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Fujita T, Koyanagi A, Kishimoto K. Complete thoracoscopic lobectomy versus hybrid video-assisted thoracoscopic lobectomy for non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2024; 72:31-40. [PMID: 37311943 DOI: 10.1007/s11748-023-01947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Video-assisted thoracoscopic surgery (VATS) is the standard approach to lobectomy for early-stage non-small cell lung cancer (NSCLC). However, there are many different types. One of its approaches is complete thoracoscopic surgery (CTS), which may be less invasive because of low chest wall stress. This study compared the treatment outcomes of CTS and hybrid VATS lobectomy for NSCLC. METHODS In total, 442 eligible patients with clinical N0 NSCLC underwent lobectomy between 2007 and 2016. Patients were classified into a group of patients who underwent CTS and a group of those who underwent hybrid VATS. Propensity score matching was performed between the two groups. RESULTS There were 175 patients after matching. The median follow-up period in the CTS and hybrid VATS groups was 60 and 63 months, respectively. The CTS group showed less blood loss (CTS, 50 mL vs. 100 mL, p = 0.005), fewer complications (CTS, 25.7% vs. 36.6%, p = 0.037), and shorter postoperative hospital stays (CTS, 8 days vs. 12 days, p < 0.001). There was no significant difference in the postoperative 30-day mortality rates. Between the patients who underwent CTS and hybrid VATS groups, the 5-year overall survival rates were 85.4% and 86.0% (p = 0.701), the relapse-free survival rates were 76.5% and 74.9% (p = 0.435), and the lung cancer-specific survival rates were 91.5% and 91.7% (p = 0.90), respectively. CONCLUSIONS CTS is less invasive and has superior short-term outcomes as an approach to lobectomy for early-stage NSCLC.
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Affiliation(s)
- Tomohiro Fujita
- Department of Thoracic Surgery, Shimane University Hospital, 89-1, Enyacho, Izumoshi, Shimane, 693-8501, Japan.
- Department of Thoracic Surgery, National Hospital Organization Hamada Medical Center, 777-12, Asaicho, Hamadashi, Shimane, 697-8511, Japan.
| | - Akira Koyanagi
- Department of Thoracic Surgery, Shimane University Hospital, 89-1, Enyacho, Izumoshi, Shimane, 693-8501, Japan
| | - Koji Kishimoto
- Department of Thoracic Surgery, Shimane University Hospital, 89-1, Enyacho, Izumoshi, Shimane, 693-8501, Japan
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2
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Mansouri S, Daniel L, Amhis N, Leveille M, Boudreau JE, Alkayyal AA, Collin Y, Tai LH. Perioperative oncolytic virotherapy to counteract surgery-induced immunosuppression and improve outcomes in pancreatic ductal adenocarcinoma. Front Oncol 2023; 13:1071751. [PMID: 36874130 PMCID: PMC9978493 DOI: 10.3389/fonc.2023.1071751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a high fatality cancer with one of the worst prognoses in solid tumors. Most patients present with late stage, metastatic disease and are not eligible for potentially curative surgery. Despite complete resection, the majority of surgical patients will recur within the first two years following surgery. Postoperative immunosuppression has been described in different digestive cancers. While the underlying mechanism is not fully understood, there is compelling evidence to link surgery with disease progression and cancer metastasis in the postoperative period. However, the idea of surgery-induced immunosuppression as a facilitator of recurrence and metastatic spread has not been explored in the context of pancreatic cancer. By surveying the existing literature on surgical stress in mostly digestive cancers, we propose a novel practice-changing paradigm: alleviate surgery-induced immunosuppression and improve oncological outcome in PDAC surgical patients by administering oncolytic virotherapy in the perioperative period.
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Affiliation(s)
- Sarah Mansouri
- Department of Immunology and Cell Biology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Lauren Daniel
- Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nawal Amhis
- Department of Immunology and Cell Biology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Maxime Leveille
- Department of Immunology and Cell Biology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jeanette E Boudreau
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
| | - Almohanad A Alkayyal
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia.,Immunology Research Program, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yves Collin
- Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Lee-Hwa Tai
- Department of Immunology and Cell Biology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
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3
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Applications of Robotic Surgery in Thoracic Diseases. J Clin Med 2022; 11:jcm11144201. [PMID: 35887965 PMCID: PMC9317933 DOI: 10.3390/jcm11144201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
With the ever-expanding implement of screening programs, as well as a raised awareness of patients about their own health, the number of cases of early-stage lung cancer is progressively increasing, leading surgeons to adapt their practice and to develop new surgical techniques that are less and less invasive [...]
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4
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Choi H, Hwang W. Perioperative Inflammatory Response and Cancer Recurrence in Lung Cancer Surgery: A Narrative Review. Front Surg 2022; 9:888630. [PMID: 35898583 PMCID: PMC9309428 DOI: 10.3389/fsurg.2022.888630] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/24/2022] [Indexed: 11/14/2022] Open
Abstract
While surgical resection is the gold standard treatment for solid tumors, cancer recurrence after surgery is common. Immunosurveillance of remnant tumor cells is an important protective mechanism. Therefore, maintenance of anti-tumor cell activity and proper levels of inflammatory mediators is crucial. An increasing body of evidence suggests that surgery itself and perioperative interventions could affect these pathophysiological responses. Various factors, such as the extent of tissue injury, perioperative medications such as anesthetics and analgesics, and perioperative management including transfusions and methods of mechanical ventilation, modulate the inflammatory response in lung cancer surgery. This narrative review summarizes the pathophysiological mechanisms involved in cancer recurrence after surgery and perioperative management related to cancer recurrence after lung cancer surgery.
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Long-Term Outcomes of Robotic-Assisted, Video-Assisted and Open Surgery in Non-Small Cell Lung Cancer: A Matched Analysis. J Clin Med 2022; 11:jcm11123363. [PMID: 35743434 PMCID: PMC9225497 DOI: 10.3390/jcm11123363] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study makes a comparison between stage I non-small cell lung cancer (NSCLC) patients subjected to either robotic-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS) or open thoracotomy, with the aim to evaluate differences between these three approaches in terms of oncological outcomes. METHOD We reviewed data from 1367 consecutive patients who, between 2011 and 2017, underwent lobectomy for NSCLC with either open surgery, VATS or RATS, and performed a matched case-control study based on patients' age, gender, clinical stage (IA, IB) and ASA score. RESULTS 180 patients (n = 72 RATS, n = 36 VATS, n = 72 open) were analyzed. Complication rates were found to be comparable (72.2% open, 86.1% VATS, 81.9% RATS), with similar grades of severity. The median number of resected lymph nodes was higher in open surgery (n = 22) than in VATS (n = 15; p = 0.0001) and in RATS (n = 17; p = 0.004). Pathological N2 upstaging was higher in open surgery (9.7%) compared to VATS (5.6%) and RATS (5.6%). However, the recurrence rate in VATS was significantly higher than in RATS (log rank p = 0.03). No statistically significant differences were detected in 5-year OS and cancer-specific survival. CONCLUSIONS no differences were found in OS and cancer-specific survival between VATS, RATS and open lobectomy for stage I NSCLC patients; even if in VATS, the incidence of recurrences, in particular local recurrences, was higher than in RATS and in open surgery.
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6
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Ypsilantis P, Lambropoulou M, Anagnostopoulos K, Kiroplastis K, Tepelopoulos G, Bangeas P, Ypsilantou I, Pitiakoudis M. Gut-Barrier Disruption After Laparoscopic Versus Open Major Liver Resection in the Rat. Surgery 2021; 171:973-979. [PMID: 34876288 DOI: 10.1016/j.surg.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Major liver resection may compromise gut-barrier function, increasing the risk of postoperative infectious complications. The aim of the present experimental study was to compare the effect of the laparoscopic versus the open technique for major liver resection on integrity as well as inflammatory and immune responses of the gut barrier. METHODS Wistar rats were subjected to open 70% hepatectomy (group H), laparoscopic 70% hepatectomy (group LH), sham operation (group S) or no intervention (group C). At various timepoints (1 hour-1 week) after operation, ileal tissue was excised for oxidative state assessment (TBARS levels), histopathologic examination, histomorphometric analysis, immunohistochemical assessment of the mitotic and apoptotic activity, and tissue expression of inflammatory (interleukin-6, tumor necrosis factor-α, nuclear factor-κB and vascular cell adhesion molecule-1) and immune response biomarkers (CD4+ and CD8+ T-lymphocytes) of the intestinal mucosa. RESULTS No changes were noted in oxidative state. The histopathologic profile was less deteriorated in group LH compared to group H. Intestinal mucosa atrophy was less intense in group LH compared to group H and was related to an equally compromised crypt cell mitotic activity. Tissue overexpression of interleukin-6, tumor necrosis factor-α, nuclear factor-κΒ, vascular cell adhesion molecule-1, CD4+, and CD8+ T-lymphocytes was less pronounced in group LH compared to group H. CONCLUSION The employment of the laparoscopic technique for major liver resection in the rat attenuated disruption of the gut barrier compared to the open procedure. This was related to less pronounced inflammatory and immune responses of the intestinal mucosa.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Maria Lambropoulou
- Laboratory of Histology and Embryology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Konstantinos Kiroplastis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Tepelopoulos
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Petros Bangeas
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ifigenia Ypsilantou
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael Pitiakoudis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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7
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Costantino CL, Wright CD. Extended Pulmonary Resection by Sleeve Lobectomy and Carinal Pneumonectomy: Selection and Technique. Thorac Surg Clin 2021; 31:273-281. [PMID: 34304835 DOI: 10.1016/j.thorsurg.2021.04.003] [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] [Indexed: 10/20/2022]
Abstract
Minimally invasive surgical approaches for extended pulmonary resections are becoming increasingly common as more surgeons gain experience in thoracoscopic and robotic technique. Outcome studies demonstrate improved decreased morbidity as compared with an open surgery.
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Affiliation(s)
- Christina L Costantino
- Department of Thoracic Surgery, Massachusetts General Hospital, GRB 4-425, Boston, MA 02114, USA
| | - Cameron D Wright
- Department of Thoracic Surgery, Massachusetts General Hospital, Founders House, FND-7, Boston, MA 02114, USA.
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Uniportal video-assisted thoracic surgery for major lung resection is associated with less immunochemokine disturbances than multiportal approach. Sci Rep 2021; 11:10369. [PMID: 33990645 PMCID: PMC8121796 DOI: 10.1038/s41598-021-89598-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/29/2021] [Indexed: 12/26/2022] Open
Abstract
Multiportal video-assisted thoracic surgery (VATS) for major lung resection causes less immunochemokine production compared to thoracotomy. Whether uniportal VATS is similarly associated with lower early postoperative circulating levels of immunochemokines compared to multiportal VATS have not been studied. Selected patients who received uniportal or multiportal VATS major lung resection were recruited. Blood samples were collected preoperatively and on postoperative days 1 and 3 for enzyme linked immunosorbent assay of serum levels of Tissue Inhibitor of Metalloproteinase (TIMP)-1, Insulin Growth Factor Binding Protein (IGFBP)-3, and Matrix Metalloproteinase (MMP)-9. A linear mixed-effects models were used to analyze the effects of uniportal VATS on the postoperative circulating chemokine levels. From March 2014 to April 2017, 68 consecutive patients consented for the prospective study and received major lung resection by either uniportal VATS (N = 29) or multiportal VATS (N = 39) were identified. Uniportal VATS major lung resection was associated with lower post-operative levels of TIMP-1 and MMP-9 compared to multiportal VATS after controlling for the effects of the corresponding baseline level and the time of follow-up measurement. No difference was observed for the level of IGFBP-3. Less immunochemokine disturbances was observed after uniportal VATS major lung resection compared to multiportal VATS.
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9
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Bai J, Chu H, Ma S, Ge Q. Clinical features and prognosis of patients with COVID-19 after lung surgery: A retrospective clinical study. Asia Pac J Clin Oncol 2021; 17:555-560. [PMID: 33609000 PMCID: PMC8013518 DOI: 10.1111/ajco.13517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023]
Abstract
AIM To evaluate whether the history of lung surgery in patients was associated with poor prognosis of coronavirus disease 2019 (COVID-19). METHODS Clinical data of patients with COVID-19 in a single-center were retrospectively analyzed. Patients with and without lung surgery were matched in 1:4 ratio to compare the differences in clinical characteristics, laboratory results, computed tomography findings, treatment regimens, and prognosis between them. RESULTS Four patients had a history of lung surgery. The time from surgery to COVID-19 onset ranged from 3 to 10 days, with a median of 6.75 days. The mortality rate in the surgical group was higher than that in the nonsurgical group (25.0% vs. 6.3%). CONCLUSION Patients contracting COVID-19 after lung surgery presented a higher death rate; hence, it is necessary to omit lung surgery in patients with active COVID-19 infection.
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Affiliation(s)
- Jie Bai
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing, China
| | - Hongling Chu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Shaohua Ma
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing, China
| | - Qinggang Ge
- Department of Intensive Care Unit, Peking University Third Hospital, Beijing, China
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10
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[Approaches to the pre-operative functional assessment of patients with lung cancer and preoperative rehabilitation]. Rev Mal Respir 2020; 37:800-810. [PMID: 33199069 DOI: 10.1016/j.rmr.2020.07.007] [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: 06/08/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
Surgery is the best treatment for early lung cancer but requires a preoperative functional evaluation to identify patients who may be at a high risk of complications or death. Guideline algorithms include a cardiological evaluation, a cardiopulmonary assessment to calculate the predicted residual lung function, and identify patients needing exercise testing to complete the evaluation. According to most expert opinion, exercise tests have a very high predictive value of complications. However, since the publication of these guidelines, minimally-invasive surgery, sublobar resections, prehabilitation and enhanced recovery after surgery (ERAS) programmes have been developed. Implementation of these techniques and programs is associated with a decrease in postoperative mortality and complications. In addition, the current guidelines and the cut-off values they identified are based on early series of patients, and are designed to select patients before major lung resection (lobectomy-pneumonectomy) performed by thoracotomy. Therefore, after a review of the current guidelines and a brief update on prehabilitation (smoking cessation, exercise training and nutritional aspects), we will discuss the need to redefine functional criteria to select patients who will benefit from lung surgery.
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11
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Ypsilantis P, Lambropoulou M, Anagnostopoulos K, Panidou-Tsoulou E, Ioannidis O, Totsi A, Pitiakoudis M, Simopoulos C. Effect of laparoscopic liver resection versus the open technique on hepatocyte regenerating activity in the rat. Surg Endosc 2020; 34:4812-4817. [PMID: 31741154 DOI: 10.1007/s00464-019-07257-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/11/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic liver resection offers a safe and feasible option primarily for the excision of hepatic neoplasms. Timely recovery of liver volume is a key factor for improving prognosis and post-operative mortality of patients undergone liver resection. The aim of the present study was to compare liver regeneration after laparoscopic over open partial hepatectomy. METHODS Wistar rats were subjected to laparoscopic 70% hepatectomy (group LAP-HEP), open 70% hepatectomy (group HEP), sham operation (group Sham) or no intervention (group Control). At various timepoints following operation (1 h-2 weeks), the liver was excised to assess relative liver weight, thiobarbituric acid reactive substances (TBARS) levels, mitotic activity, tissue expression of Nuclear Factor-κB (NFκB), Intercellular Adhesion Molecule-1 (ICAM-1) and Vascular Cell Adhesion Molecule-1 (VCAM-1) and the histopathologic profile. RESULTS No differences were seen in relative liver weight between hepatectomy groups. Mitotic index was increased in all operative study groups, being higher in group LAP-HEP than in group HEP. TBARS levels were higher in group LAP-HEP compared to group HEP. NFκB and VCAM-1 tissue expression scores were increased in all operative study groups with VCAM-1 being higher in group HEP, while ICAM-1 was overexpressed only in hepatectomy groups. Mild histopathologic lesions were noted in hepatectomy groups with the histopathologic score being higher in group HEP (24 h). CONCLUSIONS Laparoscopic liver resection enhanced hepatocyte mitotic activity which was accompanied by mild oxidative stress and a less pronounced local inflammatory response and tissue injury to that of the open technique.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Maria Lambropoulou
- Laboratory of Histology and Embryology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Eleni Panidou-Tsoulou
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Orestis Ioannidis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Albion Totsi
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael Pitiakoudis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Constantinos Simopoulos
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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12
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A Comparative Analysis of Long-Term Survival of Robotic Versus Thoracoscopic Lobectomy. Ann Thorac Surg 2020; 110:1139-1146. [DOI: 10.1016/j.athoracsur.2020.03.085] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/25/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
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13
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Postoperative prognostic nutritional index as a prognostic factor after non-small cell lung cancer surgery. Gen Thorac Cardiovasc Surg 2020; 68:1163-1171. [DOI: 10.1007/s11748-020-01366-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
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14
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Vanni G, Materazzo M, Perretta T, Meucci R, Anemona L, Buonomo C, Dauri M, Granai AV, Rho M, Ingallinella S, Tacconi F, Ambrogi V, Chiaravalloti A, Schillaci O, Petrella G, Buonomo OC. Impact of Awake Breast Cancer Surgery on Postoperative Lymphocyte Responses. In Vivo 2020; 33:1879-1884. [PMID: 31662515 DOI: 10.21873/invivo.11681] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Surgical stress and anesthesia affect the patient's immune system. Analysis of the lymphocyte response after breast-conserving surgery was conducted to investigate the differences between effects after general and local anesthesia. MATERIALS AND METHODS Fifty-six patients with breast cancer were enrolled for BCS through local or general anesthesia. Total leukocytes, total lymphocytes, lymphocyte-subsets including CD3+, CD19+, CD4+, CD8+, CD16+CD56+ and CD4+/CD8+ ratio was examined at baseline and on postoperative days 1, 2 and 3. RESULTS Baseline data showed no statistical difference between the two groups. Within-group ANOVA test showed significant differences for total leukocyte count (p<0.001), total lymphocyte count (p=0.009) and proportion of natural-killer cells (p=0.01) in the control group. Between-group analysis showed lower median values of total lymphocytes in the awake surgery group on postoperative days 1, 2 and 3 (p=0.001, p=0.02 and p=0.01, respectively) when compared to the control group. Patients who underwent surgery under general anesthesia had higher total lymphocyte counts on postoperative day 2 (p=0.04). CONCLUSION In this randomized study, breast-conserving surgery plus local anesthesia had a lower impact on postoperative lymphocyte response when compared to the same procedure performed under general anesthesia.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Buonomo
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Rome, Italy
| | - Mario Dauri
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Rome, Italy
| | | | - Maurizio Rho
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Sara Ingallinella
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Federico Tacconi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Vincenzo Ambrogi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Giuseppe Petrella
- Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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15
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Ye B, Wang M. Video-assisted Thoracoscopic Surgery versus Thoracotomy for Non-Small Cell Lung Cancer: A Meta-Analysis. Comb Chem High Throughput Screen 2020; 22:187-193. [PMID: 30987564 DOI: 10.2174/1386207322666190415103030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/20/2018] [Accepted: 12/11/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients undergoing surgery for non-small cell lung cancer (NSCLC) are often elderly and have co-morbidity conditions and decreased performance status. Compared with open thoracotomy, video-assisted thoracoscopic lobectomy is associated with fewer postoperative complications. Despite encouraging results for patients with NSCLC who underwent VATS, the procedure is still not widely accepted, and large retrospective studies have yielded conflicting results. OBJECTIVES In video-assisted lobectomy for NSCLC, it has remained controversial whether mediastinal lymphadenectomy can be performed as effectively as an open procedure via thoracotomy. To deal with inherent biases in any non-randomized comparison, we analyzed propensity-matched studies and randomized controlled trials. The aim of this study was to evaluate the treatment outcomes of VATS and open thoracotomy for NSCLC patients. METHODS We collected publications on comparison of VATS versus open thoracotomy for NSCLC patients from 2007 to 2017. All trials analyzed the summary Hazard Ratios (HRs) of the endpoints of interest, including perioperative mortality and morbidity, and individual postoperative complications. Revman 5.3 software was used to analyze the combined pooled HRs using fixed- or random-effects models according to heterogeneity. RESULTS A systematic literature search was conducted including 15 studies. The results indicated that VATS was associated with lower postoperative morbidity and mortality, and significantly lower rates of prolonged pneumonia, atrial arrhythmias and renal failure. CONCLUSIONS Compared with lobectomy by thoracotomy, thoracoscopic lobectomy is associated with a lower incidence of major complications, including lower rates of prolonged pneumonia, atrial arrhythmias and renal failure. Lobectomy via VATs may be the preferred strategy for appropriately selected NSCLC patients. The determinants of this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.
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Affiliation(s)
- Bo Ye
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Ming Wang
- Department of Thoracic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, Zhejiang, China
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Chan JWY, Yu PSY, Yang JH, Yuan EQ, Jia H, Peng J, Lau RWH, Ng CSH. Surgical access trauma following minimally invasive thoracic surgery. Eur J Cardiothorac Surg 2020; 58:i6-i13. [PMID: 32061088 DOI: 10.1093/ejcts/ezaa025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/05/2019] [Accepted: 12/22/2019] [Indexed: 12/11/2022] Open
Abstract
SummarySurgical access trauma has important detrimental implications for immunological status, organ function and clinical recovery. Thoracic surgery has rapidly evolved through the decades, with the advantages of minimally invasive surgery becoming more and more apparent. The clinical benefits of enhanced recovery after video-assisted thoracoscopic surgery (VATS) may be, at least in part, the result of better-preserved cellular immunity and cytokine profile, attenuated stress hormone release and improved preservation of pulmonary and shoulder function. Parameters of postoperative pain, chest drain duration, hospital stay and even long-term survival are also indirect reflections of the advantages of reduced access trauma. With innovations of surgical instruments, optical devices and operative platform, uniportal VATS, robotic thoracic surgery and non-intubated anaesthesia represent the latest frontiers in minimizing trauma from surgical access.
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Affiliation(s)
- Joyce W Y Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jack Hong Yang
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Evan Qize Yuan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hao Jia
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jia Peng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Ng CS, MacDonald JK, Gilbert S, Khan AZ, Kim YT, Louie BE, Blair Marshall M, Santos RS, Scarci M, Shargal Y, Fernando HC. Optimal Approach to Lobectomy for Non-Small Cell Lung Cancer: Systemic Review and Meta-Analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:90-116. [DOI: 10.1177/1556984519837027] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective Video-assisted thoracic surgery (VATS) lobectomy was introduced over 25 years ago. More recently, the technique has been modified from a multiport video-assisted thoracic surgery (mVATS) to uniportal (uVATS) and robotic (rVATS), with proponents for each approach. Additionally most lobectomies are still performed using an open approach. We sought to provide evidence-based recommendations to help define the optimal surgical approach to lobectomy for early stage non-small cell lung cancer. Methods Systematic review and meta-analysis of articles searched without limits from January 2000 to January 2018 comparing open, mVATS, uVATS, and rVATS using sources Medline, Embase, and Cochrane Library were considered for inclusion. Articles were individually scrutinized by ISMICS consensus conference members, and evidence-based statements were created and consensus processes were used to determine the ensuing recommendations. The ACC/AHA Clinical Practice Guideline Recommendation Classification system was used to assess the overall quality of evidence and the strength of recommendations. Results and recommendations One hundred and forty-five studies met the predefined inclusion criteria and were included in the meta-analysis. Comparisons were analyzed between VATS and open, and between different VATS approaches looking at oncological outcomes (survival, recurrence, lymph node evaluation), safety (adverse events), function (pain, quality of life, pulmonary function), and cost-effectiveness. Fifteen statements addressing these areas achieved consensus. The highest level of evidence suggested that mVATS is preferable to open lobectomy with lower adverse events (36% versus 42%; 88,460 patients) and less pain (IIa recommendation). Our meta-analysis suggested that overall survival was better (IIb) with mVATS compared with open (71.5% versus 66.7% 5-years; 16,200 patients). Different VATS approaches were similar for most outcomes, although uVATS may be associated with less pain and analgesic requirements (IIb). Conclusions This meta-analysis supports the role of VATS lobectomy for non-small cell lung cancer. Apart from potentially less pain and analgesic requirement with uVATS, different minimally invasive surgical approaches appear to have similar outcomes.
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Affiliation(s)
| | | | | | | | - Young T. Kim
- Seoul National University Hospital, Chongro-Ku, South Korea
| | - Brian E. Louie
- Swedish Cancer Institute and Medical Center, Seattle, WA, USA
| | | | | | | | - Yaron Shargal
- St Joseph’s Healthcare, MacMaster University, Hamilton, ON, Canada
| | - Hiran C. Fernando
- Inova Fairfax Medical Campus, Virginia Commonwealth University, Falls Church, Richmond, VA, USA
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Robotic-Assisted Lobectomy for Non-Small Cell Lung Cancer: A Comprehensive Institutional Experience. Ann Thorac Surg 2019; 108:370-376. [PMID: 31004583 DOI: 10.1016/j.athoracsur.2019.03.051] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/30/2019] [Accepted: 03/18/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND It is unclear whether the enhanced dexterity and visualization of the surgical robot lessens morbidity and influences staging or survival. We compared outcomes of robotic-assisted lobectomy (RAL) with thoracoscopic video-assisted lobectomy (VAL) or open lobectomy (OL) of non-small cell lung cancer. METHODS Using a prospective surgical database, perioperative and cancer-related outcomes of patients who received a lobectomy for non-small cell lung cancer from 2011 to 2017 were analyzed. Outcomes between each surgical approach were compared using inverse probability of treatment weighting generated from the inverse of the propensity score. RESULTS There were 831 patients: 106 RAL, 301 VAL, and 424 OL. More RAL patients than VAL received neoadjuvant therapy (16% vs 6%, P = .001), but less than OL (28% vs 16%, P = .014). After adjustment, RAL was associated with longer operative times, less blood loss, and improved nodal harvest (all P < .02). There were no differences in morbidity, nodal upstaging, or mortality between surgical approaches. Length of stay was shorter with RAL vs OL (P < .01). Unadjusted cost was higher after RAL vs VAL (P = .003), but after adjustment, cost differences disappeared. CONCLUSIONS Robotic-assisted lobectomy was associated with improved nodal harvest and less blood loss as compared with VAL or OL. Length of stay was shorter with RAL as opposed to OL. Unexpectedly, cost was not higher with RAL. The profile of patients who received RAL more closely approximated OL, suggesting RAL may allow typical thoracotomy patients to receive minimally invasive surgery after adequate training and experience.
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Casiraghi M, Spaggiari L. Robotic resection of stage III lung cancer: an international retrospective study. J Thorac Dis 2018; 10:S3081-S3083. [PMID: 30370084 DOI: 10.21037/jtd.2018.07.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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20
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Menna C, De Falco E, Teodonio L, Andreetti C, Maurizi G, Ciccone AM, D’Andrilli A, Cassiano F, Vanni C, Baccarini AE, Rendina EA, Ibrahim M. Surgical wound-site inflammation: video-assisted thoracic surgery versus thoracotomy. Interact Cardiovasc Thorac Surg 2018; 28:240-246. [DOI: 10.1093/icvts/ivy231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/19/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cecilia Menna
- Division of Thoracic Surgery, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Rome, Italy
| | - Elena De Falco
- Department of Medical-Surgical Science and Biotechnologies, Faculty of Pharmacy and Medicine, University of Rome ‘Sapienza’, Latina, Italy
| | - Leonardo Teodonio
- Division of Thoracic Surgery, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Rome, Italy
| | - Claudio Andreetti
- Division of Thoracic Surgery, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Rome, Italy
| | - Giulio Maurizi
- Division of Thoracic Surgery, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Rome, Italy
| | - Anna Maria Ciccone
- Division of Thoracic Surgery, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Rome, Italy
| | - Antonio D’Andrilli
- Division of Thoracic Surgery, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Rome, Italy
| | - Francesco Cassiano
- Division of Thoracic Surgery, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Rome, Italy
| | - Camilla Vanni
- Division of Thoracic Surgery, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Rome, Italy
| | - Alberto E Baccarini
- Division of Thoracic Surgery, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Rome, Italy
- Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sant’Andrea Hospital, Faculty of Medicine and Psychology, University of Rome ‘Sapienza’, Rome, Italy
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Huang J, Li J, Li H, Lin H, Lu P, Luo Q. Continuous 389 cases of Da Vinci robot-assisted thoracoscopic lobectomy in treatment of non-small cell lung cancer: experience in Shanghai Chest Hospital. J Thorac Dis 2018; 10:3776-3782. [PMID: 30069376 DOI: 10.21037/jtd.2018.06.80] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background To analyze the perioperative indexes of 389 patients with non-small cell lung cancer in single center after robot-assisted thoracoscopic (RATS) lobectomy, and to summarize the surgical key points in robotic lobectomy. Methods The clinical data of 389 stage I non-small cell lung cancer patients who underwent RATS lobectomy from May 2013 to December 2016 were retrospectively analyzed. Among them, there were 261 females (67.1%) and 128 males (32.9%); aged from 20-76 years old, with a mean age of 55.01 years; with ASA I in 106 cases, ASA II in 267 cases and ASA III in 16 cases; with BMI from 16.87-34.05, averaged at 23.09±2.79. The largest tumor in preoperative chest CT measurement was 0.3-3.0 cm, ranging from 1.29±0.59 cm; with stage Ia in 153 cases, stage Ib in 148 cases, stage Ic in 32 cases, stage IIb in 26 cases and stage IIIa in 30 cases; including 380 adenocarcinomas and 9 squamous carcinomas. Results The operating time was 46-300 min, averaged at 91.51±30.80 min; with a blood loss of 0-100 mL in 371 cases (95.80%), 101-400 mL in 12 cases (3.60%) and >400 mL in 2 cases (0.60%); there were 4 (1.2%) conversions to thoracotomy, in which 2 patients had massive hemorrhage and 2 patients had extensive dense adhesion; there was no mortality during operation and perioperatively. The drainage on the first day after operation was 0-960 mL, averaged at 231.39±141.87 mL; the postoperative chest tube was placed for 2-12 d, averaged at 3.96±1.52 d; the postoperative hospital stay was 2-12 d, averaged at 4.96±1.51 d, with postoperative hospital stay >7 d in 12 cases (3.60%). The postoperative air leakage was the main reason (35 cases, 9%) for prolonged hospital stay, and there was no re-admitted case within 30 days. All the patients underwent systemic lymph node dissection. The total cost of hospitalization was 60,389.66-134,401.65 CNY, averaged at 93,809.23±13,371.26 CNY. Conclusions The application of Da Vinci robot surgery system in resectable non-small cell lung cancer is safe and effective, and could make up for the deficiencies of traditional thoracoscopic surgery. The number and level of robot surgery in our center have reached international advanced level, but the relatively expensive cost has become a major limitation in limiting its widespread use. With continuous improvements in robotic technology, its scope of application will be wider, which will inevitably bring new insights in lung surgical technology.
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Affiliation(s)
- Jia Huang
- Shanghai Lung Tumor Clinical Medical Center, Shanghai 200030, China
| | - Jiantao Li
- Shanghai Lung Tumor Clinical Medical Center, Shanghai 200030, China
| | - Hanyue Li
- Shanghai Lung Tumor Clinical Medical Center, Shanghai 200030, China
| | - Hao Lin
- Shanghai Lung Tumor Clinical Medical Center, Shanghai 200030, China
| | - Peiji Lu
- Shanghai Lung Tumor Clinical Medical Center, Shanghai 200030, China
| | - Qingquan Luo
- Shanghai Lung Tumor Clinical Medical Center, Shanghai 200030, China
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Mueller MR. Tailored management of stage IIIa non-small-cell lung cancer in the era of the 8th edition of the TNM classification for lung cancer. Future Oncol 2018; 14:5-11. [PMID: 29664358 DOI: 10.2217/fon-2017-0382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Stage IIIA is a very heterogeneous group encompassing locally advanced disease with T3 and T4 tumors without any nodal involvement and very small T1a primary tumors with unilateral mediastinal lymphatic disease. Tailored management defines interdisciplinary management requiring board decisions, which can sometimes be difficult particularly in stage IIIa non-small-cell lung cancer (NSCLC). Lobectomy still is standard of care even for stage I NSCLC, which increasingly is implemented using minimally invasive surgical technique. On the other hand even locally extended tumors are today safely resected with low morbidity and mortality. According to the 2015 guidelines of the European Society of Thoracic Surgeons any kind of anatomical lung resection for lung cancer with curative intent has to be accompanied by formal mediastinal lymph node dissection. The transcervical route for complete bilateral mediastinal lymphadenectomy offers improved completeness of resection without the need for single lung ventilation and ideally supports the concept of minimally invasive surgery.
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Affiliation(s)
- Michael R Mueller
- Department of Thoracic Surgery, Sigmund Freud University Vienna, Otto Wagner Hospital, A1140 Vienna, Austria
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23
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Oncologic Equivalence of Minimally Invasive Lobectomy: The Scientific and Practical Arguments. Ann Thorac Surg 2018; 106:609-617. [PMID: 29678519 DOI: 10.1016/j.athoracsur.2018.02.089] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/11/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite the slow adoption of minimally invasive lobectomy (MIL), it is now a preferred approach for early lung cancer. Nevertheless, ongoing concerns about MIL oncologic effectiveness has led to calls for prospective, randomized trials. METHODS Retrospective analysis of on-line databases, collected readings, and other scholarly experiences of the experienced authors were used to construct this review. All available reports that contained long-term survival comparisons for open versus MIL were tabulated. RESULTS The preponderance of limited randomized and numerous large propensity-matched database analyses indicate equivalent or improved long-term MIL survival for early-stage disease. MIL lymph node dissection quality has been challenged; however, this was attributed to MIL avoidance of central tumors in early reports. Although technical inadequacies for MIL should be amplified for advanced cancer resections, early reports show no such concern. In fact, for special populations such as older, frail patients, evidence is much stronger that MIL confers a survival advantage. CONCLUSIONS MIL is an oncologically equivalent operation with substantially less morbidity, especially in frail populations. It is reasonable to suggest that MIL should be the technique of choice, even a quality indicator, for lobectomy.
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Zhang J, Wu Y, Li H, Shen Q, Yu C, Chai Y. Retrospective study on video-assisted vs. open mediastinal lymphadenectomy for non-small cell lung cancer: a propensity-matched analysis. J Thorac Dis 2018; 10:1884-1890. [PMID: 29707343 DOI: 10.21037/jtd.2018.02.64] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background This retrospective study is designed to compare the surgical outcomes of mediastinal lymph node (MLN) dissection between the two groups of non-small cell lung cancer (NSCLC) patients underwent lung cancer surgery through video-assisted thoracoscopic surgery (VATS) or thoracotomy, as well as classify the differences and identify the safer method between two groups. Methods A total of 497 patients underwent pulmonary lobectomy and systemic MLN dissection were enrolled in this study. They were divided into VATS group (n=242) and traditional thoracotomy (TT) group (n=255). The VATS group received three-port VATS, while the thoracotomy group underwent posterior-lateral or muscle sparing thoracotomy. The range of MLN dissection included groups 2R, 4R, 7, 8, 9 in right-sided lung cancer surgery and groups 4L, 5, 6, 7, 8, 9 in left-sided. The two groups were matched at a ratio of 1:1 using the propensity score matching (PSM) method. Results Out of 497 patients, 376 cases were matched for PSM, with 188 cases in each group. Baseline date did not get any significant difference between two groups. The average group number of MLN dissection in VATS group and TT group was 4.14 and 3.97, respectively. While the average amount of dissected lymph nodes in both groups were 16.63 and 17.32, respectively. Compare with the lymph node numbers among all the groups in TT group, only the number of group 7 though left approach (7L) in VATS group was statically significant. Besides, the operation time and postoperative length of hospital stay in VATS group were superior to those in TT group (P<0.05). No significant difference had been found in intraoperative blood loss, accessory surgical injury and postoperative complication between two groups. Conclusion Compared with thoracotomy, systemic MLN dissection and pulmonary lobectomy via VATS has quicker recovery, less postoperative complication and length of hospital stay with similar surgical outcomes. Moreover, our findings also suggest thoracotomy has an advantage on the dissection of MLN in group 7L.
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Affiliation(s)
- Jianbin Zhang
- Department of Thoracic Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China.,Department of Thoracic Surgery, Zhejiang University Huzhou Hospital, Huzhou 313000, China
| | - Yimin Wu
- Department of Thoracic Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Hongwei Li
- Department of Thoracic Surgery, Zhejiang University Huzhou Hospital, Huzhou 313000, China
| | - Qibin Shen
- Department of Thoracic Surgery, Zhejiang University Huzhou Hospital, Huzhou 313000, China
| | - Caihua Yu
- Department of Thoracic Surgery, Zhejiang University Huzhou Hospital, Huzhou 313000, China
| | - Ying Chai
- Department of Thoracic Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
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25
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Yu Z, Xie Q, Guo L, Chen X, Ni C, Luo W, Li W, Ma L. Perioperative outcomes of robotic surgery for the treatment of lung cancer compared to a conventional video-assisted thoracoscopic surgery (VATS) technique. Oncotarget 2017; 8:91076-91084. [PMID: 29207626 PMCID: PMC5710907 DOI: 10.18632/oncotarget.19533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 07/11/2017] [Indexed: 11/25/2022] Open
Abstract
Aim To conduct a meta-analysis to determine the relative merits between robotic video-assisted thoracoscopic surgery (R-VATS) and conventional video-assisted thoracoscopic surgery (VATS) for lung cancer. Results Fifteen studies matched the selection criterion, which reported 8827 subjects, of whom 1704 underwent R-VATS and 7123 underwent VATS. Compared the perioperative outcomes with VATS, reports of R-VATS indicated unfavorable outcomes considering the operative time (SMD = 0.48, 95% CI 0.15 to 0.81). Meanwhile, the number of dissected lymph nodes (SMD = 0.12, 95% CI -0.27 to 0.51) and hospital stay following surgery (SMD = -0.1; 95% CI -0.27 to 0.07), conversion (RR = 0.68; 95% CI 0.42 to 1.11), morbidity (RR = 0.99, 95% CI 0.92 to 1.07) and mortality (RR = 0.33, 95% CI 0.1 to 1.09) were similar for both procedures. Materials and Methods A literature search was performed to identify comparative studies reporting perioperative outcomes for R-VATS and VATS for lung cancer. Pooled risk ratio (RR) and standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or the random effects model. Conclusions There is no difference in terms of perioperative outcomes between R-VATS and VATS except for the operative time which is significantly high for R-VATS. Further studies are required to confirm these results.
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Affiliation(s)
- Zipu Yu
- Department of Thoracic Surgery, 2nd Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Qiong Xie
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Lei Guo
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xin Chen
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chenyao Ni
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Wenzong Luo
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Weidong Li
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Liang Ma
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
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Mineo TC, Sellitri F, Vanni G, Gallina FT, Ambrogi V. Immunological and Inflammatory Impact of Non-Intubated Lung Metastasectomy. Int J Mol Sci 2017; 18:ijms18071466. [PMID: 28686211 PMCID: PMC5535957 DOI: 10.3390/ijms18071466] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 12/22/2022] Open
Abstract
Background: We hypothesized that video-assisted thoracic surgery (VATS) lung metastasectomy under non-intubated anesthesia may have a lesser immunological and inflammatory impact than the same procedure under general anesthesia. Methods: Between December 2005 and October 2015, 55 patients with pulmonary oligometastases (at the first episode) successfully underwent VATS metastasectomy under non-intubated anesthesia. Lymphocytes subpopulation and interleukins 6 and 10 were measured at different intervals and matched with a control group composed of 13 patients with similar clinical features who refused non-intubated surgery. Results: The non-intubated group demonstrated a lesser reduction of natural killer lymphocytes at 7 days from the procedure (p = 0.04) compared to control. Furthermore, the group revealed a lesser spillage of interleukin 6 after 1 (p = 0.03), 7 (p = 0.04), and 14 (p = 0.05) days. There was no mortality in any groups. Major morbidity rate was significantly higher in the general anesthesia group 3 (5%) vs. 3 (23%) (p = 0.04). The median hospital stay was 3.0 vs. 3.7 (p = 0.033) days, the estimated costs with the non-intubated procedure was significantly lower, even excluding the hospital stay. Conclusions: VATS lung metastasectomy in non-intubated anesthesia had significantly lesser impact on both immunological and inflammatory response compared to traditional procedure in intubated general anesthesia.
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Affiliation(s)
- Tommaso Claudio Mineo
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome 00173, Italy.
| | - Francesco Sellitri
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome 00173, Italy.
- Department of Thoracic Surgery, Official Awake Thoracic Surgery Research Group, Policlinico Tor Vergata University of Rome, Roma 00133, Italy.
| | - Gianluca Vanni
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome 00173, Italy.
| | - Filippo Tommaso Gallina
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome 00173, Italy.
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome 00173, Italy.
- Department of Thoracic Surgery, Official Awake Thoracic Surgery Research Group, Policlinico Tor Vergata University of Rome, Roma 00133, Italy.
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Kendall F, Abreu P, Pinho P, Oliveira J, Bastos P. The role of physiotherapy in patients undergoing pulmonary surgery for lung cancer. A literature review. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017. [PMID: 28623106 DOI: 10.1016/j.rppnen.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This review aims to appraise the role of physiotherapy care in patients submitted to pulmonary surgery, in preoperative, perioperative, and postoperative phases. Pulmonary surgery is the gold standard treatment for patients with lung cancer if it is completely resectable. However, the major impairments and complications induced by surgery are well known. Physiotherapy has been regularly used both in the preparation of the surgical candidates; in their functional recovery in the immediate postoperative period, and in the medium/long term but there is a lack of concise evidence-based recommendations. Therefore, the aim of this review is to appraise the literature about the role of physiotherapy interventions in patients undergoing lung surgery for lung cancer, in preoperative, perioperative, postoperative and maintenance stages, to the recovery and well-being, regardless of the extent of surgical approach. In conclusion, physiotherapy programs should be individually designed, and the goals established according to surgery timings, and according to each subject's needs. It can also be concluded that in the preoperative phase, the main goals are to avoid postoperative pulmonary complications and reduce the length of hospital stay, and the therapeutic targets are respiratory muscle training, bronchial hygiene and exercise training. For the perioperative period, breathing exercises for pulmonary expansion and bronchial hygiene, as well as early mobilization and deambulation, postural correction and shoulder range of motion activities, should be added. Finally, it can be concluded that in the postoperative phase exercise training should be maintained, and adoption of healthy life-style behaviours must be encouraged.
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Affiliation(s)
- F Kendall
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal; CESPU, Polytechnic Health Institute of the North, Gandra, Portugal; CIAFEL, Faculty of Sports, University of Porto, Porto, Portugal.
| | - P Abreu
- Department of Physiotherapy, Escola Superior Saúde Dr. Lopes Dias, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - P Pinho
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal
| | - J Oliveira
- CIAFEL, Faculty of Sports, University of Porto, Porto, Portugal
| | - P Bastos
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal
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Lee BM, Rodriguez A, Mena G, Gottumukkala V, Mehran RJ, Rice DC, Feng L, Yu J, Cata JP. Platelet-to-Lymphocyte Ratio and Use of NSAIDs During the Perioperative Period as Prognostic Indicators in Patients With NSCLC Undergoing Surgery. Cancer Control 2017; 23:284-94. [PMID: 27556669 DOI: 10.1177/107327481602300312] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Hematological biomarkers of inflammation such as the neutrophil-to-lymphocytic rate have been reported as predictors of survival in a variety of cancers. The aim of the present study was to investigate the prognostic value of the perioperative platelet-to-lymphocyte ratio in patients with non-small-cell lung cancer (NSCLC) and to elucidate the effects of the perioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs) on tumor recurrence and survival in patients undergoing surgical resection for NSCLC. METHODS This retrospective study included data from 1,637 patients who underwent surgical resection for stage I, II, or III NSCLC. Perioperative data and tumor-related variables were included. Univariate and multivariable Cox proportional hazard ratio (HR) models were used to evaluate the association between perioperative platelet-to-lymphocyte ratio and NSAID use on recurrence-free survival (RFS) and overall survival (OS). RESULTS Multivariate analysis showed that a preoperative platelet-to-lymphocyte ratio of at least 180 was associated with reduced rates of RFS (HR = 1.22; 95% confidence interval [CI], 1.03-1.45; P = .019) and OS (HR = 1.33; 95% CI, 1.10-1.62; P = .004). Perioperative use of NSAIDs showed no statistically significant changes in RFS and OS rates (P = .72 and P = .44, respectively). CONCLUSIONS A higher preoperative inflammatory status is associated with decreased rates of RFS and OS in patients with NSCLC undergoing curative surgery. Perioperative use of NSAIDs was not found to be an independent predictor of survival.
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Affiliation(s)
- Brenda M Lee
- Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Houston, TX 77030.
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Zhang W, Wei Y, Jiang H, Xu J, Yu D. Thoracotomy is better than thoracoscopic lobectomy in the lymph node dissection of lung cancer: a systematic review and meta-analysis. World J Surg Oncol 2016; 14:290. [PMID: 27855709 PMCID: PMC5114806 DOI: 10.1186/s12957-016-1038-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/04/2016] [Indexed: 01/20/2023] Open
Abstract
Background The aim of this study was to investigate which surgical method is better in lymph node (LN) dissection of lung cancer. Methods A comprehensive search of PubMed, Ovid MEDLINE, EMBASE, Web of Science, ScienceDirect, the Cochrane Library, Scopus, and Google Scholar was performed to identify studies comparing thoracoscopic lobectomy (video-assisted thoracic surgery (VATS) group) and thoracotomy (open group) in LN dissection. Results Twenty-nine articles met the inclusion criteria and involved 2763 patients in the VATS group and 3484 patients in the open group. The meta-analysis showed that fewer total LNs (95% confidence interval [CI] −1.52 to −0.73, p < 0.0001) and N2 LNs (95% CI −1.25 to −0.10, p = 0.02) were dissected in the VATS group. A similar number of total LN stations, N2 LN stations, and N1 LNs were harvested in both groups. Only one study reported that fewer N1 LN stations were dissected in the VATS group (1.4 ± 0.5 vs. 1.6 ± 0.6, p = 0.04). Conclusions Open lobectomy could achieve better LN dissection efficacy than thoracoscopic lobectomy in the treatment of lung cancer, especially in the N2 LNs dissection. These findings require validation by high-quality, large-scale randomized controlled trials.
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Affiliation(s)
- Wenxiong Zhang
- Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China
| | - Yiping Wei
- Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China
| | - Han Jiang
- Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China
| | - Jianjun Xu
- Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China
| | - Dongliang Yu
- Department of Cardiothoracic surgery, The second affiliated hospital of Nanchang University, 1 Minde Rd, Nanchang, Jiangxi Province, 330006, China.
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Yi E, Kim D, Kim K. Evolution of video-assisted thoracic surgery (VATS) techniques for Lung cancer; Minimizing surgical injury and Expanding applications. Asian J Surg 2016; 39:264-6. [PMID: 27632896 DOI: 10.1016/j.asjsur.2016.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Eunjue Yi
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Dongjin Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13602, Republic of Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13602, Republic of Korea.
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Jawitz OK, Wang Z, Boffa DJ, Detterbeck FC, Blasberg JD, Kim AW. The differential impact of preoperative comorbidity on perioperative outcomes following thoracoscopic and open lobectomies. Eur J Cardiothorac Surg 2016; 51:169-174. [DOI: 10.1093/ejcts/ezw239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/25/2016] [Accepted: 06/06/2016] [Indexed: 11/13/2022] Open
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Louie BE, Wilson JL, Kim S, Cerfolio RJ, Park BJ, Farivar AS, Vallières E, Aye RW, Burfeind WR, Block MI. Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database. Ann Thorac Surg 2016; 102:917-924. [PMID: 27209613 DOI: 10.1016/j.athoracsur.2016.03.032] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 01/25/2016] [Accepted: 03/08/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data from selected centers show that robotic lobectomy is safe and effective and has 30-day mortality comparable to that of video-assisted thoracoscopic surgery (VATS). However, widespread adoption of robotic lobectomy is controversial. We used The Society of Thoracic Surgeons General Thoracic Surgery (STS-GTS) Database to evaluate quality metrics for these 2 minimally invasive lobectomy techniques. METHODS A database query for primary clinical stage I or stage II non-small cell lung cancer (NSCLC) at high-volume centers from 2009 to 2013 identified 1,220 robotic lobectomies and 12,378 VATS procedures. Quality metrics evaluated included operative morbidity, 30-day mortality, and nodal upstaging, defined as cN0 to pN1. Multivariable logistic regression was used to evaluate nodal upstaging. RESULTS Patients undergoing robotic lobectomy were older, less active, and less likely to be an ever smoker and had higher body mass index (BMI) (all p < 0.05). They were also more likely to have coronary heart disease or hypertension (all p < 0.001) and to have had preoperative mediastinal staging (p < 0.0001). Robotic lobectomy operative times were longer (median 186 versus 173 minutes; p < 0.001); all other operative measurements were similar. All postoperative outcomes were similar, including complications and 30-day mortality (robotic lobectomy, 0.6% versus VATS, 0.8%; p = 0.4). Median length of stay was 4 days for both, but a higher proportion of patients undergoing robotic lobectomy had hospital stays less than 4 days (48% versus 39%; p < 0.001). Nodal upstaging overall was similar (p = 0.6) but with trends favoring VATS in the cT1b group and robotic lobectomy in the cT2a group. CONCLUSIONS Patients undergoing robotic lobectomy had more comorbidities and robotic lobectomy operative times were longer, but quality outcome measures, including complications, hospital stay, 30-day mortality, and nodal upstaging, suggest that robotic lobectomy and VATS are equivalent.
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Affiliation(s)
- Brian E Louie
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
| | - Jennifer L Wilson
- Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sunghee Kim
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bernard J Park
- Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Ralph W Aye
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - William R Burfeind
- Division of Thoracic Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Mark I Block
- Division of Thoracic Surgery, Memorial Healthcare System, Hollywood, Florida
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Veronesi G, Novellis P, Alloisio M. Virtual navigation to guide personalized treatment of small-size lung cancer using minimally invasive techniques. J Vis Surg 2016; 2:72. [PMID: 29078500 DOI: 10.21037/jovs.2016.03.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Giulia Veronesi
- Division of Thoracic Surgery, Istituto Clinico Humanitas, Rozzano, Milano, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, Istituto Clinico Humanitas, Rozzano, Milano, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, Istituto Clinico Humanitas, Rozzano, Milano, Italy
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Asteriou C, Lazopoulos A, Rallis T, Gogakos AS, Paliouras D, Tsakiridis K, Zissimopoulos A, Tsavlis D, Porpodis K, Hohenforst-Schmidt W, Kioumis I, Organtzis J, Zarogoulidis K, Zarogoulidis P, Barbetakis N. Video-assisted thoracic surgery reduces early postoperative stress. A single-institutional prospective randomized study. Ther Clin Risk Manag 2016; 12:59-65. [PMID: 26834478 PMCID: PMC4716756 DOI: 10.2147/tcrm.s95235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Video-assisted thoracic surgery (VATS) has been shown to effectively reduce postoperative pain, enhance mobilization of the patients, shorten in-hospital length of stay, and minimize postoperative morbidity rates. The aim of this prospective study is to evaluate neuroendocrine and respiratory parameters as stress markers in cancer patients who underwent lung wedge resections, using both mini muscle-sparing thoracotomy and VATS approach. Methods The patients were randomly allocated into two groups: Group A (n=30) involved patients who were operated on using the VATS approach, while in group B (n=30), the mini muscle-sparing thoracotomy approach was used. Neuroendocrine and biological variables assessed included blood glucose levels, C-reactive protein (CRP) levels, cortisol, epinephrine, and adrenocorticotropic hormone (ACTH) levels. Arterial oxygen (PaO2) and carbon dioxide (PaCO2) partial pressure were also evaluated. All parameters were measured at the following time points: 24 hours preoperatively (T1), 4 hours (T2), 24 hours (T3), 48 hours (T4), and 72 hours (T5), after the procedure. Results PaO2 levels were significantly higher 4 and 24 hours postoperatively in group A vs group B, respectively (T2: 94.3 vs 77.9 mmHg, P=0.015, T3: 96.4 vs 88.7 mmHg, P=0.034). Blood glucose (T2: 148 vs 163 mg/dL, P=0.045, T3: 133 vs 159 mg/dL, P=0.009) and CRP values (T2: 1.6 vs 2.5 mg/dL, P=0.024, T3: 1.5 vs 2.1 mg/dL, P=0.044) were found increased in both groups 4 and 24 hours after the procedure. However, their levels were significantly lower in the VATS group of patients. ACTH and cortisol values were elevated immediately after the operation and became normal after 48 hours in both groups, without significant difference. Postoperative epinephrine levels measured in group A vs group B, respectively, (T2: 78.9 vs 115.6 ng/L, P=0.007, T3: 83.4 vs 122.5 ng/L, P=0.012, T4: 67.4 vs 102.6 ng/L, P=0.021). The levels were significantly higher in group B. Conclusion This study confirmed that minimally invasive thoracic surgery, by means of VATS, significantly reduces the acute-phase response and surgical stress, while enables better postoperative oxygenation.
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Affiliation(s)
- Christos Asteriou
- Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece
| | | | - Thomas Rallis
- Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Apostolos S Gogakos
- Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Dimitrios Paliouras
- Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece
| | - Kosmas Tsakiridis
- Cardiothoracic Surgery Department, Saint Luke Private Hospital, Panorama, Thessaloniki, Greece
| | - Athanasios Zissimopoulos
- Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Drosos Tsavlis
- Pulmonary Department-Oncology Unit, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Porpodis
- Pulmonary Department-Oncology Unit, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ioannis Kioumis
- Pulmonary Department-Oncology Unit, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John Organtzis
- Pulmonary Department-Oncology Unit, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Barbetakis
- Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece
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Fretland AA, Sokolov A, Postriganova N, Kazaryan AM, Pischke SE, Nilsson PH, Rognes IN, Bjornbeth BA, Fagerland MW, Mollnes TE, Edwin B. Inflammatory Response After Laparoscopic Versus Open Resection of Colorectal Liver Metastases: Data From the Oslo-CoMet Trial. Medicine (Baltimore) 2015; 94:e1786. [PMID: 26496309 PMCID: PMC4620756 DOI: 10.1097/md.0000000000001786] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Laparoscopic and open liver resection have not been compared in randomized trials. The aim of the current study was to compare the inflammatory response after laparoscopic and open resection of colorectal liver metastases (CLM) in a randomized controlled trial.This was a predefined exploratory substudy within the Oslo CoMet-study. Forty-five patients with CLM were randomized to laparoscopic (n = 23) or open (n = 22) resection. Ethylenediaminetetraacetic acid-plasma samples were collected preoperatively and at defined time points during and after surgery and snap frozen at -80 C. A total of 25 markers were examined using luminex and enzyme-linked immunosorbent assay techniques: high-mobility box group 1(HMGB-1), cell-free DNA (cfDNA), cytokines, and terminal C5b-9 complement complex complement activation.Eight inflammatory markers increased significantly from baseline: HMGB-1, cfDNA, interleukin (IL)-6, C-reactive protein, macrophage inflammatory protein -1β, monocyte chemotactic protein -1, IL-10, and terminal C5b-9 complement complex. Peak levels were reached at the end of or shortly after surgery. Five markers, HMGB-1, cfDNA, IL-6, C-reactive protein, and macrophage inflammatory protein -1β, showed significantly higher levels in the open surgery group compared with the laparoscopic surgery group.Laparoscopic resection of CLM reduced the inflammatory response compared with open resection. The lower level of HMGB-1 is interesting because of the known association with oncogenesis.
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Affiliation(s)
- Aasmund Avdem Fretland
- From the Intervention Centre (AAF, NP, AMK, SEP, BE); Department of HPB surgery (AAF, BAB, BE); Department of Immunology, Oslo University Hospital, Oslo (AS, PHN, INR, TEM); Institute of Clinical Medicine (AAF, AMK, BE), University of Oslo, Oslo; Department of Surgery, Finnmark Hospital, Kirkenes (AMK); Division of Emergencies and Critical Care (SEP); Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo (MWF); Research Laboratory, Nordland Hospital, Bodo, and Faculty of Health Sciences, University of Tromso (TEM); and Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway (TEM)
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Alwen SGJ, Culp WTN, Szivek A, Mayhew PD, Eckstrand CD. Portal site metastasis after thoracoscopic resection of a cranial mediastinal mass in a dog. J Am Vet Med Assoc 2015; 247:793-800. [DOI: 10.2460/javma.247.7.793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Innate immune responses after resection for lung cancer via video-assisted thoracoscopic surgery and thoracotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 9:93-103; discussion 103. [PMID: 24755536 DOI: 10.1097/imi.0000000000000061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Innate immune responses to pulmonary resection may be critical in the pathogenesis of important postoperative pulmonary complications and potentially longer-term survival. We sought to compare innate immunity of patients undergoing major pulmonary resection for bronchogenic carcinoma via video-assisted thoracoscopic surgery (VATS) and thoracotomy. METHODS Bronchoalveolar lavage was conducted in the contralateral lung before staging bronchoscopy and mediastinoscopy and immediately after lung resection. Blood and exhaled nitric oxide were sampled preoperatively and at 6, 24, and 48 hours postoperatively. RESULTS Forty patients were included (26 VATS and 14 thoracotomy). There was a lower systemic cytokine response from lung resection undertaken by VATS compared with thoracotomy [interleukin 6 (IL-6), analysis of variance (ANOVA) P = 0.026; IL-8, ANOVA P = 0.018; and IL-10, ANOVA P = 0.047]. The VATS patients had higher perioperative serum albumin levels (ANOVA P = 0.001). Lower levels of IL-10 were produced by lipopolysaccharide-stimulated blood monocytes from the VATS patients compared with the thoracotomy patients at 6 hours postoperatively (geometric mean ratio, 1.16; 95% confidence interval, 1.08-1.33; P = 0.011). No statistically significant differences in the neutrophil phagocytic capacity, overall leukocyte count, or differential leukocyte count were found between the surgical groups (ANOVA P > 0.05). No statistically significant differences in bronchoalveolar lavage fluid parameters were found. Exhaled nitric oxide levels fell postoperatively, which reached statistical significance at 48 hours (geometric mean ratio, 1.2; 95% confidence interval, 1.02-1.46; P = 0.029). There were no significant differences found between the surgical groups (ANOVA P = 0.331). CONCLUSIONS Overall, a trend toward greater proinflammatory and anti-inflammatory responses is seen with lung resection performed via thoracotomy compared with VATS.
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Yamashita SI, Goto T, Mori T, Horio H, Kadota Y, Nagayasu T, Iwasaki A. Video-assisted thoracic surgery for lung cancer: republication of a systematic review and a proposal by the guidelines committee of the Japanese Association for Chest Surgery 2014. Gen Thorac Cardiovasc Surg 2014; 62:701-5. [DOI: 10.1007/s11748-014-0467-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Indexed: 11/29/2022]
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Veronesi G. Robotic thoracic surgery: technical considerations and learning curve for pulmonary resection. Thorac Surg Clin 2014; 24:135-41, v. [PMID: 24780416 DOI: 10.1016/j.thorsurg.2014.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Retrospective series indicate that robot-assisted approaches to lung cancer resection offer comparable radicality and safety to video-assisted thoracic surgery or open surgery. More intuitive movements, greater flexibility, and high-definition three-dimensional vision overcome limitations of video-assisted thoracic surgery and may encourage wider adoption of robotic surgery for lung cancer, particularly as more early stage cases are diagnosed by screening. High capital and running costs, limited instrument availability, and long operating times are important disadvantages. Entry of competitor companies should drive down costs. Studies are required to assess quality of life, morbidity, oncologic radicality, and cost effectiveness.
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Affiliation(s)
- Giulia Veronesi
- Lung Cancer Early Detection Unit, Division of Thoracic Surgery, European Institute of Oncology, Via Ripamonti 435, Milan 20141, Italy.
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Begum S, Hansen HJ, Papagiannopoulos K. VATS anatomic lung resections-the European experience. J Thorac Dis 2014; 6 Suppl 2:S203-10. [PMID: 24868437 DOI: 10.3978/j.issn.2072-1439.2014.05.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 05/13/2014] [Indexed: 11/14/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) has undergone significant evolution over several decades. Although endoscopic instruments continued to improve, it was not until 1992 that the first VATS lobectomy for lung cancer was performed. Despite significant seeding of such procedure in several thoracic units globally, the uptake was slow and frustrating. Many surgeons considered it complex and unsafe being skeptic about its oncological validity. The last decade has witnessed significant change of practice in many thoracic units with a new generation of VATS thoracic surgeons. Additionally the technique has been refined, standardized and proved its validity and superiority in lung cancer treatment.
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Affiliation(s)
- Sofina Begum
- 1 St. James's University Hospital, Leeds, UK ; 2 Rigshospitalet, University of Copenhagen, Denmark
| | - Henrik Jessen Hansen
- 1 St. James's University Hospital, Leeds, UK ; 2 Rigshospitalet, University of Copenhagen, Denmark
| | - Kostas Papagiannopoulos
- 1 St. James's University Hospital, Leeds, UK ; 2 Rigshospitalet, University of Copenhagen, Denmark
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Tong BC, Kosinski AS, Burfeind WR, Onaitis MW, Berry MF, Harpole DH, D'Amico TA. Sex differences in early outcomes after lung cancer resection: analysis of the Society of Thoracic Surgeons General Thoracic Database. J Thorac Cardiovasc Surg 2014; 148:13-8. [PMID: 24726742 DOI: 10.1016/j.jtcvs.2014.03.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 02/25/2014] [Accepted: 03/11/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Women with lung cancer have superior long-term survival outcomes compared with men, independent of stage. The cause of this disparity is unknown. For patients undergoing lung cancer resection, these survival differences could be due, in part, to relatively better perioperative outcomes for women. This study was undertaken to determine differences in perioperative outcomes after lung cancer surgery on the basis of sex. METHODS The Society of Thoracic Surgeons' General Thoracic Database was queried for all patients undergoing resection of lung cancer between 2002 and 2010. Postoperative complications were analyzed with respect to sex. Univariable analysis was performed, followed by multivariable modeling to determine significant risk factors for postoperative morbidity and mortality. RESULTS A total of 34,188 patients (16,643 men and 17,545 women) were considered. Univariable analysis demonstrated statistically significant differences in postoperative complications favoring women in all categories of postoperative complications. Women also had lower in-hospital and 30-day mortality (odds ratio, 0.56; 95% confidence interval, 0.44-0.71; P < .001). Multivariable analysis demonstrated that several preoperative conditions independently predicted 30-day mortality: male sex, increasing age, lower diffusion capacity, renal insufficiency, preoperative radiation therapy, cancer stage, extent of resection, and thoracotomy as surgical approach. Coronary artery disease was an independent predictor of mortality in women but not in men. Thoracotomy as the surgical approach and preoperative radiation therapy were predictive of mortality for men but not for women. Postoperative prolonged air leak and empyema predicted mortality in men but not in women. CONCLUSIONS Women have lower postoperative morbidity and mortality after lung cancer surgery. Some risk factors are sex-specific with regard to mortality. Further study is warranted to determine the cause of these differences and to determine their effect on survival.
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Affiliation(s)
- Betty C Tong
- Section of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
| | - Andrzej S Kosinski
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | | | - Mark W Onaitis
- Section of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Mark F Berry
- Section of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - David H Harpole
- Section of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Thomas A D'Amico
- Section of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
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Protective Ventilatory Approaches to One-Lung Ventilation: More than Reduction of Tidal Volume. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0057-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jones RO, Anderson NH, Murchison JT, Brittan M, Simon EJ, Casali G, Simpson AJ, Walker WS. Innate Immune Responses after Resection for Lung Cancer via Video-Assisted Thoracoscopic Surgery and Thoracotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Richard O. Jones
- The University of Edinburgh, Medical Research Council Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh, UK
- Department of Thoracic Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Niall H. Anderson
- Centre for Population Health Sciences, The University of Edinburgh, Medical School, Edinburgh, UK
| | - John T. Murchison
- Department of Radiology, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mairi Brittan
- The University of Edinburgh, Medical Research Council Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh, UK
| | - Ellis J. Simon
- Department of Anaesthesia, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gianluca Casali
- Department of Thoracic Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A. John Simpson
- The University of Edinburgh, Medical Research Council Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh, UK
- Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle-upon-Tyne, UK
| | - William S. Walker
- Department of Thoracic Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK
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44
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Alveolar Recruitment Maneuvers for One-Lung Ventilation During Thoracic Anesthesia. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0054-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Cata JP, Gottumukkala V, Thakar D, Keerty D, Gebhardt R, Liu DD. Effects of postoperative epidural analgesia on recurrence-free and overall survival in patients with nonsmall cell lung cancer. J Clin Anesth 2014; 26:3-17. [PMID: 24095887 DOI: 10.1016/j.jclinane.2013.06.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 06/03/2013] [Accepted: 06/21/2013] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE To determine whether postoperative epidural analgesia is associated with better recurrence-free survival and overall survival after lung cancer surgery. DESIGN Retrospective study. SETTING Academic hospital. MEASUREMENTS Data of patients with stage 1, stage 2, and stage 3 nonsmall cell lung cancer, who underwent tumor resection surgery, were studied. Patient data were grouped into three different postoperative pain management interventions: intravenous patient-controlled analgesia, patient-controlled epidural analgesia, and their combination. Univariate and multicovariate Cox proportional hazards models were applied to assess the effects of covariates of interest on overall survival and recurrence-free survival. MAIN RESULTS The type of postoperative analgesia used for patients who underwent surgery for nonsmall cell lung cancer did not affect recurrence-free survival or overall survival. However, certain variables, including age ≥ 65 years, male gender, body mass index ≥ 25 kg/m(2), ASA physical status 4, and the need for preoperative blood transfusions, pneumonectomy, and postoperative radiation, were associated with decreased recurrence-free survival and overall survival. CONCLUSIONS The type of postoperative analgesia used after surgery for nonsmall cell lung cancer is not associated with better 2-year or 5-year recurrence-free survival or overall survival rates.
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Affiliation(s)
- Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dilip Thakar
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dinesh Keerty
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rodolfo Gebhardt
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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46
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Tian W, Tong H, Sun Y, Wu Q, Ma C, Jiao P. [Changes in serum vascular endothelial growth factor and matrix metalloproteinase-9 after video-assisted thoracoscopic surgery and thoracotomic Lobectomy in the treatment of patients with non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:24-9. [PMID: 24398310 PMCID: PMC6000206 DOI: 10.3779/j.issn.1009-3419.2014.01.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) are important factors in angiogenesis. These factors function in the angiogenesis of lung cancers. The aim of this study is to determine the changes in serum VEGF and MMP-9 after patients with NSCLC were subjected to lobectomy. The aim of this study is also to compare the differences in the changes observed between video-assisted thoracoscopic surgery (VATS) and traditional open surgery (TOS). METHODS A total of 43 consecutive patients with NSCLC were recruited from October 2010 to August 2012. All of these patients underwent lobectomy and systematic mediastinal lymphadenectomy. Blood was drawn from these patients to measure the serum levels of VEGF and MMP-9 in the morning before surgery and on postoperative days 1, 2, 3, and 7 (POD1, POD2, POD3, and POD7, respectively). Perioperative variations in serum VEGF and MMP-9 were also observed. Using different surgical options, we divided the patients into two groups: VATS group (25 patients) and TOS group (18 patients). The differences in the changes in serum VEGF and MMP-9 were then compared between the two groups. RESULTS After surgery, the serum VEGF and MMP-9 of patients with NSCLC initially increased and subsequently decreased. The peak levels were observed on POD2 and POD3, and these levels were significantly higher than the preoperative levels (P=0.031, P=0.020). On POD7, the serum VEGF and MMP-9 remained higher than the preoperative levels. In VATS and TOS groups, the serum VEGF and MMP-9 levels also initially increased and subsequently decreased. The TOS group showed a more evident variation. However, no significant statistical differences in the changes of VEGF and MMP-9 were found between the two groups (F=2.022, P=0.163; F=1.703, P=0.199). CONCLUSIONS Serum VEGF and MMP-9 remarkably increase in TOS group and VATS group. Although the serum level of VEGF an MMP-9 in TOS group were higher than that in VATS group. But no significant difference was observed between VATS and TOS group.
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Affiliation(s)
- Wenxin Tian
- Department of Thoracic Surgery, Beijing Hospital, Beijing 100730, China
| | - Hongfeng Tong
- Department of Thoracic Surgery, Beijing Hospital, Beijing 100730, China
| | - Yaoguang Sun
- Department of Thoracic Surgery, Beijing Hospital, Beijing 100730, China
| | - Qingjun Wu
- Department of Thoracic Surgery, Beijing Hospital, Beijing 100730, China
| | - Chao Ma
- Department of Thoracic Surgery, Beijing Hospital, Beijing 100730, China
| | - Peng Jiao
- Department of Thoracic Surgery, Beijing Hospital, Beijing 100730, China
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Wang H, D'Amico TA. Efficacy of mediastinal lymph node dissection during thoracoscopic lobectomy. Ann Cardiothorac Surg 2013; 1:27-32. [PMID: 23977461 DOI: 10.3978/j.issn.2225-319x.2012.04.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 04/23/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Hanghang Wang
- Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27705, USA
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48
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Richards JMJ, Dunning J, Oparka J, Carnochan FM, Walker WS. Video-assisted thoracoscopic lobectomy: the Edinburgh posterior approach. Ann Cardiothorac Surg 2013; 1:61-9. [PMID: 23977469 DOI: 10.3978/j.issn.2225-319x.2012.04.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 04/28/2012] [Indexed: 11/14/2022]
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49
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Rybojad P, Jabłonka A, Wilczyńska B, Tabarkiewicz J. Surgery decreases number of cells secreting cytotoxic mediators and increases secretion of interleukin 10 in patients with lung cancer. Eur J Surg Oncol 2013; 39:1269-77. [PMID: 23906695 DOI: 10.1016/j.ejso.2013.07.083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/20/2013] [Accepted: 07/03/2013] [Indexed: 01/18/2023] Open
Abstract
AIMS The phenomenon of immunosuppression induced by surgery is widely described as the adverse impact of surgical interventions on leukocytes' populations and secretion of several cytokines. Best of our knowledge, we present the first report evaluating the effect of surgical treatment on the specific anti-cancer immune response against tumour antigens. METHODS The study included 30 patients operated on for lung cancer. Specific secretion of IFN-γ, Granzyme B, perforines, IL-4, IL-5, IL-10, IL-17a was assessed by ELISPOT (Enzyme-Linked Immunosorbent Spot Assay). RESULTS Number of cells secreting IFN-γ, Granzyme B and perforines under the influence of autologous tumour antigens or mitogens was significantly decreased on the first day after surgery. During the postoperative recovery we observed an increase in the number of cells secreting IFN-γ, but on the 7th day it still remained lower than before the operation. On the 28th postoperative day it reached a level which was not significantly higher than before the surgery. On the 1st and 7th postoperative day we discovered a significant increase in IL-10 secretion, in response to autologous tumour antigens. CONCLUSIONS Our results suggest an immunosuppressive effect of surgery on the specific and nonspecific immune stimulation. This effect is particularly expressed in relation to Th1-type immunological response which is associated with direct elimination of cancer cells. Another unfavourable observation is elevated secretion of immunosuppressive IL-10 in response to cancer antigens. These phenomena are associated with shorter survival of the patients.
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Affiliation(s)
- P Rybojad
- Chair and Department of Thoracic Surgery, Medical University of Lublin, SPSK 4, Jaczewskiego 8, 20-090 Lublin, Poland.
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50
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Billè A, Okiror L, Draaisma W, Choudhuri D, Harrison-Phipps K, Routledge T. Thoracoscopic Lobectomy: Comparison of Intraoperative and Postoperative Outcomes between 3 and 4 Incision Accesses. TUMORI JOURNAL 2013; 99:505-9. [DOI: 10.1177/030089161309900411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Several techniques have been proposed to perform a video-assisted thoracic lobectomy. We compared the results of a 3 versus 4-port procedure, analyzing intraoperative data, morbidity, and mortality. Methods Prospective analysis of 30 consecutive patients who underwent a 4-port approach video-assisted thoracic lobectomy (group A) and comparison with a historical series with 30 patients who had a 3-port video-assisted thoracic lobectomy (group B). Results The groups were comparable for clinical characteristics and pathological staging. There was no difference in operating time: median, 128 min for group A versus 129 min for group B (P = 0.9). There was a significant difference in rate of conversion to thoracotomy: 1 of 30 (3.3%) in group A and 7 of 30 (23.3%) in group B (3 ports) (P = 0.02). In group A, 11 patients (36.7%) experienced postoperative complications and in group B, 13 patients (43.3%; P = 0.6). The difference in median time to drain removal and median length of hospital stay between the two groups was not significant. There was a significant difference in persistent pain between group A and group B: 6 patients (20%) in group B presented with persistent neuropathic pain on regular medication (P = 0.02). Conclusions Our study showed that the 4-port approach was similar in operative time, length of drain and hospital stay but showed a statistically significant lower conversion rate and lower rate of persistent pain than the 3-port access.
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Affiliation(s)
- Andrea Billè
- Department of Thoracic Surgery, Guy's and St Thomas Hospital, London, United Kingdom
| | - Lawrence Okiror
- Department of Thoracic Surgery, Guy's and St Thomas Hospital, London, United Kingdom
| | - Werner Draaisma
- Department of Thoracic Surgery, Guy's and St Thomas Hospital, London, United Kingdom
| | - Debajeet Choudhuri
- Department of Thoracic Surgery, Guy's and St Thomas Hospital, London, United Kingdom
| | - Karen Harrison-Phipps
- Department of Thoracic Surgery, Guy's and St Thomas Hospital, London, United Kingdom
| | - Tom Routledge
- Department of Thoracic Surgery, Guy's and St Thomas Hospital, London, United Kingdom
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