospital Ludhiana, Ludhiana, India
| | - Bruce M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Observatory, South Africa
| | | | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Carísi A Polanczyk
- Graduate Program in Epidemiology and Cardiovascular Science, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Institute for Health Technology Assessment, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Tiboni
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Richard Whitlock
- Department of Surgery, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - Gareth L Ackland
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mohamed Panju
- Department of Medicine, McMaster University, Hamilton, Canada
| | - André Lamy
- Department of Surgery, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - Robert Sapsford
- Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Colin Williams
- Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - William Ka Kei Wu
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Olga L Cortés
- Research Department and Nursing Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá DC, Colombia
| | - S Danielle MacNeil
- Schulich School of Medicine and Dentistry, Western University, London, Canada; Otolaryngology-Head & Neck Surgery, London Health Sciences Centre, London, Canada
| | - Ameen Patel
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Emilie P Belley-Côté
- Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - Sandra Ofori
- Population Health Research Institute, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - William F McIntyre
- Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - Darryl P Leong
- Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | | | - P J Devereaux
- Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
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Zirafa CC, Manfredini B, Romano G, Sicolo E, Castaldi A, Bagalà E, Morganti R, Cariello C, Davini F, Melfi F. Comparison of Robotic and Open Lobectomy for Lung Cancer in Marginal Pulmonary Function Patients: A Single-Centre Retrospective Study. Curr Oncol 2023; 31:132-144. [PMID: 38248094 PMCID: PMC10814225 DOI: 10.3390/curroncol31010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The treatment of non-small-cell lung cancer (NSCLC) patients with reduced respiratory function represents a challenge for thoracic surgeons. Minimally invasive surgery seems to be beneficial for these patients because it reduces tissue trauma and its impact on respiratory mechanics. Application of the robotic technique, the use of CO2 insufflation and longer surgical time are factors that could influence the outcomes of marginal pulmonary function patients. The objective of this study was to evaluate the impact of the robotic technique on the postoperative outcomes of patients with poor lung function. METHODS We retrospectively collected and analyzed data from consecutive marginal respiratory function patients who underwent robotic or open lobectomy for NSCLC. Data regarding clinical, operative and postoperative details were compared between the open and robotic approaches. RESULTS The outcomes of 100 patients with reduced respiratory function were evaluated, of whom 59 underwent open lobectomies and 41 underwent robotic lobectomies. Robotic lobectomy was characterized by a longer operative time, a reduced hospital stay and a lower incidence of postoperative complications (22% vs. 33.9%), when compared to the open approach. CONCLUSION Robotic lobectomy is a safe and feasible procedure for patients with marginal pulmonary function.
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Affiliation(s)
- Carmelina Cristina Zirafa
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Beatrice Manfredini
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Elisa Sicolo
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Andrea Castaldi
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Elena Bagalà
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, 56124 Pisa, Italy;
| | - Claudia Cariello
- Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Anaesthesia and Critical Care Medicine, University Hospital of Pisa, 56124 Pisa, Italy;
| | - Federico Davini
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular, and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy; (B.M.); (G.R.); (E.S.); (A.C.); (E.B.); (F.D.); (F.M.)
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7
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Okamoto T, Matsuki Y, Ogata H, Okutani H, Ueki R, Kariya N, Tatara T, Hirose M. Association between averaged intraoperative nociceptive response index and postoperative complications after lung resection surgery. Interact Cardiovasc Thorac Surg 2022; 35:6754818. [PMID: 36214634 PMCID: PMC9725181 DOI: 10.1093/icvts/ivac258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Since postoperative complications, defined as Clavien-Dindo grade ≥II, correlate with long-term survival after lung resection surgery in patients with primary lung cancer, identification of intraoperative risk factors for postoperative complications is crucial for better perioperative management. In the present study, we investigated the possible association between intraoperative variables for use in anaesthetic management and Clavien-Dindo grade ≥II. METHODS In this multi-institutional observational study, consecutive adult patients undergoing video-assisted thoracic surgery for primary lung cancer under general anaesthesia from March 2019 to April 2021 were enrolled. All patients were divided into 2 groups with Clavien-Dindo grade <II and ≥II. Uni- and multivariable analyses were performed to identify intraoperative risk factors. RESULTS After univariable analysis between patients with Clavien-Dindo grade <II (n = 415) and ≥II (n = 121), multivariable analysis revealed higher averaged nociceptive response (NR) index during surgery (mean NR), male sex, lower body mass index, longer duration of surgery, higher blood loss and lower urine volume, as independent risk factors for postoperative complications. In sensitivity analysis, based on the cut-off value of mean NR for postoperative complications, all patients were divided into high and low mean NR groups. The incidence of postoperative complications was significantly higher in patients with high mean NR (n = 332) than in patients with low mean NR (n = 204; P < 0.001). CONCLUSIONS Higher mean NR, as intraoperative variables for use in anaesthetic management, is associated with the higher incidence of postoperative complications after primary lung cancer surgery.
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Affiliation(s)
- Takuma Okamoto
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Yuka Matsuki
- Department of Anaesthesiology and Reanimatology, Faculty of Medicine Sciences, University of Fukui, Fukui, Japan
| | - Hiroki Ogata
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Hiroai Okutani
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Ryusuke Ueki
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Nobutaka Kariya
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Tsuneo Tatara
- Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Munetaka Hirose
- Corresponding author. Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 6638501, Japan. Tel: +81-798-45-6392; fax: +81-798-45-6393; e-mail: (M. Hirose)
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