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Xu Y, Qin Y, Ma D, Liu H. The impact of segmentectomy versus lobectomy on pulmonary function in patients with non-small-cell lung cancer: a meta-analysis. J Cardiothorac Surg 2022; 17:107. [PMID: 35526006 PMCID: PMC9077940 DOI: 10.1186/s13019-022-01853-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/20/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Segmentectomy has been reported as an alternative to lobectomy for small-sized NSCLC without detriment to survival. The long-term benefits of segmentectomy over lobectomy on pulmonary function have not been firmly established. This meta-analysis aims to compare postoperative changes in pulmonary function in NSCLC patients undergoing segmentectomy or lobectomy. Methods Medline, Embase, Web of Science and Scopus were searched through March 2021. Statistical comparisons were made when appropriate. Results Fourteen studies (2412 participants) out of 324 citations were included in this study. All selected studies were high quality, as indicated by the Newcastle–Ottawa scale for assessing the risk of bias. Clinical outcomes were compared between segmentectomy and lobectomy. ΔFEV1 [10 studies, P < 0.01, WMD = 0.40 (0.29, 0.51)], ΔFVC [4 studies, P < 0.01, WMD = 0.16 (0.07, 0.24)], ΔFVC% [4 studies, P < 0.01, WMD = 4.05 (2.32, 5.79)], ΔFEV1/FVC [2 studies, P < 0.01, WMD = 1.99 (0.90, 3.08)], and ΔDLCO [3 studies, P < 0.01, WMD = 1.30 (0.69, 1.90)] were significantly lower in the segmentectomy group than in the lobectomy group. Subgroup analysis showed that in stage IA patients, the ΔFEV1% [3 studies, P < 0.01, WMD = 0.26 (0.07, 0.46)] was significantly lower in the segmentectomy group. The ΔDLCO% and ΔMVV% were incomparable. Conclusion Segmentectomy preserves more lung function than lobectomy. There were significantly smaller decreases in FEV1, FVC, FVC%, FEV1/FVC and DLCO in the segmentectomy group than in the lobectomy group. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01853-3.
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Affiliation(s)
- Yuan Xu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Piccioni F, Droghetti A, Bertani A, Coccia C, Corcione A, Corsico AG, Crisci R, Curcio C, Del Naja C, Feltracco P, Fontana D, Gonfiotti A, Lopez C, Massullo D, Nosotti M, Ragazzi R, Rispoli M, Romagnoli S, Scala R, Scudeller L, Taurchini M, Tognella S, Umari M, Valenza F, Petrini F. Recommendations from the Italian intersociety consensus on Perioperative Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative care. Perioper Med (Lond) 2020; 9:37. [PMID: 33292657 PMCID: PMC7704118 DOI: 10.1186/s13741-020-00168-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Anesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care. METHODS A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from 19 Italian centers, was established to develop recommendations for anesthesia practice in patients undergoing thoracic surgery (specifically lung resection for cancer). The project focused on preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and PubMed and Embase literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventative Services Task Force criteria. RESULTS Recommendations for preoperative care focus on risk assessment, patient preparation (prehabilitation), and the choice of procedure (open thoracotomy vs. video-assisted thoracic surgery). CONCLUSIONS These recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
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Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, 20133, Milan, Italy.
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute "Regina Elena"-IRCCS, Rome, Italy
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Carlo Curcio
- Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Carlo Del Naja
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Paolo Feltracco
- Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Padua, Italy
| | - Diego Fontana
- Thoracic Surgery Unit - San Giovanni Bosco Hospital - Torino, Turin, Italy
| | | | - Camillo Lopez
- Thoracic Surgery Unit, V Fazzi Hospital, Lecce, Italy
| | - Domenico Massullo
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria S. Andrea, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Marco Rispoli
- Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy
- Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Raffaele Scala
- Pneumology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy
| | - Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Marco Taurchini
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Silvia Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - Marzia Umari
- Combined Department of Emergency, Urgency and Admission, Cattinara University Hospital, Trieste, Italy
| | - Franco Valenza
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Flavia Petrini
- Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
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Singer ES, Kneuertz PJ, Nishimura J, D'Souza DM, Diefenderfer E, Moffatt-Bruce SD, Merritt RE. Effect of operative approach on quality of life following anatomic lung cancer resection. J Thorac Dis 2020; 12:6913-6919. [PMID: 33282394 PMCID: PMC7711373 DOI: 10.21037/jtd.2020.01.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patient-reported outcomes (PRO) after lung cancer surgery are of increasing interest to patients and clinicians. A variety of studies have investigated the impact of the surgical approach on quality of life (QOL) after surgery for early non-small-cell lung cancer (NSCLC). Our aim is to review the current evidence on how minimally-invasive approaches, including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), versus open thoracotomy for lung cancer affect QOL. We conducted a systematic review of the literature of studies comparing QOL after VATS/RATS versus thoracotomy approach using studies published before 2019 on PubMed and Google Scholar. Studies were assessed for differences in QOL by domains. Fifteen studies met our inclusion criteria including 14 observational studies and one randomized trial. Survey instruments and timing of QOL assessments differed between all studies. A thoracoscopic (VATS or RATS) approach was associated with better general health (3/10 studies), physical functioning (9/14 studies), social functioning (1/12 studies), mental health (3/13 studies), emotional role functioning (4/12 studies), physical role functioning (7/12 studies), and bodily pain (7/12 studies) as compared to open surgery. The open thoracotomy approach was associated with better general health and mental health in one study each. Although QOL assessment in current studies is highly variable, the existing evidence suggests that a thoracoscopic approach is associated with improved QOL, particularly in the areas of physical functioning and pain as compared to open lung cancer surgery.
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Affiliation(s)
- Emily S Singer
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J Kneuertz
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer Nishimura
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Desmond M D'Souza
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ellen Diefenderfer
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Susan D Moffatt-Bruce
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Robert E Merritt
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Sihoe ADL. Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology 2020; 25 Suppl 2:49-60. [PMID: 32734596 DOI: 10.1111/resp.13920] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
Surgical resection remains the only effective means of cure in the vast majority of patients with early-stage lung cancer. It can be performed via a traditional open approach (particularly thoracotomy) or a minimally invasive approach. VATS is 'keyhole' surgery in the chest, and was first used for lung cancer resection in the early 1990s. Since then, a large volume of evolving clinical evidence has confirmed that VATS lung cancer resection offered proven safety and feasibility, better patient-reported post-operative outcomes, less surgical trauma as quantified by objective outcome measures and equivalent or better survival than open surgery. This has firmly established VATS as the surgical approach of choice for early-stage lung cancer today. Although impressive new non-surgical lung cancer therapies have emerged in recent years, VATS is also being constantly rejuvenated by the development of 'next generation' VATS techniques, the refinement of VATS sublobar resection for selected patients, the utilization of bespoke post-operative recovery programmes for VATS and the synthesis of VATS into multi-modality lung cancer therapy. There is little doubt that VATS will remain as the gold standard for lung cancer surgery for the foreseeable future.
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Affiliation(s)
- Alan D L Sihoe
- Gleneagles Hong Kong Hospital, Hong Kong SAR, China.,International Medical Centre, Hong Kong SAR, China
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5
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Wang Z, Pang L, Tang J, Cheng J, Chen N, Zhou J, Liu L. Video-assisted thoracoscopic surgery versus muscle-sparing thoracotomy for non-small cell lung cancer: a systematic review and meta-analysis. BMC Surg 2019; 19:144. [PMID: 31615490 PMCID: PMC6794906 DOI: 10.1186/s12893-019-0618-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/30/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It has been widely accepted that video-assisted thoracoscopic surgery (VATS) lobectomy is superior to conventional open thoracotomy lobectomy in many aspects. However, the direct comparison between VATS and Muscle-sparing thoracotomy (MST) has not been widely conducted. We aimed to compare the perioperative outcomes in non-small cell lung cancer (NSCLC) patients following VATS and MST. METHODS PubMed, EMBASE, the Cochrane Library and Web of Science were searched for relevant studies. The retrieval time was up to April 24, 2019. Studies investigating the comparison of video-assisted thoracoscopy and muscle-sparing thoracotomy were included in our meta-analysis. Odds ratio and mean differences with 95% confidential interval were applied to determine the effectiveness of dichotomous or continuous variables respectively. RESULTS A total of 10 studies were included with 1514 patients. Compared with MST, the incidence of postoperative complications in VATS [OR = 0.54; 95%CI(0.4, 0.73); P < 0.001] and the hospital stay [MD = -1.5; 95%CI(- 2.28, - 0.73); P = 0.0001] decreased significantly, chest tube drainage time [MD = -0.71; 95%CI(- 1.18, - 0.24); P = 0.003] were shorter and the intraoperative blood loss [MD = - 43.87; 95%CI(- 73.66, - 14.08); P = 0.004] were less in VATS group. VATS also showed a relatively longer operative time [MD = 17.11; 95%CI(2.38, 31.85); P = 0.02]. However, no significant differences were observed in numbers of resected lymph nodes, postoperative mortality, postoperative pneumonia and postoperative bleeding. CONCLUSION Compared with MST, VATS was associated with lower incidence of postoperative complications, shorter length of hospital stay, less intraoperative blood loss and less chest tube drainage, which showed that VATS was a comparable method to MST. Meanwhile, these results should be further conformed by more randomized control trials.
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Affiliation(s)
- Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Long Pang
- West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Jiexi Tang
- West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Jiahan Cheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China. .,West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Minimally Invasive Anterior Thoracotomy for Routine Lung Cancer Resection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 2:76-83. [DOI: 10.1097/imi.0b013e31804bfb7e] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives A 7-year experience with a minimally invasive approach to routine lung cancer resection is compared with standard lateral open thoracotomy. Methods All patients undergoing lung resection with curative intent for primary lung cancer between July 1998 and November 2005 by a single surgical team were registered. Surgical access was obtained through a mini 5- to 6-cm anterior thoracotomy with video assistance; direct visualization was also used extensively. Results Patients (n = 167) underwent major pulmonary resection for primary lung cancer. The minimally invasive group (MI), 137 patients, included 12 fully endoscopic or robotic approaches. The open lateral (OL) approach included 30 patients (18%). Both groups included pneumonectomies (8 MI, 3 OL), sleeve resections (3 MI, 2 OL), chest wall resections (2 MI, 5 OL), and pancoasts (3 MI, 0 OL) and had full lymph node resections. The Kaplan-Meier estimated overall mean survival was 64.5 months (95% CL, 58 to 71 months). Mean estimate survivals were stage 1a, 66%; stage 1b, 65%; stage 2a, 61%; stage 2b, 55%; stage 3a, 52%; stage 3b, 45%. Mean survival in the MI group was 64.3 months versus 59.3 with standard open access (OL) (X2 = 0.003 Mantel-Cox; significance, 0.959). In-hospital mortality rate was 2.2%; conversion from a mini to open procedure was 1.5%. Avoidance of rib spreading (soft tissue retractor) and small incisions appeared to have reduced pain and improved early recovery. Conclusions Kaplan-Meier survival for routine unselected lung cancer resection through a minimal access approach was not significantly different from the open approach and reflects published survival curves.
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Robotic-Assisted Lung Resection for Malignant Disease. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 2:254-8. [DOI: 10.1097/imi.0b013e31815e52f1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective There have been few reports of the use of robotic surgery to resect lung malignancies. Feasibility and safety of robotic lung resection for malignant lung lesions will be assessed by performing a retrospective analysis. Methods Between September 2004 and November 2006, 21 patients (11 male and 10 female patients) underwent robotic lung resection. Twenty resections were performed for primary nonsmall cell lung cancer and two for metastatic lesions. One patient had bilateral resections for two primary tumors. Fourteen lobectomies, five segementectomies, one wedge resection, and two bilobectomies were performed. Seventy-two percent of operative procedures included mediastinoscopy and/or bronchoscopy at the time of resection. Results Thirty-day mortality and conversion rate was 0%. The median operating room time and estimated blood loss was 3.6 hours and 100 mL, respectively. The median intensive care unit and total length of hospital stays were 2 and 4 days, respectively. Chest tubes were removed after a median of 2.0 days. The complication rate was 27%, which included atrial fibrillation, need for postoperative bronchoscopy, and pneumonia. The median tumor size and number of lymph nodes harvested was 2.3 cm and 16, respectively. All resection margins were negative. Median follow-up time was 9.8 months, with no local recurrences at this time. Conclusion Robotic lung resection appears safe and feasible and allows for significant lymph node retrieval, offers short hospital stays and low morbidity for patients undergoing surgical resection of lung malignancies. Future studies are needed to define the role of robotic surgery in lung cancer treatment.
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Gossot D. Comparing open and closed chest surgery for early-stage lung cancer: still relevant? J Thorac Dis 2019; 11:S1307-S1309. [PMID: 31245117 DOI: 10.21037/jtd.2019.04.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dominique Gossot
- Thoracic Department, Curie-Montsouris Thoracic Institute, Institut Mutualiste Montsouris, Paris, France
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9
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Anderson CA, Hellan M, Falebella A, Lau CS, Grannis FW, Kernstine KH. Robotic-Assisted Lung Resection for Malignant Disease. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698450700200507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Minia Hellan
- Departments of Surgical Oncology, City of Hope, Duarte, California
| | | | - Clayton S. Lau
- Departments of Urologic Oncology, and City of Hope, Duarte, California
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Hamaji M, Lee HS, Kawaguchi A, Burt BM. Overall Survival Following Thoracoscopic vs Open Lobectomy for Early-stage Non-small Cell Lung Cancer: A Meta-analysis. Semin Thorac Cardiovasc Surg 2017; 29:104-112. [PMID: 28683985 DOI: 10.1053/j.semtcvs.2017.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 11/11/2022]
Abstract
A majority of observational studies on overall survival following thoracoscopic vs open lobectomy for early-stage non-small cell lung cancer did not demonstrate a significant difference, whereas several meta-analyses on this topic showed a significant difference. The PubMed, Scopus, and Web of Science databases were queried for studies published in the English language. We searched for meta-analyses and original studies comparing overall survival between thoracoscopic and open lobectomy for early-stage non-small cell lung cancer. Our meta-analysis, using random effect models and with a hazard ratio as a measure of effect, was performed on original studies. Publication bias was evaluated with funnel plots of precision and the Egger test. Seven meta-analyses on this topic were found and all of them have shown that thoracoscopic lobectomy is associated with significantly more favorable overall survival than open lobectomy, using odds ratio, risk ratio, or risk difference as measures of effect. Our meta-analysis of 11 observational studies demonstrated no significant difference in overall survival between thoracoscopic (n = 2386) and open lobectomy (n = 3494) for early-stage non-small cell lung cancer (pooled hazard ratio: 0.91, 95% confidence interval: 0.76-1.09, P = 0.30). Neither funnel plots of precision nor the Egger test suggested a publication bias. Our meta-analysis, using a hazard ratio as a measure of effect for a time-to-event outcome, did not demonstrate a significant difference in overall survival between thoracoscopic and open lobectomy with the current dataset available in the literature, as opposed to previous meta-analyses.
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Affiliation(s)
- Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
| | - Hyun-Sung Lee
- Division of Thoracic Surgery, Baylor College of Medicine, Houston, Texas
| | - Atsushi Kawaguchi
- Section of Clinical Cooperation System, Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Bryan M Burt
- Division of Thoracic Surgery, Baylor College of Medicine, Houston, Texas
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Kobayashi N, Kobayashi K, Kikuchi S, Goto Y, Ichimura H, Endo K, Sato Y. Long-term pulmonary function after surgery for lung cancer. Interact Cardiovasc Thorac Surg 2017; 24:727-732. [DOI: 10.1093/icvts/ivw414] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/17/2016] [Indexed: 11/13/2022] Open
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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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13
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Scanagatta P. Muscle-Sparing Thoracotomy: A Systematic Literature Review and the “AVE” Classification. ACTA ACUST UNITED AC 2015. [DOI: 10.17352/2455-2968.000011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Miyata K, Fukaya M, Itatsu K, Abe T, Nagino M. Muscle sparing thoracotomy for esophageal cancer: a comparison with posterolateral thoracotomy. Surg Today 2015; 46:807-14. [PMID: 26311005 DOI: 10.1007/s00595-015-1240-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to investigate whether muscle sparing thoracotomy (MST) improved postoperative chest pain and an impairment of the postoperative pulmonary function in comparison with posterolateral thoracotomy (PLT). METHODS Twenty-four patients with esophageal cancer who underwent PLT from September 2006 to August 2008 and 30 patients who underwent MST from September 2008 to August 2010 were selected as subjects of this study. Postoperative acute and chronic chest pain and the recovery of the pulmonary function were retrospectively compared between the two groups. RESULTS The frequency of the additional use of analgesics was on days 3, 6, and 7 (mean 0.4 vs. 1.2, p = 0.027, 0.4 vs. 1.5, p = 0.007, and 0.2 vs. 1.2, p = 0.009, respectively) in the early postoperative period. The number of patients requiring analgesics at 1 and 3 months after surgery was significantly lower in the MST group than in the PLT group (13.3 vs. 58.3 %, p = 0.002, 10.0 vs. 50.0 %, p = 0.001, respectively). The postoperative vital capacity, expressed as a percentage of the preoperative value, 3 and 12 months after surgery was significantly higher in the MST group than in the PLT group (86.0 vs. 73.8 %, p = 0.028, 93.2 vs. 76.9 %, p = 0.002, respectively). CONCLUSION Compared with PLT, MST might, therefore, reduce postoperative chest pain and offer a better recovery of pulmonary function in patients with esophageal cancer.
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Affiliation(s)
- Kazushi Miyata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masahide Fukaya
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Keita Itatsu
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tetsuya Abe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Dujon A, Mordant P, Saab M, Riquet M. [Major pulmonary resections for lung cancer and thoracoscopic approach: some reflections on published data]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:286-292. [PMID: 25131371 DOI: 10.1016/j.pneumo.2014.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 06/03/2023]
Abstract
Video-assisted thoracic surgery has a renewed topicality in treating early stage non-small cell lung cancer. Numerous publications show the benefits of this surgical technique in comparison with conventional thoracotomy. However, some surgeons are still apprehensive for its validity in lung cancer. Few works were dedicated to the critical aspect of this new technique which generates silent controversy and is far from having the general approval of all surgical teams. A critical review of several papers disclosed some concerns related to this approach, notably the risk of intra-operative technical problems and the possibility of questionable results concerning cancer dissection and clearance. A randomized clinical trial is now mandatory to confirm the safety and usefulness of this technique.
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Affiliation(s)
- A Dujon
- Centre médico-chirurgical du Cèdre, Bois-Guillaume, France
| | - P Mordant
- Service de chirurgie thoracique, hôpital Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France
| | - M Saab
- Centre médico-chirurgical du Cèdre, Bois-Guillaume, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France.
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Baste JM, Orsini B, Rinieri P, Melki J, Peillon C. Résections pulmonaires majeures par vidéothoracoscopie : 20ans après les premières réalisations. Rev Mal Respir 2014; 31:323-35. [DOI: 10.1016/j.rmr.2013.10.650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 10/07/2013] [Indexed: 11/27/2022]
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Erus S, Tanju S, Kapda l M, Ozkan B, Dilege U, Toker A. The comparison of complication, pain, quality of life and performance after lung resections with thoracoscopy and axillary thoracotomy. Eur J Cardiothorac Surg 2014; 46:614-9. [DOI: 10.1093/ejcts/ezu050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Video-assisted thoracic surgery in lung cancer resection: a meta-analysis and systematic review of controlled trials. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 2:261-92. [PMID: 22437196 DOI: 10.1097/imi.0b013e3181662c6a] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES : This meta-analysis sought to determine whether video-assisted thoracic surgery (VATS) improves clinical and resource outcomes compared with thoracotomy (OPEN) in adults undergoing lobectomy for nonsmall cell lung cancer. METHODS : A comprehensive search was undertaken to identify all randomized (RCT) and nonrandomized (non-RCT) controlled trials comparing VATS with OPEN thoracotomy available up to April 2007. The primary outcome was survival. Secondary outcomes included any other reported clinical outcome and resource utilization. Odds ratios (OR), weighted mean differences (WMD), or standardized mean differences (SMD), and their 95% confidence intervals (95% CI) were analyzed as appropriate. RESULTS : Baseline prognosis was more favorable for VATS (more females, smaller tumor size, less advanced stage, histology associated with peripheral location and with more indolent disease) than for OPEN in non-RCTs, but not RCT. Postoperative complications were significantly reduced in the VATS group compared with OPEN surgery when both RCT and non-RCT were considered in aggregate (OR 0.48, 95% CI 0.32-0.70). Although overall blood loss was significantly reduced with VATS compared with OPEN (-80 mL, 95% CI -110 to -50 mL), the incidence of excessive blood loss (generally defined as >500 mL) and incidence of re-exploration for bleeding was not significantly reduced. Pain measured via visual analog scales (10-point VAS) was significantly reduced by <1 point on day 1, by >2 points at 1 week, and by <1 point at week 2 to 4. Similarly, analgesia requirements were significantly reduced in the VATS group. Postoperative vital capacity was significantly improved (WMD 20, 95% CI 15-25), and at 1 year was significantly greater for VATS versus OPEN surgery (WMD 7, 95% CI 2-12). The incidence of patients reporting limited activity at 3 months was reduced (OR 0.04, 95% CI 0.00-0.82), and time to full activity was significantly reduced in the VATS versus OPEN surgery (WMD -1.5, 95% CI -2.1 to -0.9). Overall patient-reported physical function scores did not differ between groups at 3 years follow-up. Hospital length of stay was significantly reduced by 2.6 days despite increased 16 minutes of operating time for VATS versus OPEN. The incidence of cancer recurrence (local or distal) was not significantly different, but chemotherapy delays were significantly reduced for VATS versus OPEN (OR 0.15, 95% CI 0.06-0.38). The need for chemotherapy reduction was also decreased (OR 0.37, 95% CI 0.16-0.87), and the number of patients who did not receive at least 75% of their planned chemotherapy without delays were reduced (OR 0.41, 95% CI 0.18-0.93). The risk of death was not significantly reduced when RCTs were considered alone; however, when non-RCTs (n = 18) were included, the risk of death at 1 to 5 years was significantly reduced (OR 0.72, 95% CI 0.55-0.94; P = 0.02) for VATS versus OPEN. Stage-specific survival to 5 years was not significantly different between groups. CONCLUSIONS : This meta-analysis suggests that there may be some short term, and possibly even long-term, advantages to performing lung resections with VATS techniques rather than through conventional thoracotomy. Overall, VATS for lobectomy may reduce acute and chronic pain, perioperative morbidity, and improve delivery of adjuvant therapies, without a decrease in stage specific long-term survival. However, the results are largely dependent on non-RCTs, and future adequately powered randomized trials with long-term follow-up are encouraged.
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Video-assisted thoracoscopic surgery for stage I non-small cell lung cancer: long-term survival and prognostic factors. Tumour Biol 2013; 34:3389-96. [DOI: 10.1007/s13277-013-0911-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022] Open
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Taioli E, Lee DS, Lesser M, Flores R. Long-term survival in video-assisted thoracoscopic lobectomy vs open lobectomy in lung-cancer patients: a meta-analysis. Eur J Cardiothorac Surg 2013; 44:591-7. [PMID: 23413015 DOI: 10.1093/ejcts/ezt051] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Video-assisted thoracic surgery (VATS) lobectomy is an appealing alternative to open lobectomy via thoracotomy for non-small-cell lung cancer. However, there is no clear consensus in regard to the superior approach for long-term outcomes. The data are limited to small series, which precludes further clarification. Meta-analysis of these studies was performed in order to obtain a more objective determination of the oncological feasibility of VATS lobectomy. A systematic review of the PubMed and Embase databases was performed. Twenty observational studies reporting long-term outcomes were included, involving 2106 VATS and 2661 thoracotomy patients. There was an advantage in long-term mortality for patients who underwent VATS vs patients who underwent thoracotomy (meta difference in survival: 5%; 95% CI: 3-6%) with large heterogeneity among studies (Q = 42.6; P-value: 0.001; I(2) = 55.7%). There was no evidence of publication bias. Compared with open lobectomy, VATS lobectomy appears to have improved long-term outcomes.
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Affiliation(s)
- Emanuela Taioli
- Division of Thoracic Surgery, Mount Sinai School of Medicine, New York, NY, USA
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Videothoracoscopic identification of chondromatous hamartoma of the lung. Wideochir Inne Tech Maloinwazyjne 2013; 8:152-7. [PMID: 23837099 PMCID: PMC3699776 DOI: 10.5114/wiitm.2011.33013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/02/2012] [Accepted: 07/20/2012] [Indexed: 11/28/2022] Open
Abstract
Introduction The main disadvantage of a videothoracoscopic procedure is the lack of touch sensation. The probability of easily finding the lesion is usually estimated according to computed tomography (CT). Aim To find useful parameters of location of chondromatous hamartoma of the lung parenchyma in relation to its size to assess the probability of successful search via a videothoracoscopic approach only. Material and methods A group of 55 patients operated on for chondromatous hamartoma of the lung at the First Department of Surgery in Olomouc from January 2006 to June 2011 was analyzed. Initially, the tumor's longest diameter and its nearest distance to the pleural surface were measured on CT scans. Subsequently, the surgery began using the videothoracoscopic approach. A short thoracotomy with direct palpation followed when videothoracoscopy failed. Results No significant differences in age, sex and side of localization between the group with and without successful videothoracoscopic detection were found. A significant difference was found in the median size (p = 0.026) and the depth of the tumor (p < 0.0001) and in the calculated index “tumor size/depth” (p < 0.0001). Deeper analysis revealed that the parameters “depth” and “index size/depth” are considered to be good predictors but the parameter “size” is not a suitable predictor. Conclusions The main predictors of successful videothoracoscopic detection of lung chondromatous hamartoma are considered to be the depth of the tumor in the lung parenchyma with a cut-off value ≤ 7.5 mm and the index “size/depth” with a cut-off value ≥ 1.54; the tumor size is not considered to be a good predictor.
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Kuo E, Bharat A, Bontumasi N, Sanchez C, Zoole JB, Patterson GA, Meyers BF. Impact of Video-Assisted Thoracoscopic Surgery on Benign Resections for Solitary Pulmonary Nodules. Ann Thorac Surg 2012; 93:266-72; discussion 272-3. [DOI: 10.1016/j.athoracsur.2011.08.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 08/10/2011] [Accepted: 08/15/2011] [Indexed: 12/01/2022]
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Gossot D, Girard P, Raynaud C, Stern JB, Caliandro R, Validire P, Debrosse D, Magdeleinat P. Fully endoscopic major pulmonary resection for stage I bronchial carcinoma: initial results. Rev Mal Respir 2011; 28:e123-30. [PMID: 22123151 DOI: 10.1016/j.rmr.2011.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 06/07/2009] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Several case-series studies of major pulmonary resection (MPR) by video-assisted thoracic surgery (VATS) for non-small-cell lung cancer (NSCLC) have been published, but fully endoscopic MPR is still very rarely performed. Our objective here was to report the outcomes in 71 patients recently managed using fully endoscopic MPR for NSCLC. METHODS From 2007 to 2009, 635 patients with NSCLC underwent MPR (pneumonectomy, lobectomy or segmentectomy). Among them, 71 (11%) had features strongly suggesting clinical stage I NSCLC and were managed by fully endoscopic MPR, with no utility incision. Lobectomy was performed in 63 patients and segmentectomy in eight patients. Conversion to thoracotomy was required in two (2.8%) patients, because of a fused fissure in one and tight pleural adhesions in the other. Radical lymphadenectomy was performed in all patients. RESULTS Of the 69 patients managed endoscopically, none died and none experienced intraoperative complications. Mean operating time was 226±38 minutes (range, 137-307 minutes) and mean intraoperative blood loss was 111±93mL (range, 0-450mL). The final histological examination showed stage I NSCLC in 52 patients, NSCLC with node involvement in nine patients (pN1 in 6 and pN2 in 3) and other types of malignancies in eight patients. Mean number of nodes removed was 21±8 after right-sided lymphadenectomy and 23±8 after left-sided lymphadenectomy and the mean number of dissected node sites was 3 (range, 2-5). The postoperative morbidity rate was 23%. Mean postoperative hospital stay length was 6.9±2 days (range, 3-12). CONCLUSION Fully endoscopic MPR is safe and meets the criteria for oncological surgery.
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Affiliation(s)
- D Gossot
- Département thoracique, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
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Abstract
Non-small cell lung cancer remains one of the leading causes of cancer-related mortality worldwide. Despite recent advances in molecular characterization and targeted and adjuvant therapies, surgical resection remains the mainstay of curative treatment. Minimally invasive video-assisted thoracic surgery techniques, in particular video-assisted thoracic surgery lobectomy, are being increasingly utilized and championed over traditional thoracotomy approaches in the treatment of localized non-small cell lung cancer for the reported benefits of lower operative morbidity, accelerated postoperative recovery, and oncological equivalence. This article reviews the available literature comparing surgical outcomes of minimally invasive versus traditional open lobectomy with an emphasis on differences in surgical morbidity.
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[Totally endoscopic major pulmonary resection for stage I bronchial carcinoma: initial results]. Rev Mal Respir 2010; 26:961-70. [PMID: 19953042 DOI: 10.1016/s0761-8425(09)73331-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Several series of video-assisted (VATS) major pulmonary resection (MPR) for non small cell bronchial carcinoma (NSCBC) have been published recently. However, totally endoscopic MPR is still very uncommon. We report the initial results of a recent series of 71 patients. METHODS From 2007 to 2009, 635 patients had a major pulmonary resection (pneumonectomy, lobectomy or segmentectomy) for NSCBC. Seventy-one out of these patients (11%) in whom a clinical stage I NSCBC was strongly suspected were operated on via a totally endoscopic approach, without mini-thoracotomy or utility incision. Sixty-three had a lobectomy and 8 a segmentectomy. There were 2 conversions to thoracotomy (2.8%), for a fused fissure (1 patient) and for tight pleural adhesions (1 patient). The resection was completed by a radical lymphadenectomy in all patients. RESULTS For the 69 patients who had a totally endoscopic procedure, there was no mortality. No intraoperative complications occurred. The mean duration of operation was 226 minutes + or - 38 (range: 137-307 minutes). The mean intraoperative blood loss was 111 cc + or - 93 (range: 0-450 cc). Final pathological examination confirmed stage I NSCBC in 52 patients while 9 NSCBC were upstaged pN1 (n = 6) or pN2 (n = 3). In 8 cases, another type of malignant tumour was found. The mean number of lymph nodes collected was 21 + or - 8 after right-side lymphadenectomy and 23 + or - 8 after left-side lymphadenectomy and the mean number of dissected lymph node stations was 3 (range:2-5). Postoperative morbidity was 23%. The mean postoperative stay was 6.9 days + or - 2 (range: 3-12 days). CONCLUSIONS MPR via a totally endoscopic approach is safe and fulfils the criteria for an oncological resection.
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Abstract
As limited as are the studies regarding peritoneal Natural Orifice Trans-Luminal Endoscopic Surgery, mediastinal transluminal experiments are certainly in their infancy. The authors evaluate the parallel development of minimally invasive thoracic surgery with regard to its counterpart in peritoneal laparoscopy to NOTES. Transesophageal interventions by both endosonographic and direct visualization are examined in the context of minimally invasive surgery and mediastinal NOTES. Techniques of viscerotomy creation, visualization, and closure are examined with particular emphasis on mediastinal structures. The state of current interventions is examined. Finally, current morbidity (including infectious complications) and survival outcomes are examined in those animals that have undergone transesophageal exploration.
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Abstract
Minimally invasive thoracic surgery (MITS) has become part of the modern thoracic surgeon's armamentarium. Its applications include diagnostic and therapeutic procedures, and over the past one and a half decades, the scope of MITS has undergone rapid evolution. The role of MITS is well established in the management of pleural and mediastinal conditions, and it is beginning to move beyond diagnostic procedures for lung parenchyma conditions, to gain acceptance as a viable option for primary lung cancer treatment. However MITS poses technical challenges that are quite different from the conventional open surgical procedures. After a brief review of the history of MITS, an overview of the scope of MITS is given. Important examples of diagnostic and therapeutic indications are then discussed, with special emphasis on the potential complications specific to MITS, and their prevention and management.
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Affiliation(s)
- Michael K Y Hsin
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
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Seder CW, Hanna K, Lucia V, Boura J, Kim SW, Welsh RJ, Chmielewski GW. The Safe Transition from Open to Thoracoscopic Lobectomy: A 5-Year Experience. Ann Thorac Surg 2009; 88:216-25; discussion 225-6. [PMID: 19559229 DOI: 10.1016/j.athoracsur.2009.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 03/31/2009] [Accepted: 04/02/2009] [Indexed: 11/24/2022]
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Knop C, Kranabetter T, Reinhold M, Blauth M. Combined posterior-anterior stabilisation of thoracolumbar injuries utilising a vertebral body replacing implant. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:949-63. [PMID: 19357875 PMCID: PMC2899585 DOI: 10.1007/s00586-009-0970-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 01/12/2009] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
Abstract
The authors report on a prospectively followed series of 35 patients with injuries of the thoracolumbar spine from T7 to L3. The radiological course after combined posterior-anterior surgery with anterior column reconstruction with a distractible vertebral body replacing implant demonstrated a stable reconstruction technique with almost no re-kyphosing. In 18/18 patients with CT follow-up intervertebral fusion was observed as bony bridging lateral to the VBR implant. The functional/clinical outcome of the patients was analysed with a set of eight validated outcome scales. After an average follow-up period of 2(1/2) years encouraging results were noticed. The neurological improvement rate (> or =1 Frankel/ASIA grade) was 8/12 patients (67%) with a complete recovery in 6 cases. 17/29 patients returned to former occupation; 20/29 patients returned to former leisure activities; 24/28 patients rated their general outcome as "unlimited and pain free" or "occasionally and/or mild complaints" with a VAS score of >80 (scale 0-100). The psychometric questionnaires revealed good results with strong correlation comparing the different scoring systems statistically: mean McGill Pain Questionnaire 12.5 (0-40); mean Oswestry Disability Index 20% (0-51). 13/29 patients scored <4 in the Roland and Morris Disability Questionnaire. The German back pain questionnaire (Funktionsfragebogen Hannover Rücken) showed a mean "functional capacity" of 75%, corresponding with moderate restriction. We concluded the presented method as highly effective to completely reduce and maintain an anatomic spinal alignment. The outcome tended to be better in comparison with non-operatively treated patients as well as with norm populations with low back pain.
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Affiliation(s)
- Christian Knop
- Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Innsbruck, Austria.
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Muscolino G. A new thoracoscopic technique for pulmonary lobectomies. MINIM INVASIV THER 2009; 18:248-50. [PMID: 19544218 DOI: 10.1080/13645700903059219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) for pulmonary lobectomies has recently been introduced as a minimally invasive technique for selected patients. Herein I describe an original technique, which allows for lobectomies under the direct vision of a surgeon respecting the principles that are the basis of the thoracoscopic techniques. The originality of the technique consists in the supine position of the patient and the use of a modified retractor for lower lobectomies. This approach required two ports, an access incision (6-7 cm), and an additional port which may be used for lower lobectomies. Utilizing this technique I operated on twenty patients affected by stage I lung cancer with poor respiratory function. The ability to perform lobectomies with this method allows for shorter operative time than when utilizing previous techniques (80 min. mean operative time) including the lymph nodal dissection. Moreover, cosmetic results were good and patients benefited from excellent early pulmonary function and fast recovery time. I recommend the use of this approach which is a safe technique for the patient and an advantageous procedure for both surgeon and anaesthesiologist.
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Choh MS, Madura JA. The role of minimally invasive treatments in surgical oncology. Surg Clin North Am 2009; 89:53-77, viii. [PMID: 19186231 DOI: 10.1016/j.suc.2008.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article reviews the use of minimally invasive surgical and endoscopic techniques in the field of surgical oncology. It reviews the indications and techniques of the use of minimally invasive surgery for several oncologic indications in general surgery. In particular, it reviews the currently published literature discussing the oncologic outcomes of these techniques.
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Affiliation(s)
- Mark S Choh
- Department of General Surgery, Rush University Medical Center, and Department of Surgery, John H Stroger Hospital of Cook County, 1725 West Harrison Avenue, Chicago, IL 60612, USA
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Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 2009; 27:2553-62. [PMID: 19289625 DOI: 10.1200/jco.2008.18.2733] [Citation(s) in RCA: 548] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The current randomized trials comparing video-assisted thoracic surgery (VATS) lobectomy with open lobectomy for patients with early-stage non-small-cell lung cancer (NSCLC) have been of small size. We performed the present meta-analysis of the randomized and nonrandomized comparative studies in an attempt to assess the safety and efficacy of VATS lobectomy. METHODS Electronic searches identified 21 eligible comparative studies (two randomized and 19 nonrandomized) for inclusion. Two reviewers independently appraised each study. Meta-analysis was performed by combining the results of reported incidence of morbidity and mortality, recurrence, and 5-year mortality rates. The relative risk (RR) was used as a summary statistic. RESULTS There were no significant statistical differences between VATS and open lobectomy in terms of postoperative prolonged air leak (P = .71), arrhythmia (P = .86), pneumonia (P = .09), and mortality (P = .49). VATS did not demonstrate any significant difference in locoregional recurrence (P = .24), as compared with the open lobectomy arm, but the data suggested a reduced systemic recurrence rate (P = .03) and an improved 5-year mortality rate of VATS (P = .04). There was no evidence to suggest heterogeneity of trial results. Fourteen studies reported VATS to open lobectomy conversion rate ranging from 0% to 15.7% (median = 8.1%). CONCLUSION Both randomized and nonrandomized trials suggest that VATS lobectomy is an appropriate procedure for selected patients with early-stage NSCLC when compared with open surgery.
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Affiliation(s)
- Tristan D Yan
- University of Sydney, Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Carballo M, Maish MS, Jaroszewski DE, Holmes CE. Video-assisted thoracic surgery (VATS) as a safe alternative for the resection of pulmonary metastases: a retrospective cohort study. J Cardiothorac Surg 2009; 4:13. [PMID: 19239710 PMCID: PMC2654561 DOI: 10.1186/1749-8090-4-13] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 02/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND VATS has become a preferred method for benign surgical conditions, yet still remains controversial for malignancies. The purpose of this study was to review our results of pulmonary metastasectomies using both conventional open thoracotomy and VATS techniques. METHODS This is a retrospective chart review of pulmonary metastasectomies performed from 1986 to 2006. The surgical approach used for the initial pulmonary metastasectomy was either open thoracotomy or VATS. Main outcomes were overall survival and recurrence free survival, evaluated using Kaplan Meier analysis. A non-inferiority margin was set at 0.2. RESULTS A total of 280 surgical procedures were performed on 186 patients. From 171 eligible individuals, 135 patients were treated with thoracotomy (82 M, 53 F; median age 49 years), and 36 with VATS (18 M, 18 F; median age 58.5 years). Primary cancers were mainly: 81 sarcoma (47%), 26 colorectal adenocarcinoma (15%) and 22 renal cell carcinoma (13%). Median postoperative follow was 26.2 months. The conversion rate was 10.3% and there were no cases of pleural cavity seeding. The 5-year overall survival rates were 58.8% for thoracotomy and 69.6% for VATS, with median overall survival of 53.2 months and 30.1 months, respectively (p = 0.03). The estimated difference in 5-year overall survival was 10.8%. Second occurrences were noted in 59 thoracotomy and 10 VATS patients. The 5-year recurrence free survival rates were 51% in thoracotomy and 67% in VATS (p = 0.27), with median recurrence free survival of 24.8 months and 25.6 months, respectively. CONCLUSION In cases of pulmonary metastases, VATS is an acceptable alternative that is both safe and efficacious. Non-inferiority analysis of 5-year overall survival demonstrates that VATS is equivalent to thoracotomy. VATS patients also have a longer recurrence free survival. Based on our experience, it is permissible to use VATS resection in these circumstances: small tumor, fewer nodules, single lesion, age < or = 53, unilateral, tumor size amenable to wedge resection, and non-recurrent disease.
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Affiliation(s)
- Marilee Carballo
- Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
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The VATS lobectomist: analysis of costs and alterations in the traditional surgical working pattern in the modern surgical unit. Thorac Surg Clin 2008; 18:281-7. [PMID: 18831504 DOI: 10.1016/j.thorsurg.2008.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
It is beyond the scope of this article to review the advantages of VATS lobectomy, but the data in support of this technique are increasing progressively. There is excellent evidence to support the oncologic equivalence and safety profile as compared with open thoracotomy, and data that demonstrate the reduced pain associated with VATS resection. Also, reduction in immune disturbance provides a tantalizing glimpse of one additional potential modality of benefit for less traumatic surgery. Unfortunately, in the economic world, equivalence, preferably with less cost, is the test applied. Whatever the societal benefit of improved quality of life following surgery, this has no cost benefit attached. From the foregoing discussion one can conclude that VATS lobectomy is no more costly than open resection and does generate additional hospital beds. The authors remain uncertain as to the preferred form of VATS lobectomy but it seems that the reduced trauma of the endoscopic procedure is associated with more benefit in terms of shorter hospitalization albeit at the cost of some increase in operating time. VATS techniques and lobectomy sit comfortably within the structure of any thoracic unit requiring little adjustment to established process. It is likely that ultimately 30% or thereabouts of major pulmonary resection will be undertaken using this technique and that VATS interventions will aid patient assessment regardless of stage or ultimate intended therapy. Competency and responsible use remain paramount considerations.
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Grogan EL, Jones DR. VATS lobectomy is better than open thoracotomy: what is the evidence for short-term outcomes? Thorac Surg Clin 2008; 18:249-58. [PMID: 18831499 DOI: 10.1016/j.thorsurg.2008.04.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
VATS lobectomy is an acceptable alternative to open lobectomy for treating early-stage NSCLC. Although no large randomized control trial has compared these procedures, recent large series and case-control studies provide strong evidence that patients undergoing VATS lobectomy have less pain, fewer perioperative complications, shorter chest-tube duration, and decreased length of stay. Increasing evidence supports improved quality of life up to 1 year, less inflammation, and greater safety profile in high-risk patients. More data are needed to better show an improvement in the economic efficacy, ability to more effectively administer adjuvant therapies, and benefit of robotic assistance in VATS lobectomy.
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Affiliation(s)
- Eric L Grogan
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, P.O. Box 800679, Charlottesville, VA 22908-0679, USA
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Does failed video-assisted lobectomy for lung cancer prejudice immediate and long-term outcomes? Ann Thorac Surg 2008; 86:235-9. [PMID: 18573430 DOI: 10.1016/j.athoracsur.2008.03.080] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 03/25/2008] [Accepted: 03/28/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lobectomy for lung cancer by video-assisted thorascopic surgery (VATS) remains an infrequently performed operation despite numerous publications showing the benefits of successful VATS compared with an open thoracotomy approach. However, concern remains regarding patient safety, notably the need for emergency intraoperative conversion to open thoracotomy leading to potential adverse consequences. We therefore compared the outcomes of converted VATS patients with open thoracotomy controls. METHODS Between May 1992 and April 2006, 30 of 286 VATS lobectomies for lung cancer required intraoperative conversion to open thoracotomy. Four patients were of advanced stage and excluded from the study. The remaining patients were matched 2:1 with open thoracotomy controls by age, sex, cancer stage, year, and type of operation. Postoperative complications and pathology were determined from the hospital discharge summary and pathology report. Long-term survival information was obtained from the family doctor or central registry. RESULTS There were no statistically significant differences in postoperative complications between the two groups (p = 0.093). There were no in-hospital deaths in the converted VATS group. Kaplan-Meier survival analysis for cancer-related or unassociated death demonstrated no statistically significant difference (log-rank p = 0.1627). CONCLUSIONS Conversion during attempted VATS resection does not prejudice short-term or long-term surgical outcomes. We therefore suggest that VATS lobectomy should be the treatment strategy of choice for stage I and II non-small cell lung cancer in view of the well-established short-term benefits and equivalent survival associated with successful VATS resection.
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Imperatori A, Rotolo N, Gatti M, Nardecchia E, De Monte L, Conti V, Dominioni L. Peri-operative complications of video-assisted thoracoscopic surgery (VATS). Int J Surg 2008; 6 Suppl 1:S78-81. [DOI: 10.1016/j.ijsu.2008.12.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Schuchert MJ, Luketich JD, Fernando HC. Video-Assisted Thoracic Surgery. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lobectomies et segmentectomies par thoracoscopie exclusive pour pathologie bénigne ou métastatique. Rev Mal Respir 2008; 25:50-8. [DOI: 10.1016/s0761-8425(08)70466-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cheng D, Downey RJ, Kernstine K, Stanbridge R, Shennib H, Wolf R, Ohtsuka T, Schmid R, Waller D, Fernando H, Yim A, Martin J. Video-Assisted Thoracic Surgery in Lung Cancer Resection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2007. [DOI: 10.1177/155698450700200601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Davy Cheng
- Department of Anesthesia and Perioperative Medicine, Evidence-Based Perioperative Clinical Outcomes Research Group (EPiCOR), London Health Sciences Centre, The University of Western Ontario, London, ON, Canada
| | - Robert J. Downey
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kemp Kernstine
- Department of Thoracic Surgery Program, Lung Cancer and Thoracic Oncology Program City of Hope National Medical Center and Beckman Research Institute, Duarte, CA
| | - Rex Stanbridge
- Department of Cardiothoracic Surgery, St. Mary Hospital, Imperial NHS Trust, London, UK
| | - Hani Shennib
- Department of Cardiothoracic Surgery, Brunswick Medical Center, Montreal, Quebec, Canada
| | - Randall Wolf
- Department of Cardiovascular Surgery, University of Cincinnati, Cincinnati, OH
| | - Toshiya Ohtsuka
- Department of Cardiovascular Surgery, Tokyo Metropolitan Fuchu General Hospital, Tokyo, Japan
| | - Ralph Schmid
- Klinik und Poliklinik für Thoraxchirurgie, Universitätsspital Bern, Bern, Schweiz
| | - David Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | | | - Anthony Yim
- Minimally Invasive Centre, Union Hospital, Hong Kong, China
| | - Janet Martin
- Department of Anesthesia and Perioperative Medicine, Evidence-Based Perioperative Clinical Outcomes Research Group (EPiCOR), London Health Sciences Centre, The University of Western Ontario, London, ON, Canada
- Minimally Invasive Centre, Union Hospital, Hong Kong, China
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Swanson SJ, Herndon JE, D'Amico TA, Demmy TL, McKenna RJ, Green MR, Sugarbaker DJ. Video-Assisted Thoracic Surgery Lobectomy: Report of CALGB 39802—A Prospective, Multi-Institution Feasibility Study. J Clin Oncol 2007; 25:4993-7. [PMID: 17971599 DOI: 10.1200/jco.2007.12.6649] [Citation(s) in RCA: 421] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the technical feasibility and safety of video-assisted thoracic surgery (VATS) lobectomy for small lung cancers. Patients and Methods The Cancer and Leukemia Group B 39802 trial was a prospective, multi-institutional study designed to elucidate the technical feasibility of VATS in early non–small-cell lung cancer (NSCLC) using a standard definition for VATS lobectomy (one 4- to 8-cm access and two 0.5-cm port incisions) that mandated videoscopic guidance and a traditional hilar dissection without rib spreading. Between 1998 and 2001, 128 patients with peripheral lung nodules ≤ 3 cm in size with suspected NSCLC were prospectively registered for VATS lobectomy. Results One hundred twenty-seven patients (66 males and 61 females; median age, 66 years; range, 37 to 86 years), with a performance status of 0 (74%) or 1 (26%), underwent surgery. Patients with lymph nodes more than 1 cm by computed tomography scan underwent mediastinal lymph node sampling to rule out N2 disease. One hundred eleven patients (87%) had stage I lung cancer, and 96 (86.5%) of these 111 patients underwent successful VATS lobectomies. The median procedure length was 130 minutes (range, 47 to 428 minutes), and median chest tube duration was 3 days (range, 1 to 14 days). Fifty-eight (60%) of 97 patients underwent diagnostic biopsy at lobectomy. Within 30 days, three (2.7%) of 111 patient deaths occurred, none of which were directly related to VATS technique; seven (7.4%) of 95 patients had grade 3 or greater complications, with only one case of bleeding. Conclusion A standardized approach to VATS lobectomy as specifically defined with avoidance of rib spreading is feasible.
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Affiliation(s)
- Scott J. Swanson
- From the Surgery Committee of the Cancer and Leukemia Group B (CALGB), Statistics Office of CALGB, and Respiratory Committee of CALGB, Chicago, IL
| | - James E. Herndon
- From the Surgery Committee of the Cancer and Leukemia Group B (CALGB), Statistics Office of CALGB, and Respiratory Committee of CALGB, Chicago, IL
| | - Thomas A. D'Amico
- From the Surgery Committee of the Cancer and Leukemia Group B (CALGB), Statistics Office of CALGB, and Respiratory Committee of CALGB, Chicago, IL
| | - Todd L. Demmy
- From the Surgery Committee of the Cancer and Leukemia Group B (CALGB), Statistics Office of CALGB, and Respiratory Committee of CALGB, Chicago, IL
| | - Robert J. McKenna
- From the Surgery Committee of the Cancer and Leukemia Group B (CALGB), Statistics Office of CALGB, and Respiratory Committee of CALGB, Chicago, IL
| | - Mark R. Green
- From the Surgery Committee of the Cancer and Leukemia Group B (CALGB), Statistics Office of CALGB, and Respiratory Committee of CALGB, Chicago, IL
| | - David J. Sugarbaker
- From the Surgery Committee of the Cancer and Leukemia Group B (CALGB), Statistics Office of CALGB, and Respiratory Committee of CALGB, Chicago, IL
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Varela G, Brunelli A, Rocco G, Jiménez MF, Salati M, Gatani T. Evidence of Lower Alteration of Expiratory Volume in Patients With Airflow Limitation in the Immediate Period After Lobectomy. Ann Thorac Surg 2007; 84:417-22. [DOI: 10.1016/j.athoracsur.2007.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 02/14/2007] [Accepted: 03/05/2007] [Indexed: 10/23/2022]
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Stanbridge RDL, Hon JKF, Bateman E, Roberts S. Minimally Invasive Anterior Thoracotomy for Routine Lung Cancer Resection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2007. [DOI: 10.1177/155698450700200206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rex De L. Stanbridge
- Department of Cardiothoracic Surgery, St. Mary's Hospital, London, United Kingdom
| | - Jimmy K. F. Hon
- Department of Cardiothoracic Surgery, St. Mary's Hospital, London, United Kingdom
| | - Elizabeth Bateman
- Department of Cardiothoracic Surgery, St. Mary's Hospital, London, United Kingdom
| | - Sian Roberts
- Department of Cardiothoracic Surgery, St. Mary's Hospital, London, United Kingdom
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Sawada S, Komori E, Yamashita M, Nakata M, Nishimura R, Teramoto N, Segawa Y, Shinkai T. Comparison in prognosis after VATS lobectomy and open lobectomy for stage I lung cancer. Surg Endosc 2007; 21:1607-11. [PMID: 17762957 DOI: 10.1007/s00464-007-9200-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 10/06/2006] [Accepted: 01/05/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has become an attractive surgical procedure, but several issues remain to be resolved. Prognosis after VATS lobectomy is important to evaluate the adequacy of VATS lobectomy as a cancer operation. Interestingly, several investigators, including us, have reported that prognosis after VATS lobectomy was superior to that after open lobectomy in early non-small-cell lung cancer (NSCLC). One of the possible reasons is the low invasiveness of VATS lobectomy. But we considered that patient bias might have some influence favoring VATS lobectomy. To evaluate our hypothesis, we reviewed medical records of stage I NSCLC patients undergoing operation between 1993 and 2002. We compared and evaluated the relationship between patient characteristics and prognosis after VATS and open lobectomy. We focused particularly on histological type, classifying it into four subgroups; (1) bronchioloalveolar carcinoma (BAC), (2) mixed BAC + papillary adenocarcinoma (BAC + Pap), (3) other adenocarcinoma (Other adeno), (4) squamous cell carcinoma + others (Sq + others). RESULTS A total of 165 patients underwent VATS lobectomy, and 123 patients underwent open lobectomy. The 5-year survival rate of the VATS lobectomy group was 94.5% and that of the open lobectomy group was 81.5%. Univariate Cox regression of survival revealed that male, CEA > 5, Other adeno, Sq + others, open lobectomy, and tumor size > 3 cm were significant negative prognostic variables. Multivariate Cox regression of survival revealed that histological subtype and tumor size were independent prognostic factors, but surgical procedure was not an independent prognostic factor. COMMENTS Prognosis after VATS lobectomy was superior to that after open lobectomy, but patient bias influenced the prognosis in favor of VATS lobectomy, and the surgical procedure itself was not a prognostic factor.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adenocarcinoma, Bronchiolo-Alveolar/mortality
- Adenocarcinoma, Bronchiolo-Alveolar/pathology
- Adenocarcinoma, Bronchiolo-Alveolar/surgery
- Aged
- Aged, 80 and over
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Female
- Humans
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Male
- Middle Aged
- Pneumonectomy
- Prognosis
- Survival Rate
- Thoracic Surgery, Video-Assisted
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Affiliation(s)
- S Sawada
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto-cho kou, Ehime, 791-0288, Japan.
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Yamaguchi A, Hashimoto O, Tamaki S. French-window thoracotomy: postoperative pain avoidance for short-stay lung cancer surgery. ACTA ACUST UNITED AC 2006; 54:520-7. [PMID: 17236654 DOI: 10.1007/s11748-006-0057-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although long years have passed since video-assisted thoracic surgery (VATS) lobectomy (VL) appeared as a new approach for resection of lung cancer, its practicality is not clear even today. As the significance of VL has still been under discussion, it has not gained consensus of its superiority to standard lateral thoracotomy. However, we think that returning to the classical posterolateral thoracotomy (PLT) is only a setback, so we developed a new thoracotomy approach that spares the thoracic bony cage by protecting costovertebral and costosternal junctions without spreading the ribs, the same mechanism for avoiding pain as in VL. It was named French-window thoracotomy (FWT). Postoperative pain and length of hospital stay after pulmonary lobectomy were compared between PLT (n = 18) and FWT (n = 13). METHODS An anterolateral skin incision was made along the fifth intercostal space. The operative field was made through double intercostal spaces by cutting two ribs temporally at anterior and posterior points. The bone-muscle flaps were rolled back outside with protection of intercostal neurovascular bundles. The four cut points of the ribs were firmly repaired by the staking technique with stainless steel mesh wire and a stainless steel sleeve after intrathoracic manipulation. RESULTS There was a significant difference between PLT and FWT lobectomy (55.6% vs 7.7%, respectively, P = 0.0059) with regard to severe postoperative pain. Patients undergoing a FWT lobectomy had a shorter postoperative stay (6.4 +/- 2.1 vs. 12.3 +/- 3.3 days, P = 0.000003). CONCLUSIONS The lobectomy patients by FWT complained less of postoperative pain and required a shorter postoperative stay than with patients with the classical rib-spreading thoracotomy. We believe that FWT is an anatomically correct approach for preserving the whole structure of the chest cage.
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Affiliation(s)
- Akira Yamaguchi
- Department of Thoracic Surgery, Chiba Tokushukai Hospital, 1-27-1 Narashinodai, Funabashi, Chiba 274-8503, Japan.
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Abstract
Given the discomfort of thoracic surgical incisions, thoracic surgeons must understand and use contemporary multimodality pain treatments. Acute postthoracotomy pain not only causes psychologic distress to the patient but also has detrimental effects on pulmonary function and postoperative mobility, leading to increased morbidity. By choosing the most appropriate and least traumatic surgical incision, adhering to meticulous surgical techniques, and avoiding intercostal nerve injury or rib fractures, surgeons can minimize postoperative pain. Aggressive perioperative and postoperative pain management is best accomplished with use of an epidural anesthetic and covering breakthrough pain with an IV-PCA. Alternatively, an infusion system for continuous administration of local anesthetics directly in the subpleural plane, posterior to the intercostal incision, also provides excellent pain control. Again, use of an IV-PCA as adjuvant therapy is recommended. With careful planning, severe pain and its negative impact on thoracic surgical patients can be prevented.
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Affiliation(s)
- Richard P Koehler
- Department of Cardiovascular and Thoracic Surgery, Allegheny General Hospital, 320 East North Avenue, South Tower, 14th Floor, Pittsburgh, PA 15212, USA
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Onaitis MW, Petersen RP, Balderson SS, Toloza E, Burfeind WR, Harpole DH, D'Amico TA. Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg 2006; 244:420-5. [PMID: 16926568 PMCID: PMC1856541 DOI: 10.1097/01.sla.0000234892.79056.63] [Citation(s) in RCA: 299] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Advantages of thoracoscopic lobectomy for early stage non-small cell lung cancer (NSCLC), as compared with lobectomy by conventional thoracotomy, include less postoperative pain and shorter length of hospitalization. The outcomes after thoracoscopic lobectomy in patients with more complex pulmonary conditions are analyzed to determine safety, efficacy, and versatility. METHODS A prospective database of 500 consecutive patients who underwent thoracoscopic lobectomy between June 1999 and January 2006 was queried. Demographic, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics and Kaplan-Meier survival analyses. RESULTS Thoracoscopic lobectomy was successfully performed in 492 patients (conversion rate, 1.6%). Pathologic analysis included primary NSCLC in 416 patients (83.2%), centrally located secondary pulmonary malignancy in 37 patients (7.4%), and a variety of benign conditions in 45 patients (9%). Among the 416 patients with NSCLC, pathologic analysis demonstrated stage I in 330 patients (55.3%), stage II in 40 patients (9.6%), and stage III or greater NSCLC in 44 patients (10.6%). The operative and perioperative (30-day) mortality was 0% and 1%, respectively. The overall 2-year survival rate for the entire cohort was 80%, and the 2-year overall survival rates for stage I NSCLC, stage II or greater NSCLC, secondary pulmonary malignancy, and granulomatous disease patients were 85%, 77%, 73%, and 89%, respectively. CONCLUSIONS Thoracoscopic lobectomy is applicable to a spectrum of malignant and benign pulmonary disease and is associated with a low perioperative morbidity and mortality rate. Survival rates are comparable to those for lobectomy with thoracotomy.
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Affiliation(s)
- Mark W Onaitis
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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Le Pimpec-Barthes F, Bagan P, Hubsch J, Bry X, Pereira Das Neves J, Riquet M. Évaluation des pratiques en chirurgie thoracique. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)71799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ng T, Ryder BA. Evolution to video-assisted thoracic surgery lobectomy after training: initial results of the first 30 patients. J Am Coll Surg 2006; 203:551-7. [PMID: 17000401 DOI: 10.1016/j.jamcollsurg.2006.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 06/03/2006] [Accepted: 06/05/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND In early-stage lung cancer, evidence is accumulating for the benefits of lobectomy by video-assisted thoracic surgery (VATS) over open lobectomy. Few thoracic training programs offer sufficient experience in this technically demanding procedure. This article describes the evolution of a new graduate's practice from open thoracotomy to VATS lobectomy. STUDY DESIGN Our model involves a transition in technique from posterolateral thoracotomy to muscle-sparing thoracotomy and, ultimately, to VATS lobectomy. This approach was evaluated by examining outcomes of open thoracotomy patients before VATS lobectomy and outcomes of the initial 30 VATS patients. Data were collected prospectively. RESULTS Before undertaking VATS lobectomy, 94 major pulmonary resections were performed by thoracotomy. Mortality was 1.2% for lobectomy and 0% for pneumonectomy. Use of the muscle-sparing thoracotomy increased from 17% of patients in the first half to 70% in the latter half of this group. For the first 30 VATS lobectomy patients, the mean operative time was 168 minutes. Median blood loss was 200 mL. Conversion rate to open thoracotomy was 13.3%. Mortality was 3.3% and morbidity was 26.7%. After short-term followup (mean followup 16 months), overall survival for stage I lung cancer was 96%. CONCLUSIONS With our approach, new graduates of thoracic surgery programs can safely transition to VATS lobectomy. Gaining experience with the lateral muscle-sparing thoracotomy is an important step in the transition, as it offers similar operative exposure. Longterm disease-free and overall survival data are needed to evaluate our oncologic efficacy with this approach.
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Affiliation(s)
- Thomas Ng
- Department of Surgery, Brown Medical School, 2 Dudley Street, Providence, RI 02905, USA.
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