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Aguinagalde B, Ferrer-Bonsoms JA, López I, Lizarbe IA, Fernández-Monge A, Recuero JL, Royo I, Embún R. Comparison of 5-Year Survival and Disease Recurrence After Trisegmentectomy or Left Upper Lobectomy: A Propensity Score Analysis of the National GEVATS Database. Arch Bronconeumol 2024:S0300-2896(24)00214-X. [PMID: 38971669 DOI: 10.1016/j.arbres.2024.05.032] [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: 02/07/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Trisegmentectomy, or resection of the upper subdivision of the left upper lobe with preservation of the lingula, is considered by some authors to be equivalent to right upper lobectomy with middle lobe preservation. Our objective was to compare survival and recurrence after trisegmentectomy versus left upper lobectomy procedures registered in the Spanish Video-Assisted Thoracic Surgery group (GEVATS) database. METHODS We compared mortality, survival and recurrence in patients with left upper lobectomy or trisegmentectomy after propensity score matching for the following variables: age, smoking habit, tumor size, histologic type, radiological density of tumor, surgical access, forced expiratory volume in one second, diffusing capacity of the lungs for carbon monoxide, hypertension, chronic heart failure, ischemic heart disease, arrhythmia, stroke, peripheral vascular disease, diabetes and pre-surgery nodal status by positron emission tomography/computed tomography. RESULTS A total of 540 left upper lobectomies and 83 trisegmentectomies were registered in the GEVATS database. After propensity score matching, 134 left upper lobectomies and 67 trisegmentectomies were selected. Survival outcomes were similar, but differences were found for recurrence (21.5% for trisegmentectomies vs. 35.4% for left upper lobectomies, p=0.05). Moreover, the recurrence patterns differed, with the lobectomy group showing a greater tendency to distant dissemination. CONCLUSIONS Trisegmentectomy and left upper lobectomy show similar 5-year survival rates. In our database, recurrence after trisegmentectomy was lower than after left upper lobectomy, while the recurrence pattern differed among the 2 surgical approaches, with a greater tendency to distant metastasis after left upper lobectomy.
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Affiliation(s)
- Borja Aguinagalde
- Osakidetza Basque Health Service, Donostia University Hospital, Department of Thoracic Surgery, Donostia, Spain; Department of Surgery, UPV/EHU, Leioa, Spain; Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain.
| | - Juan A Ferrer-Bonsoms
- Biomedical Engineering and Science Department, TECNUN, Universidad de Navarra, San Sebastian, Spain
| | - Iker López
- Osakidetza Basque Health Service, Donostia University Hospital, Department of Thoracic Surgery, Donostia, Spain; Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain
| | - Ion Ander Lizarbe
- Osakidetza Basque Health Service, Donostia University Hospital, Department of Thoracic Surgery, Donostia, Spain; Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain
| | - Arantza Fernández-Monge
- Osakidetza Basque Health Service, Donostia University Hospital, Department of Thoracic Surgery, Donostia, Spain; Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain
| | - José Luis Recuero
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Iñigo Royo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Raúl Embún
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Universidad Zaragoza, Zaragoza, Spain
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Paglialunga PL, Molins L, Guzmán R, Guirao A, Grando L, Sanchez-Lorente D, Guerrero C, Bello I, Quiroga N, Boada M. Starting a robotic thoracic surgery program: From wedge resection to sleeve lobectomy in six months. Initial conclusions. Cir Esp 2023; 101:833-840. [PMID: 37544607 DOI: 10.1016/j.cireng.2023.04.020] [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: 10/20/2022] [Accepted: 04/08/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Robot-assisted thoracic surgery (RATS) is a rapidly expanding technique. In our study, we aimed to analyze the results of the process to adopt robotic surgery in our Department of Thoracic Surgery. METHODS This is an intention-to-treat analysis of a series of consecutive patients operated on using the RATS approach in our hospital from January 2021 to March 2022. Data were registered for patient characteristics, type of surgery, operative times, conversion rate, chest tube duration, length of hospital stay and complications. The IBM SPSS® statistical software was used for the statistical analysis. A cumulative sum analysis of the operating time was performed to define the learning curve. RESULTS During the study period, 51 patients underwent robotic surgery, including pulmonary and non-pulmonary interventions. In addition, 15 patients (29.4%) underwent non-pulmonary interventions: one pleural (2%), 2 diaphragmatic (3.9%), and 12 mediastinal (23.5%). Among the mediastinal surgeries, one conversion was necessary (8.3%) for a complex vascular malformation, and 11 were completed by RATS, including 7 (58.3%) thymomas, 3 (25%) pleuro-pericardial cysts, and one (8.3%) neurogenic tumor. Mean operative time was 141 min (104-178), mean chest tube duration was 0.9 days (0-2), and mean length of stay was 1.45 days (1-2). Thirty-six patients underwent lung surgery (70.6%). The complete RATS resections (34; 94.4%) included: 3 wedge resections (11.1%), 2 segmentectomies (3.7%), 28 lobectomies (81.5%), and one sleeve lobectomy (3.7%). Mean surgery time was 194.56 min (141-247), chest tube duration was 3.92 days (1-8), and length of stay was 4.6 days (1-8). Complications occurred in 4 patients (11.1%). No 90-day mortalities were registered. CONCLUSIONS The implementation of RATS was achieved with good clinical results and operative times for all indications. A rapid learning curve was accomplished in short time. Previous VATS experience, patient selection, team training and program continuity are fundamental to successfully develop a RATS program.
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Affiliation(s)
- Pablo Luis Paglialunga
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain.
| | - Laureano Molins
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Rudith Guzmán
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Angela Guirao
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Leandro Grando
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - David Sanchez-Lorente
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Carlos Guerrero
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Irene Bello
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Nestor Quiroga
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Marc Boada
- Department of Thoracic Surgery, Institut Clínic Respiratori (ICR), Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
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Fra-Fernández S, Muñoz-Molina GM, Cabañero-Sánchez A, Del Campo-Albendea L, Bolufer-Nadal S, Embún-Flor R, Martínez-Hernández NJ, Moreno-Mata N. Postoperative morbidity after anatomical lung resections by VATS vs thoracotomy: Treatment and intention-to-treat analysis of the Spanish Video-Assisted Thoracic Surgery Group. Cir Esp 2023; 101:778-786. [PMID: 37422151 DOI: 10.1016/j.cireng.2023.05.012] [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: 10/25/2022] [Accepted: 05/04/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES In recent years, video-assisted thoracoscopic lung resections (VATS) have been associated with lower morbidity than open surgery. The aim of our study is to compare postoperative morbidity among patients from the national database of the Spanish Group of Video-Assisted Thoracic Surgery (GE-VATS) after open and video-assisted anatomic lung resections using a propensity score analysis. METHODS From December 2016 to March 2018, a total of 3533 patients underwent anatomical lung resection at 33 centers. Pneumonectomies and extended resections were excluded. A propensity score analysis was performed to compare the morbidity of the thoracotomy group (TG) vs the VATS group (VATSG). Treatment and intention-to-treat (ITT) analyses were conducted. RESULTS In total, 2981 patients were finally included in the study: 1092 (37%) in the TG and 1889 (63%) in the VATSG for the treatment analysis; and 816 (27.4%) in the TG and 2165 patients (72.6%) in the VATSG for the ITT analysis. After propensity score matching, in the treatment analysis, the VATSG was significantly associated with fewer overall complications than the TG OR 0.680 [95%CI 0.616, 0.750]), fewer respiratory (OR 0.571 [0.529, 0.616]) cardiovascular (OR 0.529 [0.478, 0.609]) and surgical (OR 0.875 [0.802, 0.955]) complications, lower readmission rate (OR 0.669 [0.578, 0.775]) and a reduction of hospital length of stay (-1.741 ([-2.073, -1.410]). Intention-to-treat analysis showed only statistically significant differences in overall complications (OR 0.76 [0.54-0.99]) in favor of the VATSG. CONCLUSION In this multicenter population, VATS anatomical lung resections have been associated with lower morbidity than those performed by thoracotomy. However, when an intention-to-treat analysis was performed, the benefits of the VATS approach were less prominent.
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Affiliation(s)
- Sara Fra-Fernández
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | | | | | | | - Sergio Bolufer-Nadal
- Department of Thoracic Surgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Raúl Embún-Flor
- Department of Thoracic Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Nicolás Moreno-Mata
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Romero Román A, Crowley Carrasco S, Gil Barturen M, Royuela A, Obiols C, Call S, Recuero JL, Royo Í, Embún R, Gómez de Antonio D. Pathological N1/N2 in Clinical Stage I Bronchogenic Carcinoma. Analysis From a Prospective Multicentre Database. Arch Bronconeumol 2023:S0300-2896(23)00109-6. [PMID: 37005150 DOI: 10.1016/j.arbres.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To determine the incidence of occult N1/N2 nodal metastases and associated risk factors in patients with non-small cell lung cancer no larger than 3cm and deemed cN0 by CT and PET-CT in a prospective, multicentre national database. METHODS Patients with a NSCLC no larger than 3cm, deemed cN0 by PET-CT and CT scan, who had undergone at least a lobectomy, were selected from a national multicentre database of 3533 patients who had undergone anatomic lung resection between 2016 and 2018. Clinical and pathological variables of patients with pN0 and patients with pN1/N2 were compared to identify factors associated with the presence of lymph node metastases. Chi2 and the Mann-Whitney U test were used for categorical and numerical variables, respectively. All variables with p<0.2 in the univariate analysis were included in the multivariate logistic regression analysis. RESULTS The study included 1205 patients from the cohort. The incidence of occult pN1/N2 disease was 10.70% (95%CI, 9.01-12.58). The multivariable analysis revealed that the degree of differentiation, size, location (central or peripheral) and SUV of the tumour in PET, surgeon experience and number of lymph nodes resected were associated with occult N1/N2 metastases. CONCLUSIONS The incidence of occult N1/N2 in patients with bronchogenic carcinoma with cN0 tumours no larger than 3cm is no negligible. Data about the degree of differentiation, tumour size in CT scan, maximal uptake of the tumour in PET-CT, location (central or peripheral), number of lymph nodes resected and surgeon seniority is relevant in order to detect patients at risk.
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Affiliation(s)
- Alejandra Romero Román
- Thoracic Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | | | - Mariana Gil Barturen
- Thoracic Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), CIBERESP, Madrid, Spain
| | - Carme Obiols
- Thoracic Surgery Department, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Sergi Call
- Thoracic Surgery Department, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - José Luis Recuero
- Thoracic Surgery Department, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Íñigo Royo
- Thoracic Surgery Department, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Raúl Embún
- Thoracic Surgery Department, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - David Gómez de Antonio
- Thoracic Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Lopez I, Aguinagalde B, Urreta I, Royo I, Bolufer S, Sanchez L, Zabaleta J, Fernández-Monge A, Recuero JL, Sesma J, Amor S, Moradiellos FJ, Arrarás MJ, Blanco AI, Boada M, Sanchez D, Cabañero A, Moreno N, Cal I, Moreno R, Cilleruelo Á, Crowley S, Gómez D, Fernández E, Hernando F, García S, López C, García MD, García JM, Rivo JE, Garcia JA, Gelbenzu JJ, Ramírez ME, Giraldo CF, Mongil R, Gómez MT, Jiménez M, Henández J, Fibla JJ, Illana JD, Jauregui A, Jiménez U, Rojo R, Martínez NJ, Martínez E, Trujillo JC, Milla L, Moreno SB, Congregado M, Obiols C, Call S, Quero F, Ramos R, Rodríguez A, Simón CM, Embun R. Results in mediastinal lymph node staging of surgical lung cancer: Data from the prospective cohort of the Spanish Video-Assisted Thoracic Surgery Group. Cir Esp 2022:S2173-5077(22)00157-0. [PMID: 35671974 DOI: 10.1016/j.cireng.2022.06.006] [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: 03/02/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objective of this study was to assess the diagnostic performance of combined computerised tomography (CT) and positron emission tomography (PET) in mediastinal staging of surgical lung cancer based on data obtained from the prospective cohort of the Spanish Group for Video-Assisted Thoracic Surgery (GEVATS). METHODS A total of 2782 patients underwent surgery for primary lung carcinoma. We analysed diagnostic success in mediastinal lymph node staging (cN2) using CT and PET. Bivariate and multivariate analyses were performed of the factors involved in this success. The risk of unexpected pN2 disease was analysed for cases in which an invasive testing is recommended: cN1, the tumour centrally located or the tumour diameter >3 cm. RESULTS The overall success of CT together with PET was 82.9% with a positive predictive value of 0.21 and negative predictive value of 0.93. If the tumour was larger than 3 cm and for each unit increase in mediastinal SUVmax, the probability of success was lower with OR 0.59 (0.44-0.79) and 0.71 (0.66-0.75), respectively. In the video-assisted thoracic surgery (VATS) approach, the probability of success was higher with OR 2.04 (1.52-2.73). The risk of unexpected pN2 increased with the risk factors cN1, the tumour centrally located or the tumour diameter >3 cm: from 4.5% (0 factors) to 18.8% (3 factors) but did not differ significantly as a function of whether invasive testing was performed. CONCLUSIONS CT and PET together have a high negative predictive value. The overall success of the staging is lower in the case of tumours >3 cm and high mediastinal SUVmax, and it is higher when VATS is performed. The risk of unexpected pN2 is higher if the disease is cN1, the tumour centrally located or the tumour diameter >3 cm but does not vary significantly as a function of whether patients have undergone invasive testing.
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Affiliation(s)
- Iker Lopez
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Instituto de Investigación Sanitaria Biodonostia, San Sebastián-Donostia, Spain.
| | - Borja Aguinagalde
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Instituto de Investigación Sanitaria Biodonostia, San Sebastián-Donostia, Spain
| | - Iratxe Urreta
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Epidemiología Clínica, Servicio Vasco de Salud Osakidetza, Hospital Universitario Donostia, Unidad de Epidemiología Clínica, San Sebastián-Donostia, Spain
| | - Iñigo Royo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Sergio Bolufer
- Servicio de Cirugía Torácica, Hospital Universitario General de Alicante, Alicante, Spain
| | - Laura Sanchez
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Jon Zabaleta
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Instituto de Investigación Sanitaria Biodonostia, San Sebastián-Donostia, Spain
| | - Arantza Fernández-Monge
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Instituto de Investigación Sanitaria Biodonostia, San Sebastián-Donostia, Spain
| | - José Luis Recuero
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Julio Sesma
- Servicio de Cirugía Torácica, Hospital Universitario General de Alicante, Alicante, Spain
| | - Sergio Amor
- Servicio de Cirugía Torácica, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | | | - Miguel Jesús Arrarás
- Servicio de Cirugía Torácica, Instituto Valenciano de Oncología, Valencia, Spain
| | - Ana Isabel Blanco
- Servicio de Cirugía Torácica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Marc Boada
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Barcelona, Spain
| | - David Sanchez
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alberto Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Nicolás Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Isabel Cal
- Servicio de Cirugía Torácica, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ramón Moreno
- Servicio de Cirugía Torácica, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ángel Cilleruelo
- Servicio de Cirugía Torácica, Hospital Universitario Clínico de Valladolid, Valladolid, Spain
| | - Silvana Crowley
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Gómez
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Elena Fernández
- Servicio de Cirugía Torácica, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Santiago García
- Servicio de Cirugía Torácica, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Cipriano López
- Servicio de Cirugía Torácica, Hospital Universitario de Badajoz, Badajoz, Spain
| | - María Dolores García
- Servicio de Cirugía Torácica, Hospital Universitario de Albacete, Albacete, Spain
| | - Jose María García
- Servicio de Cirugía Torácica, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Eduardo Rivo
- Servicio de Cirugía Torácica, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Alberto Garcia
- Servicio de Cirugía Torácica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan José Gelbenzu
- Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - María Elena Ramírez
- Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Roberto Mongil
- Servicio de Cirugía Torácica, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - María Teresa Gómez
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Marcelo Jiménez
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Jorge Henández
- Servicio de Cirugía Torácica, Hospital Universitario Sagrat Cor, Barcelona, Spain
| | - Juan José Fibla
- Servicio de Cirugía Torácica, Hospital Universitario Sagrat Cor, Barcelona, Spain
| | | | - Alberto Jauregui
- Servicio de Cirugía Torácica, Hospital Universitario Vall d́Hebron, Barcelona, Spain
| | - Unai Jiménez
- Servicio de Cirugía Torácica, Hospital Universitario de Cruces, Bilbao, Spain
| | - Rafael Rojo
- Servicio de Cirugía Torácica, Hospital Universitario de Cruces, Bilbao, Spain
| | - Néstor J Martínez
- Servicio de Cirugía Torácica, Hospital Universitario La Ribera, Alcira, Valencia, Spain
| | - Elisabeth Martínez
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Juan Carlos Trujillo
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Lucía Milla
- Servicio de Cirugía Torácica, Hospital Arnau de Vilanova, Lleida, Spain
| | - Sergio B Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Miguel Congregado
- Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Carme Obiols
- Servicio de Cirugía Torácica, Hospital Universitario MútuaTerrasa, Universidad de Barcelona, Terrasa, Barcelona, Spain
| | - Sergi Call
- Servicio de Cirugía Torácica, Hospital Universitario MútuaTerrasa, Universidad de Barcelona, Terrasa, Barcelona, Spain
| | - Florencio Quero
- Servicio de Cirugía Torácica, Hospital Virgen de las Nieves, Granada, Spain
| | - Ricard Ramos
- Servicio de Cirugía Torácica, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Rodríguez
- Servicio de Cirugía Torácica, Hospital del Mar, Instituto de Investigación Médica Hospital del Mar, Barcelona, Spain
| | - Carlos María Simón
- Servicio de Cirugía Torácica, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Raul Embun
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
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Resultados de la estadificación clínica ganglionar mediastínica del cáncer pulmonar quirúrgico: datos de la cohorte prospectiva nacional del Grupo Español de Cirugía Torácica Videoasistida. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Gómez Hernández MT, Novoa Valentín NM, Fuentes Gago MG, Embún Flor R, Gómez de Antonio D, Jiménez López MF. Predictive factors of pathological complete response after induction (ypT0N0M0) in non-small cell lung cancer and short-term outcomes: Results of the Spanish Group of Video-assisted Thoracic Surgery (GE-VATS). Cir Esp 2022; 100:345-351. [PMID: 35643356 DOI: 10.1016/j.cireng.2022.05.025] [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: 08/21/2020] [Accepted: 01/18/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION To analyze the predictors of pCR in NSCLC patients who underwent anatomical lung resection after induction therapy and to evaluate the postoperative results of these patients. METHODS All patients prospectively registered in the database of the GE-VATS working group undergone anatomic lung resection by NSCLC after induction treatment and recruited between 12/20/2016 and 3/20/2018 were included in the study. The population was divided into two groups: patients who obtained a complete pathological response after induction (pCR) and patients who did not obtain a complete pathological response after induction (non-pCR). A multivariate analysis was performed using a binary logistic regression to determine the predictors of pCR and the postoperative results of patients were analyzed. RESULTS Of the 241 patients analyzed, 36 patients (14.9%) achieved pCR. Predictive factors for pCR are male sex (OR: 2.814, 95% CI: 1.015-7.806), histology of squamous carcinoma (OR: 3.065, 95% CI: 1.233-7.619) or other than adenocarcinoma (OR: 5.788, 95% CI: 1.878-17.733) and induction therapy that includes radiation therapy (OR: 4.096, 95% CI: 1.785-9.401) and targeted therapies (OR: 7.625, 95% CI: 2.147-27.077). Prevalence of postoperative pulmonary complications was higher in patients treated with neoadjuvant chemo-radiotherapy (p = 0.032). CONCLUSIONS Male sex, histology of squamous carcinoma or other than ADC, and induction therapy that includes radiotherapy or targeted therapy are positive predictors for obtaining pCR. Induction chemo-radiotherapy is associated with a higher risk of postoperative pulmonary complications.
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Affiliation(s)
| | | | - Marta G Fuentes Gago
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Raúl Embún Flor
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - David Gómez de Antonio
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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Gómez de Antonio D, Crowley Carrasco S, Romero Román A, Royuela A, Calle ÁS, Obiols Fornell C, Call Caja S, Embún R, Royo Í, Recuero JL, Cabañero A, Moreno N, Bolufer S, Congregado M, Jimenez MF, Aguinagalde B, Amor-Alonso S, Arrarás MJ, Blanco Orozco AI, Boada M, Cal I, Cilleruelo Ramos Á, Fernández-Martín E, García-Barajas S, García-Jiménez MD, García-Prim JM, Garcia-Salcedo JA, Gelbenzu-Zazpe JJ, Giraldo-Ospina CF, Gómez Hernández MT, Hernández J, Wolf JDI, Jáuregui Abularach A, Jiménez U, López Sanz I, Martínez-Hernández NJ, Martínez-Téllez E, Milla Collado L, Mongil Poce R, Moradiellos-Díez FJ, Moreno-Basalobre R, Moreno Merino SB, Quero-Valenzuela F, Ramírez-Gil ME, Ramos-Izquierdo R, Rivo E, Rodríguez-Fuster A, Rojo-Marcos R, Sanchez-Lorente D, Sánchez Moreno L, Simón C, Trujillo-Reyes JC, López García C, Fibla Alfara JJ, Sesma Romero J, Hernando Trancho F. [Translated article] Surgical Risk Following Anatomic Lung Resection in Thoracic Surgery: A Prediction Model Derived From a Spanish Multicenter Database. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Obiols C, Call S, Rami-Porta R, Jaén Á, Gómez de Antonio D, Crowley Carrasco S, Royo-Crespo Í, Embún R. Radicality of lymphadenectomy in lung cancer resections by thoracotomy and video-assisted thoracoscopic approach: A prospective, multicentre and propensity-score adjusted study. Lung Cancer 2022; 165:63-70. [PMID: 35091211 DOI: 10.1016/j.lungcan.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyse differences in intraoperative nodal assessment in patients undergoing lung cancer resection by thoracotomy and video-assisted thoracoscopy (VATS) in the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). METHODS Prospective multicentre cohort study of anatomic pulmonary resections (n = 3533) performed from December 2016 to March 2018. Main surgical, clinical and oncological variables related with lymphadenectomy were compared according to surgical approach. Corresponding tests for homogeneity were performed. Multiple logistic regression analyses were used to determine the odds ratio (OR) and 95% confidence interval (95%CI). Covariate adjustment using the propensity score (PS) was performed to reduce confounding effects. RESULTS After exclusions, 2532 patients were analysed. Systematic nodal dissection (SND) was performed in 65%, with a median of resected/sampled lymph nodes (LN) of 7 (IQR 4-12) and pathologic (p) N2 and uncertain (u) pNu rates of 9.4% and 28.9%, respectively. At multivariate analysis, the following were associated with thoracotomy (OR; 95%CI): SND (1.4; 1.08-1.96; p = 0.014), staging mediastinoscopy (2.6; 1.59-4.25; p < 0.001), tumor > 3 cm (2.1; 1.66-2.78; p < 0.001), central tumor (2.5; 1.90-3.24; p < 0.001); pN1 (1.8; 1.25-2.67; p < 0.002), pN2 (1.8; 1.18-2.76; p = 0.006), lower FEV1 (0.9; 0.98-0.99; p < 0.001), squamous cell carcinoma (1.5; 1.16-1.98; p = 0.002) and inexperienced surgeons in VATS (compared with > 100 VATS experience) (37.6; 13.55-104.6; p < 0.001). After PS adjustment, SND maintained the OR, but in the limit of signification (1.4; 1-1.98; p = 0.05). Nodal upstaging was significantly higher in the thoracotomy group. Complication rates of SND and no SND were similar. CONCLUSIONS Thoracotomy was associated with a more thorough lymphadenectomy in GEVATS. Therefore, intraoperative lymph node evaluation performed at VATS should be improved to have better prognostic information and more solid grounds to indicate adjuvant therapy.
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Affiliation(s)
- Carme Obiols
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain.
| | - Sergi Call
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain; Department of Morphological Sciences, Medical School, Autonomous University of Barcelona, Bellaterra, Spain
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain; Network of Centres of Biomedical Research in Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Spain
| | - Ángeles Jaén
- Unit of Research. Fundació Docència i Recerca Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - David Gómez de Antonio
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Silvana Crowley Carrasco
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Íñigo Royo-Crespo
- Department of Thoracic Surgery, IIS Aragón, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Raúl Embún
- Department of Thoracic Surgery, IIS Aragón, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Sesma J, Bolufer S, García-Valentín A, Embún R, López ÍJ, Moreno-Mata N, Jiménez U, Trancho FH, Martín-Ucar AE, Gallar J. Thoracoscopic segmentectomy versus lobectomy: A propensity score–matched analysis. JTCVS OPEN 2022; 9:268-278. [PMID: 36003470 PMCID: PMC9390783 DOI: 10.1016/j.xjon.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy. Methods From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score–matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan–Meier and competing risks method were used to compare survival. Results In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score–matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan–Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression–related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups. Conclusions Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.
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Affiliation(s)
- Julio Sesma
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
- Address for reprints: Julio Sesma, MD, Pintor Baeza 12. 03013, Alicante, Spain.
| | - Sergio Bolufer
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Antonio García-Valentín
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Raúl Embún
- Cardiac Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Íker Javier López
- Thoracic Surgery Department, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Nicolás Moreno-Mata
- Thoracic Surgery Department, Hospital Universitario de Donostia, San Sebastián-Donostia, Spain
| | - Unai Jiménez
- Thoracic Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Antonio Eduardo Martín-Ucar
- Thoracic Surgery Department, Hospital Clínico San Carlos, Madrid, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Juana Gallar
- Miguel Hernandez de Elche University, Alicante, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6550397. [DOI: 10.1093/ejcts/ezac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/11/2022] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6537078. [DOI: 10.1093/ejcts/ezac122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/11/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 61:1251-1257. [DOI: 10.1093/ejcts/ezac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/24/2021] [Accepted: 01/31/2022] [Indexed: 11/14/2022] Open
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Cilleruelo-Ramos A, Cladellas-Gutiérrez E, de la Pinta C, Quintana-Cortés L, Sosa-Fajardo P, Couñago F, Mielgo-Rubio X, Trujillo-Reyes JC. Advances and controversies in the management of early stage non-small cell lung cancer. World J Clin Oncol 2021; 12:1089-1100. [PMID: 35070733 PMCID: PMC8716990 DOI: 10.5306/wjco.v12.i12.1089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Complete resection continues to be the gold standard for the treatment of early-stage lung cancer. The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the management of early-stage non-small cell lung cancer, as it was associated with lower recurrence and metastasis rates than sublobar resection and lower postoperative morbidity and mortality than pneumonectomy. There is a growing tendency to perform sublobar resection in selected cases, as, depending on factors such as tumor size, histologic subtype, lymph node involvement, and resection margins, it can produce similar oncological results to lobectomy. Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery.
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Affiliation(s)
- Angel Cilleruelo-Ramos
- Department of Thoracic Surgery, Clinic Universitary Hospital, Valladolid 47005, Spain
- Department of Surgery, Universidad de Valladolid, Valladolid 47001, Spain
| | | | - Carolina de la Pinta
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Laura Quintana-Cortés
- Department of Medical Oncology, Hospital Don Benito-Villanueva, Badajoz 06400, Spain
| | - Paloma Sosa-Fajardo
- Department of Radiation Therapy, Complejo Hospitalario Universitario, Santiago de Compostela, La Coruña 15706, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28223, Spain
- Department of Medicine, School of Biomedical Sciences, Universidad Europea, Madrid 28223, Spain
| | - Xabier Mielgo-Rubio
- Department of Medical Oncology Unit, Hospital Universitario Fundación Alcorcón, Madrid 28922, Spain
| | - Juan Carlos Trujillo-Reyes
- Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona 08029, Spain
- Department of Surgery, Universitat Autónoma, Barcelona 08029, Spain
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Aguinagalde B, Insausti A, Lopez I, Sanchez L, Bolufer S, Embun R. VATS lobectomy morbidity and mortality is lower in patients with the same ppoDLCO: Analysis of the database of the Spanish Video-Assisted Thoracic Surgery Group. Arch Bronconeumol 2021; 57:750-756. [PMID: 35698981 DOI: 10.1016/j.arbr.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/25/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Measuring predicted post-operative diffusion capacity of the lung for carbon monoxide (ppoDLCO) is essential to determine patient operability and to stratify the risk of patients who are candidates for major lung cancer surgery. Studies that established surgical risk variables were based on open surgery series. The aim of our study was to analyze morbidity and mortality as a function of ppoDLCO and to compare its behavior in open and video-assisted thoracic surgery (VATS). METHODS We compared 90-day mortality and morbidity in patients undergoing open surgery versus VATS as a function of decline in ppoDLCO. Propensity score matching (using age, ASA, arterial vascular disease, BMI, gender, stage, ppoDLCO, and ppoFEV1) was applied to create comparable open surgery and VATS groups. RESULTS Of 2,530 patients with lung cancer and ppoDLCO values, a sample of 1,624 (812 per group) was obtained after score matching. The relative risk of mortality associated with thoracotomy in patients with ppoDLCO < 60 is 2.66 (p < 0.02) compared to VATS. The risk of thoracotomy in terms of overall and cardiac and respiratory morbidity is higher than that of VATS for almost all ppoDLCO values. CONCLUSIONS Major resection by VATS shows lower morbidity and mortality in patients with the same ppoDLCO. A steady rise in the risk of mortality begins to occur at higher ppoDLCO values in thoracotomy (∼60) than in VATS (∼45).
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Affiliation(s)
- Borja Aguinagalde
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Donostia, Guipúzcoa, Spain.
| | | | - Iker Lopez
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Donostia, Guipúzcoa, Spain
| | - Laura Sanchez
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Sergio Bolufer
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, Spain
| | - Raul Embun
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain; Servicio de Cirugía Torácica, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
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Gómez Hernández MT, Novoa Valentín NM, Fuentes Gago MG, Embún Flor R, Gómez de Antonio D, Jiménez López MF. Predictive factors of pathological complete response after induction (ypT0N0M0) in non-small cell lung cancer and short-term outcomes: results of the Spanish Group of Video-assisted Thoracic Surgery (GE-VATS). Cir Esp 2021; 100:S0009-739X(21)00039-7. [PMID: 33640140 DOI: 10.1016/j.ciresp.2021.01.017] [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: 08/21/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To analyze the predictors of pathological complete response (pCR) in not small cells lung carcinoma (NSCLC) patients who underwent anatomical lung resection after induction therapy and to evaluate the postoperative results of these patients. METHODS All patients prospectively registered in the database of the GE-VATS working group undergone anatomic lung resection by NSCLC after induction treatment and recruited between December 20th 2016, and March 20th 2018, were included in the study. The population was divided into two groups: patients who obtained a complete pathological response after induction (pCR) and patients who did not obtain a complete pathological response after induction (non-pCR). A multivariate analysis was performed using a binary logistic regression to determine the predictors of pCR and the postoperative results of patients were analyzed. RESULTS Of the 241 patients analyzed, 36 patients (14.9%) achieved pCR. Predictive factors for pCR are male sex (OR 2.814, 95% CI 1.015-7.806), histology of squamous carcinoma (OR 3.065, 95% CI 1.233-7.619) or other than adenocarcinoma (ADC) (OR 5.788, 95% CI 1.878-17.733) and induction therapy that includes radiation therapy (OR 4.096, 95% CI 1.785-9.401) and targeted therapies (OR 7.625, 95% CI 2.147-27.077). Prevalence of postoperative pulmonary complications was higher in patients treated with neoadjuvant chemo-radiotherapy (p = 0.032). CONCLUSIONS Male sex, histology of squamous carcinoma or other than ADC, and induction therapy that includes radiotherapy or targeted therapy are positive predictors for obtaining pCR. Induction chemo-radiotherapy is associated with a higher risk of postoperative pulmonary complications.
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Affiliation(s)
| | | | - Marta G Fuentes Gago
- Servicio de Cirugía Torácica. Hospital Universitario de Salamanca, Salamanca, España
| | - Raúl Embún Flor
- Servicio de Cirugía Torácica. Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón. Universidad de Zaragoza, Zaragoza, España
| | - David Gómez de Antonio
- Servicio de Cirugía Torácica. Hospital Universitario Puerta de Hierro, Majadahonda, España
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Gómez de Antonio D, Crowley Carrasco S, Romero Román A, Royuela A, Sánchez Calle Á, Obiols Fornell C, Call Caja S, Embún R, Royo Í, Recuero JL, Cabañero A, Moreno N, Bolufer S, Congregado M, Jimenez MF, Aguinagalde B, Amor-Alonso S, Arrarás MJ, Blanco Orozco AI, Boada M, Cal I, Cilleruelo Ramos Á, Fernández-Martín E, García-Barajas S, García-Jiménez MD, García-Prim JM, Garcia-Salcedo JA, Gelbenzu-Zazpe JJ, Giraldo-Ospina CF, Gómez Hernández MT, Hernández J, Illana Wolf JD, Jáuregui Abularach A, Jiménez U, López Sanz I, Martínez-Hernández NJ, Martínez-Téllez E, Milla Collado L, Mongil Poce R, Moradiellos-Díez FJ, Moreno-Basalobre R, Moreno Merino SB, Quero-Valenzuela F, Ramírez-Gil ME, Ramos-Izquierdo R, Rivo E, Rodríguez-Fuster A, Rojo-Marcos R, Sanchez-Lorente D, Moreno LS, Simón C, Trujillo-Reyes JC, López García C, Fibla Alfara JJ, Sesma Romero J, Hernando Trancho F. Surgical Risk Following Anatomic Lung Resection in Thoracic Surgery: A Prediction Model Derived from a Spanish Multicenter Database. Arch Bronconeumol 2021; 58:398-405. [PMID: 33752924 DOI: 10.1016/j.arbres.2021.01.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). METHODS Data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. RESULTS The incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. CONCLUSIONS The risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection.
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Affiliation(s)
- David Gómez de Antonio
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España.
| | - Silvana Crowley Carrasco
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España
| | - Alejandra Romero Román
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España
| | - Ana Royuela
- Unidad de Bioestadística, Instituto de Investigación Biomédica Puerta de Hierro (IDIPHISA); CIBERESP. Madrid, España
| | - Álvaro Sánchez Calle
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España
| | - Carme Obiols Fornell
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España
| | - Sergi Call Caja
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España
| | - Raúl Embún
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
| | - Íñigo Royo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
| | - José Luis Recuero
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
| | - Alberto Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal. Madrid, España
| | - Nicolás Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal. Madrid, España
| | - Sergio Bolufer
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
| | - Miguel Congregado
- Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Marcelo F Jimenez
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Universidad de Salamanca, IBSAL, Salamanca, España
| | - Borja Aguinagalde
- Servicio de Cirugía Torácica, Hospital Universitario de Donostia, San Sebastián-Donostia, España
| | - Sergio Amor-Alonso
- Servicio de Cirugía Torácica, Hospital Universitario Quironsalud Madrid, Madrid, España
| | - Miguel Jesús Arrarás
- Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología, Valencia, España
| | | | - Marc Boada
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Instituto Respiratorio, Universidad de Barcelona, Barcelona, España
| | - Isabel Cal
- Servicio de Cirugía Torácica, Hospital Universitario La Princesa, Madrid, España
| | | | | | | | | | - Jose María García-Prim
- Servicio de Cirugía Torácica, Hospital Universitario Santiago de Compostela , Santiago de Compostela, España
| | | | | | | | - María Teresa Gómez Hernández
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Universidad de Salamanca, IBSAL, Salamanca, España
| | - Jorge Hernández
- Servicio de Cirugía Torácica, Hospital Universitario Sagrat Cor, Barcelona, España
| | | | | | - Unai Jiménez
- Servicio de Cirugía Torácica, Hospital Universitario Cruces, Bilbao, España
| | - Iker López Sanz
- Servicio de Cirugía Torácica, Hospital Universitario de Donostia, San Sebastián-Donostia, España
| | | | - Elisabeth Martínez-Téllez
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | | | - Roberto Mongil Poce
- Servicio de Cirugía Torácica, Hospital Regional Universitario, Málaga, España
| | | | | | | | | | | | - Ricard Ramos-Izquierdo
- Servicio de Cirugía Torácica, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Eduardo Rivo
- Servicio de Cirugía Torácica, Hospital Universitario Santiago de Compostela , Santiago de Compostela, España
| | - Alberto Rodríguez-Fuster
- Servicio de Cirugía Torácica, Hospital del Mar, IMIM (Instituto de Investigación Médica Hospital del Mar), Barcelona, España
| | - Rafael Rojo-Marcos
- Servicio de Cirugía Torácica, Hospital Universitario Cruces, Bilbao, España
| | - David Sanchez-Lorente
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Instituto Respiratorio, Universidad de Barcelona, Barcelona, España
| | - Laura Sánchez Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santader, España
| | - Carlos Simón
- Servicio de Cirugía Torácica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Juan Carlos Trujillo-Reyes
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | | | | | - Julio Sesma Romero
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
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Aguinagalde B, Insausti A, Lopez I, Sanchez L, Bolufer S, Embun R. VATS Lobectomy Morbidity and Mortality is Lower in Patients with the Same ppoDLCO: Analysis of the Database of the Spanish Video-Assisted Thoracic Surgery Group. Arch Bronconeumol 2021; 57:S0300-2896(21)00055-7. [PMID: 33715848 DOI: 10.1016/j.arbres.2021.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/08/2021] [Accepted: 01/25/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Measuring predicted post-operative diffusion capacity of the lung for carbon monoxide (ppoDLCO) is essential to determine patient operability and to stratify the risk of patients who are candidates for major lung cancer surgery. Studies that established surgical risk variables were based on open surgery series. The aim of our study was to analyze morbidity and mortality as a function of ppoDLCO and to compare its behavior in open and video-assisted thoracic surgery (VATS). METHODS We compared 90-day mortality and morbidity in patients undergoing open surgery versus VATS as a function of decline in ppoDLCO. Propensity score matching (using age, ASA, arterial vascular disease, BMI, sexo, stage, ppoDLCO, and ppoFEV1) was applied to create comparable open surgery and VATS groups. RESULTS Of 2,530 patients with lung cancer and ppoDLCO values, a sample of 1,624 (812 per group) was obtained after score matching. The relative risk of mortality associated with thoracotomy in patients with ppoDLCO<60 is 2.66 (P<.02) compared to VATS. The risk of thoracotomy in terms of overall and cardiac and respiratory morbidity is higher than that of VATS for almost all ppoDLCO values. CONCLUSIONS Major resection by VATS shows lower morbidity and mortality in patients with the same ppoDLCO. A steady rise in the risk of mortality begins to occur at higher ppoDLCO values in thoracotomy (∼60) than in VATS (∼45).
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Affiliation(s)
- Borja Aguinagalde
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Donostia, Guipúzcoa, España.
| | | | - Iker Lopez
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, Donostia, Guipúzcoa, España
| | - Laura Sanchez
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Sergio Bolufer
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
| | - Raul Embun
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, España; Servicio de Cirugía Torácica, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
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