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Ma S, Li Z, Wang L. The advanced lung cancer inflammation index (ALI) predicted the postoperative survival rate of patients with non-small cell lung cancer and the construction of a nomogram model. World J Surg Oncol 2024; 22:158. [PMID: 38877553 PMCID: PMC11177447 DOI: 10.1186/s12957-024-03432-3] [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: 02/25/2024] [Accepted: 06/01/2024] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVE To investigate the prognostic significance of the advanced lung cancer inflammation index (ALI) in patients with operable non-small-cell lung carcinoma (NSCLC). By constructing the nomogram model, it can provide a reference for clinical work. METHODS A total of 899 patients with non-small cell lung cancer who underwent surgery in our hospital between January 2017 and June 2021 were retrospectively included. ALI was calculated by body mass index (BMI) × serum albumin/neutrophil to lymphocyte ratio (NLR). The optimal truncation value of ALI was obtained using the receiver operating characteristic (ROC) curve and divided into two groups. Survival analysis was represented by the Kaplan-Meier curve. The predictors of Overall survival (OS) were evaluated by the Cox proportional risk model using single factor and stepwise regression multifactor analysis. Based on the results of multi-factor Cox proportional risk regression analysis, a nomogram model was established using the R survival package. The bootstrap method (repeated sampling 1 000 times) was used for internal verification of the nomogram model. The concordance index (C-index) was used to represent the prediction performance of the nomogram model, and the calibration graph method was used to visually represent its prediction conformity. The application value of the model was evaluated by decision curve analysis (DCA). RESULTS The optimal cut-off value of ALI was 70.06, and the low ALI group (ALI < 70.06) showed a poor survival prognosis. In multivariate analyses, tumor location, pathological stage, neuroaggression, and ALI were independently associated with operable NSCLC-specific survival. The C index of OS predicted by the nomogram model was 0.928 (95% CI: 0.904-0.952). The bootstrap self-sampling method (B = 1000) was used for internal validation of the prediction model, and the calibration curve showed good agreement between the prediction and observation results of 1-year, 2-year, and 3-year OS. The ROC curves for 1-year, 2-year, and 3-year survival were plotted according to independent factors, and the AUC was 0.952 (95% CI: 0.925-0.979), 0.951 (95% CI: 0.916-0.985), and 0.939 (95% CI: 0.913-0.965), respectively. DCA shows that this model has good clinical application value. CONCLUSION ALI can be used as a reliable indicator to evaluate the prognosis of patients with operable NSCLC, and through the construction of a nomogram model, it can facilitate better individualized treatment and prognosis assessment.
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Affiliation(s)
- Shixin Ma
- Graduate School, Dalian Medical University, Dalian, 116000, Liaoning, China
- Department of Thoracic Surgery, Qingdao Municipal Hospital, No.5 Donghai Middle Road, Qingdao, 266071, Shandong, China
| | - Zongqi Li
- Graduate School, Dalian Medical University, Dalian, 116000, Liaoning, China
- Department of Thoracic Surgery, Qingdao Municipal Hospital, No.5 Donghai Middle Road, Qingdao, 266071, Shandong, China
| | - Lunqing Wang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, No.5 Donghai Middle Road, Qingdao, 266071, Shandong, China.
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Ma S, Wang L. Prognostic factors and predictive model construction in patients with non-small cell lung cancer: a retrospective study. Front Oncol 2024; 14:1378135. [PMID: 38854735 PMCID: PMC11157049 DOI: 10.3389/fonc.2024.1378135] [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: 01/29/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Objective The purpose of this study was to construct a nomogram model based on the general characteristics, histological features, pathological and immunohistochemical results, and inflammatory and nutritional indicators of patients so as to effectively predict the overall survival (OS) and progression-free survival (PFS) of patients with non-small cell lung cancer (NSCLC) after surgery. Methods Patients with NSCLC who received surgical treatment in our hospital from January 2017 to June 2021 were selected as the study subjects. The predictors of OS and PFS were evaluated by univariate and multivariable Cox regression analysis using the Cox proportional risk model. Based on the results of multi-factor Cox proportional risk regression analysis, a nomogram model was established using the R survival package. The bootstrap method (repeated sampling for 1 000 times) was used to internally verify the nomogram model, and C-index was used to represent the prediction performance of the nomogram model. The calibration graph method was used to visually represent its prediction compliance, and decision curve analysis (DCA) was used to evaluate the application value of the model. Results Univariate and multivariate analyses were used to identify independent prognostic factors and to construct a nomogram of postoperative survival and disease progression in operable NSCLC patients, with C-index values of 0.927 (907-0.947) and 0.944 (0.922-0.966), respectively. The results showed that the model had high predictive performance. Calibration curves for 1-year, 2-year, and 3-year OS and PFS show a high degree of agreement between the predicted probability and the actual observed probability. In addition, the results of the DCA curve show that the model has good clinical application value. Conclusion We established a predictive model of survival prognosis and disease progression in patients with non-small cell lung cancer after surgery, which has good predictive performance and can guide clinicians to make the best clinical decision.
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Affiliation(s)
- Shixin Ma
- Dalian Medical University, Dalian, Liaoning, China
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Lunqing Wang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, China
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Csiki E, Simon M, Papp J, Barabás M, Mikáczó J, Gál K, Sipos D, Kovács Á. Stereotactic body radiotherapy in lung cancer: a contemporary review. Pathol Oncol Res 2024; 30:1611709. [PMID: 38476352 PMCID: PMC10928908 DOI: 10.3389/pore.2024.1611709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
The treatment of early stage non-small cell lung cancer (NSCLC) has improved enormously in the last two decades. Although surgery is not the only choice, lobectomy is still the gold standard treatment type for operable patients. For inoperable patients stereotactic body radiotherapy (SBRT) should be offered, reaching very high local control and overall survival rates. With SBRT we can precisely irradiate small, well-defined lesions with high doses. To select the appropriate fractionation schedule it is important to determine the size, localization and extent of the lung tumor. The introduction of novel and further developed planning (contouring guidelines, diagnostic image application, planning systems) and delivery techniques (motion management, image guided radiotherapy) led to lower rates of side effects and more conformal target volume coverage. The purpose of this study is to summarize the current developments, randomised studies, guidelines about lung SBRT, with emphasis on the possibility of increasing local control and overall rates in "fit," operable patients as well, so SBRT would be eligible in place of surgery.
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Affiliation(s)
- Emese Csiki
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Mihály Simon
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Papp
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Márton Barabás
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Johanna Mikáczó
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Kristóf Gál
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - David Sipos
- Faculty of Health Sciences, University of Pécs, Pecs, Hungary
| | - Árpád Kovács
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Miki Y, Yamashita H, Nakajima J, Karasaki T, Kitano K, Katano A, Takenaka R, Ogita M, Sawayanagi S, Minamitani M, Jinnouchi H, Noyama T, Takeuchi K, Ishida A, Abe O. Retrospective comparison between definitive stereotactic body radiotherapy and radical surgery for 538 patients with early-stage non-small cell lung cancer in a single institution. J Cancer Res Ther 2023; 19:1350-1355. [PMID: 37787307 DOI: 10.4103/jcrt.jcrt_1873_21] [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] [Indexed: 10/04/2023]
Abstract
Introduction Survival information for stereotactic body radiotherapy (SBRT) and surgery for stage I non-small cell lung cancer (NSCLC) was examined. Methods Stage I NSCLC patients who underwent surgery or SBRT between 2012 and 2016 were retrospectively enrolled in this single-institution study. Using the Kaplan--Meier method and Cox regression model, overall survival (OS) was estimated and compared. Results Among 538 enrolled patients, compared to the surgery group (443), the SBRT group (95) had more complications (P = 0.01), worse performance status (P = 0.001), and were older (P < 0.001). Three-year OS was 70.5% post SBRT and 90.1% postsurgery. The 3-year cancer-specific survival (CSS) and disease-free survival (DFS) post SBRT and postsurgery were 92.7% vs. 92.3% and 61.1% vs 79.3%, respectively. Three-year locoregional and distant control rates post SBRT and postsurgery were 85.6% vs. 90.1% and 82.5% vs. 86.4%, respectively. Multivariate analysis using the Cox model, including age, T-stage, CCI, and C/T ratio and treatment, showed the surgery group's OS to be significantly superior to that of the SBRT group (HR of SBRT per surgery: 1.90, 95%CI: 1.12-3.21, P = 0.017). No significant differences were observed in rates of adverse events. Conclusion Although OS was better in the surgery group, no differences in CSS existed. This analysis suggests the need for future studies that compare specific radical surgeries and SBRT in a prospective and randomized setting.
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Affiliation(s)
- Yosuke Miki
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hideomi Yamashita
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Takahiro Karasaki
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kentaro Kitano
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ryousuke Takenaka
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Mami Ogita
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Subaru Sawayanagi
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masanari Minamitani
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Haruka Jinnouchi
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tomoyuki Noyama
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kenta Takeuchi
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Aki Ishida
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Huang CC, Tang EK, Shu CW, Chou YP, Goan YG, Tseng YC. Comparison of the Outcomes between Systematic Lymph Node Dissection and Lobe-Specific Lymph Node Dissection for Stage I Non-small Cell Lung Cancer. Diagnostics (Basel) 2023; 13:diagnostics13081399. [PMID: 37189500 DOI: 10.3390/diagnostics13081399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND This study compares the surgical and long-term outcomes, including disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS), between lobe-specific lymph node dissection (L-SND) and systematic lymph node dissection (SND) among patients with stage I non-small cell lung cancer (NSCLC). METHODS In this retrospective study, 107 patients diagnosed with clinical stage I NSCLC undergoing video-assisted thoracic surgery lobectomy (exclusion of the right middle lobe) from January 2011 to December 2018 were enrolled. The patients were assigned to the L-SND (n = 28) and SND (n = 79) groups according to the procedure performed on them. Demographics, perioperative data, and surgical and long-term oncological outcomes were collected and compared between the L-SND and SND groups. RESULTS The mean follow-duration was 60.6 months. The demographic data and surgical outcomes and long-term oncological outcomes were not significantly different between the two groups. The 5-year OS of the L-SND and SND groups was 82% and 84%, respectively. The 5-year DFS of the L-SND and SND groups was 70% and 65%, respectively. The 5-year CSS of the L-SND and SND groups was 80% and 86%, respectively. All the surgical and long-term outcomes were not statistically different between the two groups. CONCLUSION L-SND showed comparable surgical and oncologic outcomes with SND for clinical stage I NSCLC. L-SND could be a treatment choice for stage I NSCLC.
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Affiliation(s)
- Ching-Chun Huang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - En-Kuei Tang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chih-Wen Shu
- Institute of BioPharmaceutical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Ping Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Division of Trauma, Department of Emergency, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Yih-Gang Goan
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Surgery, Kaohsiung Veterans General Hospital Pingtung Branch, Pingtung 900, Taiwan
| | - Yen-Chiang Tseng
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
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Vessel invasion as a predictive factor for recurrence after surgery in stage I lung adenocarcinoma. Respir Investig 2021; 60:227-233. [PMID: 34933825 DOI: 10.1016/j.resinv.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/14/2021] [Accepted: 11/08/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patients with early-stage lung cancer who underwent R0 resection often encounter disease recurrence, especially during the early phase; thus, it is deemed vital to determine the predictive factors for recurrence after surgery. In this study, we aimed to identify the independent variables associated with recurrence after complete surgical resection of pathological stage I lung adenocarcinoma. METHODS We retrospectively reviewed the medical records of 169 patients who underwent pulmonary resection for primary lung adenocarcinoma pathological stage I with curative intent lung cancer surgery from 2015 to December 2018 at our institution for information on the recurrence of the disease. RESULTS Per the multivariate analysis, the presence of micropapillary pattern and vessel invasion were found to be independent predictors of disease recurrence after surgery (odds ratio [OR]: 9.36, 95% confidence interval [CI]: 2.42-36.2, P = 0.0012; and OR: 4.50, 95% CI: 1.52-13.4, P = 0.0068, respectively). Vessel invasion was also found to be an independent predictor of disease recurrence after surgery within a year (OR 11.4, 95% CI 3.08-42.5, P = 0.0003). CONCLUSIONS The presence of vessel invasion may help in distinguishing patients with the highest risk of early-phase disease recurrence after surgery. Patients with stage I adenocarcinoma with vessel invasion should undergo intensive surveillance after surgery.
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Seong YW, Jeon JH, Jang HJ, Cho S, Jheon S, Kim K. Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy. J Cardiothorac Surg 2021; 16:302. [PMID: 34656152 PMCID: PMC8520266 DOI: 10.1186/s13019-021-01685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background Video-assisted thoracic surgery sleeve resection with bronchial anastomosis or bronchoplasty is a technically demanding procedure. Three-dimensional endoscopic surgery has been reported to be helpful in decreasing operation time and improving spatial perception with less surgical errors, but there have been rare reports about relatively difficult thoracoscopic procedures utilizing 3D thoracoscope. We performed this study to evaluate early clinical outcomes of thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope.
Methods Data from a total of 36 patients who underwent thoracoscopic sleeve lobectomy or bronchoplasty at our institution from December 2015 to October 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 10 mm, 30° three-dimensional thoracoscope. Twenty-three patients (81%) were male, and mean age was 65.9 ± 9.4 years. Fourteen patients (38.9%) underwent sleeve resection with bronchial anastomosis, 22 (61.1%) underwent wedge or simple bronchoplasty, and one patient received concomitant PA procedure. Bronchial anastomosis sites were not covered with viable tissue flaps.
Results There was no (0%) suture needle injury from spatial misperception during bronchoplasty or sleeve anastomosis. There was no (0%) operative mortality. The pathologic report revealed squamous cell carcinoma (63.9%), adenocarcinoma (19.4%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (2.8%). One (2.8%) late mortality was due to systemic recurrence of sarcomatoid carcinoma. There was no (0.0%) anastomotic failure. The mean number of dissected lymph nodes were 27.4 ± 13.2, and mean operation time was 216.8 ± 60.0 min. Median postoperative 24-h drain amount was 315 mL. Median chest tube days and hospital days were 4 and 6, respectively. Two patients (5.6%) had complications greater than Clavien-Dindo grade II—one case of ARDS, and the other case of a delayed bronchopleural fistula. Conclusions Thoracoscopic sleeve resection and bronchoplasty utilizing HD 3D thoracoscope is a safe and effective procedure with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed.
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Affiliation(s)
- Yong Won Seong
- Department of Thoracic and Cardiovascular Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo-Jun Jang
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, Seoul, Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Gao Y, Abulimiti A, He D, Ran A, Luo D. Comparison of single- and triple-port VATS for lung cancer: A meta-analysis. Open Med (Wars) 2021; 16:1228-1239. [PMID: 34514169 PMCID: PMC8389499 DOI: 10.1515/med-2021-0333] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022] Open
Abstract
Objective To compare the perioperative parameters between single- and triple-port video-assisted thoracoscopic surgery (VATS) lobectomy in the treatment of lung cancer. Methods The Pubmed, Embase, Cochrane library, and the Web of Science databases were electronically searched from inception to September 2019 for all relevant studies. Study quality was evaluated using the Jadad scale or the Newcastle-Ottawa scale. The results were pooled using the generic inverse-variance method and expressed as mean differences or risk ratios, with 95% confidence intervals. Results Three randomized controlled trials (RCTs) and ten cohort studies with 2,278 subjects were included in the meta-analysis. Whether based on RCTs or cohort studies, the pooled results showed no significant difference in the operation time, chest tube duration, intraoperative blood loss, postoperative hospital stays, lymph node dissection number, postoperative drainage volume, and postoperative complications between single- and triple-port VATS lobectomy (P > 0.05). Single-port VATS could relieve postoperative pain better than triple-port VATS, especially in the first day and fifth day (P < 0.05). No evidence of significant publication bias was found (P > 0.05). Conclusion Single-port VATS lobectomy can yield similar perioperative results to those of triple-port VATS lobectomy and is more effective in relieving postoperative pain.
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Affiliation(s)
- Yunfei Gao
- Department of Thoracic Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, China
| | - Abulaiti Abulimiti
- Department of Thoracic Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, China
| | - Dan He
- Department of Thoracic Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, China
| | - Anpeng Ran
- Department of Thoracic Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, China
| | - Dongbo Luo
- Department of Thoracic Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, China
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Manerikar A, Querrey M, Cerier E, Kim S, Odell DD, Pesce LL, Bharat A. Comparative Effectiveness of Surgical Approaches for Lung Cancer. J Surg Res 2021; 263:274-284. [PMID: 33309173 PMCID: PMC8169528 DOI: 10.1016/j.jss.2020.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/18/2020] [Accepted: 10/21/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The magnitude of association and quality of evidence comparing surgical approaches for lung cancer resection has not been analyzed. This has resulted in conflicting information regarding the relative superiority of the different approaches and disparate opinions on the optimal surgical treatment. We reviewed and systematically analyzed all published data comparing near- (30-d) and long-term mortality for minimally invasive to open surgical approaches for lung cancer. METHODS Comprehensive search of EMBASE, MEDLINE, and the Cochrane Library, from January 2009 to August 2019, was performed to identify the studies and those that passed bias assessment were included in the analysis utilizing propensity score matching techniques. Meta-analysis was performed using random-effects and fixed-effects models. Risk of bias was assessed via the Newcastle-Ottawa Scale and the ROBINS-I tool. The study was registered in PROSPERO (CRD42020150923) prior to analysis. RESULTS Overall, 1382 publications were identified but 19 studies were included encompassing 47,054 patients after matching. Minimally invasive techniques were found to be superior with respect to near-term mortality in early and advanced-stage lung cancer (risk ratio 0.45, 95% confidence interval [CI] 0.21-0.95, I2 = 0%) as well as for elderly patients (odds ratio 0.45, 95% CI 0.31-0.65, I2 = 30%), but did not demonstrate benefit for high-risk patients (odds ratio 0.74, 95% CI 0.06-8.73, I2 = 78%). However, no difference was found in long-term survival. CONCLUSIONS We performed the first systematic review and meta-analysis to compare surgical approaches for lung cancer which indicated that minimally invasive techniques may be superior to thoracotomy in near-term mortality, but there is no difference in long-term outcomes.
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Affiliation(s)
- Adwaiy Manerikar
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Melissa Querrey
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily Cerier
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samuel Kim
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David D Odell
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lorenzo L Pesce
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit Bharat
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Nguyen Van N, Hung PN, Dung LT, Anh LV, Pho DC, Anh BDT, Hai VA. Short-Term and Mid-Term Outcomes of Video-Assisted Thoracic Surgery in Patients with Early-Stage Non-Small Cell Lung Cancer. OPEN ACCESS SURGERY 2021. [DOI: 10.2147/oas.s315389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Wang ML, How CH, Hung MH, Huang HH, Hsu HH, Cheng YJ, Chen JS. Long-term outcomes after nonintubated versus intubated thoracoscopic lobectomy for clinical stage I non-small cell lung cancer: A propensity-matched analysis. J Formos Med Assoc 2021; 120:1949-1956. [PMID: 33994233 DOI: 10.1016/j.jfma.2021.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/08/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nonintubated thoracoscopic lobectomy has been described as a feasible surgical treatment for early-stage lung cancer since 2011. Despite promising perioperative results, studies on tumor recurrence and long-term survival are very limited. This study was aimed to compare outcomes after thoracoscopic lobectomy with versus without intubation for stage I non-small cell lung cancer. METHODS A retrospective data set including 115 and 155 patients who underwent nonintubated and intubated thoracoscopic lobectomy, respectively, between January 2011 and December 2013 was used to identify matched nonintubated and intubated cohorts (n = 97 per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed using Cox regression analysis and Kaplan-Meier survival estimates. RESULTS No perioperative mortality occurred in both groups. At an average follow-up of 74 months, comparing nonintubated thoracoscopic lobectomy with intubated procedure, no differences were observed in recurrence rates (14.4% vs. 25.8%, respectively; p = .057). Furthermore, no significant differences were noted in overall survival (97.9% vs. 93.8%, respectively; p = .144). Nonintubated thoracoscopic lobectomy was not found to be an independent predictor of recurrence (hazard ratio, .53; 95% confidence interval [CI], .28-1.02) or overall survival (hazard ratio, .33; 95% CI, .07-1.61). CONCLUSIONS In this propensity-matched comparison, nonintubated thoracoscopic lobectomy was not associated with an increased risk for recurrence and overall survival during the 5-year follow-up. However, more randomized trials should be conducted for further validation of these results.
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Affiliation(s)
- Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hung How
- Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hui-Hsun Huang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer Center, Taiwan.
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12
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Tochii S, Kawai H, Ishizawa H, Nagano H, Negi T, Tochii D, Suda T, Hoshikawa Y. Evaluation of prognosis after thoracoscopic lobectomy for primary lung cancer. Asian J Endosc Surg 2021; 14:178-183. [PMID: 32720475 DOI: 10.1111/ases.12838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/14/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Thoracoscopic lobectomy for primary lung cancer is performed at many institutions. However, few reports are available on postoperative prognosis for progressive stages. In 2004, we adopted lobectomy by video-assisted thoracoscopic surgery (VATS), which would be applicable to the clinical stages up to stage IIIA. This study reports long-term outcomes of surgery for primary lung cancer at several stages, including IIIA. METHODS We compared the long-term outcomes of 315 VATS cases with those of 159 open thoracotomy cases. RESULTS The overall 5-year survival rate was 78.1% for the VATS group and 61.9% for the open thoracotomy group. A statistically significant difference between the survival curves of the two groups was observed (P = .001). When analyzing the survival curves for both groups by pathological (p) stage, significant differences were observed for p-stages IB and IIIA, with the VATS group producing better results than the open thoracotomy group. CONCLUSION The long-term outcomes of patients with primary lung cancer at our institution were more favorable in the group undergoing VATS lobectomy than in the group undergoing open thoracotomy.
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Affiliation(s)
- Sachiko Tochii
- Department of Minimary Invasive Thoracic Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Hiroshi Kawai
- Department of Thoracic Surgery, Fujita Health University, Toyoake, Japan
| | - Hisato Ishizawa
- Department of Thoracic Surgery, Fujita Health University, Toyoake, Japan
| | - Hiromitsu Nagano
- Department of Minimary Invasive Thoracic Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Takahiro Negi
- Department of Minimary Invasive Thoracic Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Daisuke Tochii
- Department of Minimary Invasive Thoracic Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Takashi Suda
- Department of Minimary Invasive Thoracic Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yasushi Hoshikawa
- Department of Thoracic Surgery, Fujita Health University, Toyoake, Japan
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13
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Luan TMB, Bang HT, Vuong NL, Dung LT, Tin NT, Tien TQ, Nam NH. Long-term outcomes of video-assisted lobectomy in non-small cell lung cancer. Asian Cardiovasc Thorac Ann 2021; 29:318-326. [PMID: 33631956 DOI: 10.1177/0218492321997380] [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: 11/16/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery lobectomy combined with lymphadenectomy is widely utilized worldwide for treating non-small cell lung cancer. We evaluated the long-term survival outcomes of this approach and determined the prognostic factors of overall survival. METHODS This prospective observational study was performed in patients with non-small cell lung cancer who were subjected to video-assisted lobectomy and lymphadenectomy from 2012 to 2016. Independent prognostic factors were determined via uni- and multivariable Cox models. RESULTS There were 109 patients with the mean age of 59.2 years and males accounted for 54.1%. Postoperative staging determined 22.9% of stage IA, 31.2% of stage IB, 16.5% of stage IIA and 29.4% of stage IIIA. Median follow-up time was 27 months. The overall survival rate after 1, 2, 3, 4 and 5 years was 100%, 85.9%, 65.3%, 55.9% and 55.9%, respectively. In univariable analysis, smoking (hazard ratio (HR) [95% confidence interval (CI)]: 2.50 [1.18-5.31]), Tumor--nodes--metastases (TNM) stage (IIA: 7.60 [1.57-36.9]; IIIA: 14.3 [3.28-62.7] compared to IA), histological differentiation (moderately differentiated: 4.91 [1.04-23.2]; poorly differentiated: 8.25 [1.91-35.6] compared to well differentiated), lymph node size ≥1 cm (8.22 [3.11-21.7]), tumour size ≥3 cm (4.24 [1.01-17.9]), radical lymphadenectomy (6.67 [3.14-14.2]) were identified as prognostic factors of the long-term survival. In multivariable analysis, only radical lymphadenectomy was an independent prognostic factor (HR [95% CI]: 3.94 [1.41-11.0]). CONCLUSION Video-assisted thoracoscopic lobectomy combined with lymphadenectomy is feasible, safe and effective for the treatment of non-small cell lung cancer. The long-term outcomes of this method are favourable, especially at the early stage of cancer.
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Affiliation(s)
- Tran Minh Bao Luan
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Thoracic and Vascular Department, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ho Tat Bang
- Thoracic and Vascular Department, University Medical Center HCMC, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Department of Health Organization and Management, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Tien Dung
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Trung Tin
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Quyet Tien
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoai Nam
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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14
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Chen NB, Li QW, Zhu ZF, Wang YM, Cheng ZJ, Hui ZG, Guo SP, He HQ, Wang B, Huang XY, Li JB, Guo JY, Hu N, Ai XL, Zhou Y, Wang DQ, Liu FJ, Xie CM, Qiu B, Liu H. Developing and validating an integrated gross tumor volume (GTV)-TNM stratification system for supplementing unresectable locally advanced non-small cell lung cancer treated with concurrent chemoradiotherapy. Radiat Oncol 2020; 15:260. [PMID: 33168045 PMCID: PMC7653712 DOI: 10.1186/s13014-020-01704-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose The gross tumor volume (GTV) could be an independent prognostic factor for unresectable locally advanced non-small cell lung cancer (LANSCLC). We aimed to develop and validate a novel integrated GTV-TNM stratification system to supplement LANSCLC sub-staging in patients treated with concurrent chemoradiotherapy (CCRT).
Methods We performed a retrospective review of 340 patients with unresectable LANSCLC receiving definitive CCRT. All included patients were divided into two randomized cohorts. Then the Kaplan–Meier method and Cox regression were calculated to access the prognostic value of the integrated GTV-TNM stratification system, which was further validated by the area under the receiver operating characteristic curve (AUC) score and F1-score. Results The optimal outcome-based GTV cut-off values (70 and 180 cm3) of the modeling cohort were used to determine each patient’s integrated GTV-TNM stratum in the whole cohort. Our results indicated that a lower integrated GTV-TNM stratum could had better overall survival and progression-free survival (all P < 0.001), which was recognized as an independent prognostic factor. Also, its prognostic value was robust in both the modeling and validation cohorts. Furthermore, the prognostic validity of the integrated GTV-TNM stratification system was validated by significantly improved AUC score (0.636 vs. 0.570, P = 0.027) and F1-score (0.655 vs. 0.615, P < 0.001), compared with TNM stage. Conclusions We proposed a novel integrated GTV-TNM stratification system to supplement unresectable LANSCLC sub-staging due to its prognostic value independent of TNM stage and other clinical characteristics, suggesting that it could be considered in individual treatment decision-making process.
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Affiliation(s)
- Nai-Bin Chen
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Qi-Wen Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China.,Lung Cancer Institute, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zheng-Fei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Yi-Ming Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China
| | - Zhangkai J Cheng
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Zhou-Guang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Su-Ping Guo
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Hao-Qiang He
- Medical Imaging, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Bin Wang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Xiao-Yan Huang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Ji-Bin Li
- Clinical Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Jin-Yu Guo
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Nan Hu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Xin-Lei Ai
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Yin Zhou
- Evidance Medical Technologies Inc., Ningbo, People's Republic of China
| | - Da-Quan Wang
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Fang-Jie Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Chuan-Miao Xie
- Medical Imaging, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Bo Qiu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China. .,Lung Cancer Institute, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Hui Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China. .,Lung Cancer Institute, Sun Yat-Sen University, Guangzhou, People's Republic of China.
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15
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Clinicopathological Significance of RUNX1 in Non-Small Cell Lung Cancer. J Clin Med 2020; 9:jcm9061694. [PMID: 32498288 PMCID: PMC7356912 DOI: 10.3390/jcm9061694] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
This study aimed to understand the clinicopathological significance of runt-related transcription factor 1 (RUNX1) in non-small cell lung cancer (NSCLC). The methylation and mRNA levels of RUNX1 in NSCLC were determined using the Infinium HumanMethylation450 BeadChip and the HumanHT-12 expression BeadChip. RUNX1 protein levels were analyzed using immunohistochemistry of formalin-fixed paraffin-embedded tissues from 409 NSCLC patients. Three CpGs (cg04228935, cg11498607, and cg05000748) in the CpG island of RUNX1 showed significantly different methylation levels (Bonferroni corrected p < 0.05) between tumor and matched normal tissues obtained from 42 NSCLC patients. Methylation levels of the CpGs in the tumor tissues were inversely related to mRNA levels of RUNX1. A logistic regression model based on cg04228935 showed the best performance in predicting NSCLCs in a test dataset (N = 28) with the area under the receiver operating characteristic (ROC) curve (AUC) of 0.96 (95% confidence interval (CI) = 0.81–0.99). The expression of RUNX1 was reduced in 125 (31%) of 409 patients. Adenocarcinoma patients with reduced RUNX1 expression showed 1.97-fold (95% confidence interval = 1.16–3.44, p = 0.01) higher hazard ratio for death than those without. In conclusion, the present study suggests that abnormal methylation of RUNX1 may be a valuable biomarker for detection of NSCLC regardless of race. And, reduced RUNX1 expression may be a prognostic indicator of poor overall survival in lung adenocarcinoma.
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16
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Lutz JA, Seguin-Givelet A, Grigoroiu M, Brian E, Girard P, Gossot D. Oncological results of full thoracoscopic major pulmonary resections for clinical Stage I non-small-cell lung cancer. Eur J Cardiothorac Surg 2019; 55:263-270. [PMID: 30052990 DOI: 10.1093/ejcts/ezy245] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/07/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The full thoracoscopic approach to major pulmonary resections is considered challenging and controversial as it might compromise oncological outcomes. The aim of this work was to analyse the results of a full thoracoscopic technique in terms of nodal upstaging and survival in patients with non-small-cell lung carcinoma (NSCLC). METHODS All patients who underwent a full thoracoscopic major pulmonary resection for NSCLC between 2007 and August 2016 were analysed from an 'intent-to-treat' prospective database. Overall survival and disease-free survival were estimated using the Kaplan-Meier curves and comparisons in survival using the log-rank test. RESULTS A total of 648 patients met the inclusion criteria, of whom 621 patients had clinical Stage I and 27 had higher stages (16 oligometastatic patients were excluded from the analysis, 11 cT3 or cT4). The mean follow-up was 34.5 months. There were 40 conversions to thoracotomy (6.3%). Thirty-day or in-hospital mortality was 0.95%. Complications occurred in 29.3% of patients. On pathological examination, 22.5% of clinical Stage I patients were upstaged. Nodal upstaging to N1 or N2 was observed in 15.8% of clinical Stage I patients. Five-year overall survival of the whole cohort was 75% and was significantly different between clinical Stages IA (76%) and IB (70.9%). For tumours <2 cm, no significant difference in overall survival was found for the segmentectomy group compared to the lobectomy group: 74% versus 78.9% (P = 0.634). CONCLUSIONS Long-term survival is not compromised by a full thoracoscopic approach. Our results compared favourably with those of video-assisted techniques.
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Affiliation(s)
- Jon A Lutz
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France.,Division of General Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Agathe Seguin-Givelet
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France.,Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Madalina Grigoroiu
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Emmanuel Brian
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Philippe Girard
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Dominique Gossot
- Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
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17
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Wu HL, Tai YH, Chan MY, Tsou MY, Chen HH, Chang KY. Effects of epidural analgesia on cancer recurrence and long-term mortality in patients after non-small-cell lung cancer resection: a propensity score-matched study. BMJ Open 2019; 9:e027618. [PMID: 31152035 PMCID: PMC6549742 DOI: 10.1136/bmjopen-2018-027618] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Previous studies showed reductions in recurrence and mortality rate of several cancer types in patients receiving perioperative epidural analgesia. This study aimed to investigate the effects of thoracic epidural analgesia on oncological outcomes after resection for lung cancer. DESIGN Retrospective study using propensity score matching methodology. SETTING Single medical centre in Taiwan. PARTICIPANTS Patients with stages I-III non-small-cell lung cancer undergoing primary tumour resection between January 2005 and December 2015 and had either epidural analgesia, placed preoperatively and used intra- and postoperatively, or intravenous analgesia were evaluated through May 2017. PRIMARY AND SECONDARY OUTCOME MEASURES Primary endpoint was postoperative recurrence-free survival and secondary endpoint was overall survival. RESULTS The 3-year recurrence-free and overall survival rates were 69.8% (95% CI 67.4% to 72.2%) and 92.4% (95% CI 91% to 93.8%) in the epidural group and 67.4% (95% CI 62.3% to 72.5%) and 89.6% (95% CI 86.3% to 92.9%) in the non-epidural group, respectively. Multivariable Cox regression analysis before matching demonstrated no significant difference in recurrence or mortality between groups (adjusted HR: 0.93, 95% CI 0.76 to 1.14 for recurrence; 0.81, 95% CI 0.58 to 1.13 for mortality), similar to the results after matching (HR: 0.97, 95% CI 0.71 to 1.31; 0.94, 95% CI 0.57 to 1.54). Independent risk factors for both recurrence and mortality were male, higher pretreatment carcinoembryonic antigen level, advanced cancer stage, poor differentiation, lymphovascular invasion, microscopic necrosis and postoperative radiotherapy. CONCLUSIONS Thoracic epidural analgesia was not associated with better recurrence-free or overall survival in patients receiving surgical resection for stages I-III non-small-cell lung cancer.
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Affiliation(s)
- Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Hsuan Tai
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Min-Ya Chan
- Department of Technology Application and Human Resource Development, National Taiwan Normal University, Taipei, Taiwan
| | - Mei-Yung Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuang-Yi Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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18
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Matsuoka K, Yamada T, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Analysis of conversion to thoracotomy during thoracoscopic lung resection. Asian Cardiovasc Thorac Ann 2019; 27:381-387. [PMID: 31072106 DOI: 10.1177/0218492319851396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Video-assisted thoracoscopic surgery has been widely adopted. However, conversion to open thoracotomy is still necessary when intraoperative complications are encountered. Methods Between January 2009 and December 2014, 1566 patients underwent anatomical lung resection for lung cancer using video-assisted thoracoscopic surgery at our institution. Among these patients, 39 required conversion to open thoracotomy. We retrospectively examined the current status of conversion to thoracotomy during video-assisted thoracoscopic surgery in a single city hospital. Data were compared with those of 89 patients undergoing a scheduled thoracotomy. Results The main reason for conversion was the need for angioplasty for pulmonary artery invasion by silicotic lymph nodes (12 cases), and metastatic lymph nodes or tumors (9 cases). Univariate analysis demonstrated that the risk factors for conversion were male sex, smoking habit, induction therapy, large tumor size, and advanced stage. Multivariate analysis showed that advanced clinical stage was the only significant predictor of intraoperative conversion. Compared to the video-assisted thoracoscopic surgery group, mortality and morbidity in the conversion group were significantly higher, but there was no significant difference in mortality or morbidity between the conversion and scheduled thoracotomy groups. The conversion group showed a significantly higher rate of lethal acute exacerbation of interstitial pneumonitis than the video-assisted thoracoscopic surgery group. Conclusion The main reason for conversion was angioplasty, and advanced clinical stage was a significant predictor of intraoperative conversion. Conversion was safely performed but postoperative complications, although similar in frequency to scheduled thoracotomy cases, were more frequent than those in thoracoscopic surgery cases.
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Affiliation(s)
- Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Tetsu Yamada
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Takahisa Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Shinjiro Nagai
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
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19
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Tsunou K, Hashimoto K, Yamanaka R, Arimori H. [Effect of CT Value and CT Value Difference on the Pulmonary Arteriovenous Automatic Extraction Function of the Medical Workstation]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:174-182. [PMID: 30787224 DOI: 10.6009/jjrt.2019_jsrt_75.2.174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study aimed to evaluate the effect of pulmonary arteriovenous computed tomography (CT) value and CT value difference on the pulmonary arteriovenous automatic extraction ability of a medical workstation. We classified patients who previously underwent contrast-enhanced CT as those with a pulmonary arteriovenous CT value difference of <50 Hounsfield unit (HU) and ≥100 HU. The groups were further divided into four subgroups each, with a total of eight groups, based on low pulmonary arteriovenous CT values of 200 or more and <250 HU, 250 or more and <300 HU, 300 or more and <350 HU, and 350 HU or more. A radiographer conducted a visual evaluation, and we judged whether it could extract pulmonary arteries A1-A10 and pulmonary veins V1-V10 without errors. When the CT value difference was <50 HU, the low pulmonary arteriovenous CT value of 200 or more and <250 HU significantly decreased the extraction ability compared with the ≥350 HU group (p<0.05), but when the CT value difference was ≥100 HU, no difference in the CT value was found. The pulmonary arteriovenous CT value and CT value difference affect the pulmonary arteriovenous automatic extraction ability of the medical workstation, but revision by the creator is necessary because misrecognition is included even if a CT value and CT value difference is high.
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Affiliation(s)
| | | | - Ryota Yamanaka
- Department of Radiology, Japanese Red Cross Okayama Hospital
| | - Hideo Arimori
- Department of Radiology, Japanese Red Cross Okayama Hospital
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20
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Allakhverdiev A, Davydov M, Akhmedov P. Thoracoscopic lobectomy with mediastinal lymph node dissection as a standard surgery for T1-2N0M0 non-small cell lung cancer (>300 surgeries experience). Ann Med Surg (Lond) 2018; 35:169-172. [PMID: 30319774 PMCID: PMC6180294 DOI: 10.1016/j.amsu.2018.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/01/2018] [Accepted: 09/18/2018] [Indexed: 01/05/2023] Open
Abstract
Background A lot of clinics worldwide in recent years recommend the use of minimally invasive surgical procedures in the early stages of lung cancer claiming that this technique helps reduce the number of postoperative complications, shortens the period of social rehabilitation of patients, without significantly affecting the long-term results of treatment. In this study we evaluate immediate and long-term results of surgical treatment of patients with early stages of non-small cell lung cancer (NSCLC) after video-assisted thoracoscopic lobectomy (VATS) with mediastinal lymph node dissection. Materials and methods Since 2008 317 patients with T1-2N0M0 NSCLC over 20 (median age was 65.3 ± 2.5) years underwent VATS with mediastinal lymphadenectomy. Total number of men was 186 (58.7%), women - 131 (41.3%). Histologically verified adenocarcinoma was in 278 (87, 7%), Squamous cell carcinoma in 39 (12.3%). A group of patients who underwent thoracotomy lobectomy (n = 189) was taken to compare immediate and long-term results. Median age in this group was 66.5 ± 1.7. Total number of men was 115, women - 74. Histologically verified adenocarcinoma was in 154 (82.4%), Squamous cell carcinoma in 35 (17.6%). Results Conversion to thoracotomy during VATS was in 14.3% of surgeries. There was no postoperative mortality in VATS group, whereas in open surgeries this happened in 2.6%. The 3 and 5-year overall survival (OS) rate was 94.0% and 94.0% in the VATS group respectively, 83.0% and 78.0% in the thoracotomy group for clinical stage T1N0M0 NSCLC (p = 0.04554). Conclusion Considering the results of our research and the literature review we made sure that VATS lobectomy with mediastinal lymph node dissection is an alternative procedure to open approaches: it is much safer, reduce the frequency of post-operative complications and the rehabilitation period. We believe that complete VATS lobectomy with mediastinal lymph node dissection must be taken as a standard in surgical treatment of patients with early stages of non-small cell lung cancer.
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Affiliation(s)
- Arif Allakhverdiev
- Department of Thoracic Surgery, N.N. Blokhin Cancer Research Center, Kashirskoe Road 23, 115478, Moscow, Russian Federation
| | - Mikhail Davydov
- Department of Thoracic Surgery, N.N. Blokhin Cancer Research Center, Kashirskoe Road 23, 115478, Moscow, Russian Federation
| | - Parvin Akhmedov
- Department of Thoracic Surgery, N.N. Blokhin Cancer Research Center, Kashirskoe Road 23, 115478, Moscow, Russian Federation
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Li Q, Sihoe A, Wang H, Gonzalez-Rivas D, Zhu Y, Xie D, Jiang G. Short-term outcomes of single- versus multi-port video-assisted thoracic surgery in mediastinal diseases. Eur J Cardiothorac Surg 2018; 53:216-220. [PMID: 29106491 DOI: 10.1093/ejcts/ezx217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/27/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Although there is growing interest in single-port video-assisted thoracic surgery for a number of thoracic operations, there is still not enough known about its use for mediastinal pathologies. The present study was aimed at assessing the safety and efficacy of single-port video-assisted thoracic surgery in comparison with the multi-port variants in terms of short-term perioperative outcomes. METHODS From July 2013 to December 2015, 285 consecutive non-myasthenic adult patients undergoing single- or multi-port video-assisted thoracic surgery for mediastinal diseases including thymoma were retrospectively reviewed. Patients were stratified depending on whether the pathology was thymoma. A propensity score matching pertaining to the approach used was performed within each stratified category. Perioperative outcomes were compared between matched cohorts. RESULTS During the study period, 141 (49.5%) patients were treated with single-port thoracoscopic surgery. Preoperative variables were comparable between both pairs of cohorts after matching. No morbidity or mortality occurred, except 1 case of empyema in a 2-port case. Single-port technique exhibited shorter operation time (thymoma: 78.8 vs 120.0 min, P = 0.011; non-thymoma: 78.4 vs 107.9 min, P < 0.001), less intraoperative blood loss (thymoma: 42.0 vs 78.4 ml, P = 0.002; non-thymoma: 46.0 vs 62.2 ml, P = 0.001) and a lower postoperative 10-point visual analogue scale pain score (thymoma: 2.6 vs 3.3, P = 0.026; non-thymoma: 2.4 vs 3.2, P < 0.001) than multi-port techniques in both patient categories. CONCLUSIONS Single-port video-assisted thoracic surgery is a safe approach for patients with loco-regional mediastinal disease, with potential advantages of shorter operative time, less intraoperative bleeding and less postoperative pain when compared with multi-port techniques.
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Affiliation(s)
- Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Alan Sihoe
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, China.,Department of Surgery, The University of Hong Kong Shenzhen Hospital, Hong Kong, China
| | - Haifeng Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, China.,Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain.,Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
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Um SW, Kim Y, Lee BB, Kim D, Lee KJ, Kim HK, Han J, Kim H, Shim YM, Kim DH. Genome-wide analysis of DNA methylation in bronchial washings. Clin Epigenetics 2018; 10:65. [PMID: 29796116 PMCID: PMC5960087 DOI: 10.1186/s13148-018-0498-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/09/2018] [Indexed: 12/03/2022] Open
Abstract
Background The objective of this study was to discover DNA methylation biomarkers for detecting non-small lung cancer (NSCLC) in bronchial washings and understanding the association between DNA methylation and smoking cessation. Methods DNA methylation was analyzed in bronchial washing samples from 70 NSCLCs and 53 hospital-based controls using Illumina HumanMethylation450K BeadChip. Methylation levels in these bronchial washings were compared to those in 897 primary lung tissues of The Cancer Genome Atlas (TCGA) data. Results Twenty-four CpGs (p < 1.03E−07) were significantly methylated in bronchial washings from 70 NSCLC patients compared to those from 53 controls. The CpGs also had significant methylation in the TCGA cohort. The 123 participants were divided into a training set (N = 82) and a test set (N = 41) to build a classification model. Logistic regression model showed the best performance for classification of lung cancer in bronchial washing samples: the sensitivity and specificity of a marker panel consisting of seven CpGs in TFAP2A, TBX15, PHF11, TOX2, PRR15, PDGFRA, and HOXA11 genes were 87.0 and 83.3% in the test set, respectively. The area under the curve (AUC) was equal to 0.87 (95% confidence interval = 0.73–0.96, p < 0.001). Methylation levels of two CpGs in RUNX3 and MIR196A1 genes were inversely associated with duration of smoking cessation in the controls, but not in NSCLCs, after adjusting for pack-years of smoking. Conclusions The present study suggests that NSCLC may be detected by analyzing methylation changes of seven CpGs in bronchial washings. Furthermore, smoking cessation may lead to decreased DNA methylation in nonmalignant bronchial epithelial cells in a gene-specific manner. Electronic supplementary material The online version of this article (10.1186/s13148-018-0498-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sang-Won Um
- 1Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710 South Korea
| | - Yujin Kim
- Department of Molecular Cell Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, 440-746 South Korea
| | - Bo Bin Lee
- Department of Molecular Cell Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, 440-746 South Korea
| | - Dongho Kim
- Department of Molecular Cell Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, 440-746 South Korea
| | - Kyung-Jong Lee
- 1Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710 South Korea
| | - Hong Kwan Kim
- 3Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710 South Korea
| | - Joungho Han
- 4Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710 South Korea
| | - Hojoong Kim
- 1Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710 South Korea
| | - Young Mog Shim
- 3Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710 South Korea
| | - Duk-Hwan Kim
- Department of Molecular Cell Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, 440-746 South Korea.,Samsung Medical Center, Research Institute for Future Medicine, #50 Ilwon-dong, Kangnam-gu, Professor Rm #5, Seoul, 135-710 South Korea
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Li C, Kuo SW, Hsu HH, Lin MW, Chen JS. Lung adenocarcinoma with intraoperatively diagnosed pleural seeding: Is main tumor resection beneficial for prognosis? J Thorac Cardiovasc Surg 2017; 155:1238-1249.e1. [PMID: 29254636 DOI: 10.1016/j.jtcvs.2017.09.162] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/18/2017] [Accepted: 09/30/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate whether main tumor resection improves survival compared with pleural biopsy alone in patients with lung adenocarcinoma with intraoperatively diagnosed pleural seeding. METHODS Forty-three patients with lung adenocarcinoma with pleural seeding diagnosed unexpectedly during surgery performed between January 2006 and December 2014 were included in this retrospective study using a prospectively collected lung cancer database. Each surgeon decided whether to perform main tumor resection or pleural biopsy alone. RESULTS Main tumor and visible pleural nodule resection was performed in 30 patients (tumor resection group). The remaining 13 patients underwent pleural nodule biopsy alone (open-close group). The clinical T stage was higher in the open-close group than in the tumor resection group (P = .02). The tumor resection group had longer operative times compared with the open-close group (mean, 141.8 vs 80.3 minutes). There were no other statistically significant differences in perioperative parameters. The surgical method was the sole statistically significant prognostic factor. Patients in the tumor resection group had better progression-free survival (3-year survival: 44.5% vs 0%; P = .009) and overall survival (3-year survival: 82.9% vs 38.5%; P = .013) than did the open-close group. There was no significant survival difference between sublobar resection and lobectomy for the main tumor resection. CONCLUSIONS Our study demonstrated improved progression-free and overall survival after main tumor and visible pleural nodule resection in patients with lung adenocarcinoma with intraoperatively diagnosed pleural seeding. Further randomized trials are needed to define the role of main tumor resection in these patients.
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Affiliation(s)
- Chi Li
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shuenn-Wen Kuo
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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25
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Mafé JJ, Planelles B, Asensio S, Cerezal J, Inda MDM, Lacueva J, Esteban MD, Hernández L, Martín C, Baschwitz B, Peiró AM. Cost and effectiveness of lung lobectomy by video-assisted thoracic surgery for lung cancer. J Thorac Dis 2017; 9:2534-2543. [PMID: 28932560 DOI: 10.21037/jtd.2017.07.51] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use. METHODS A cost-effectiveness study was performed comparing VATS vs. open thoracic surgery (OPEN) for lung cancer patients. Demographic data, tumor localization, dynamic pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusion capacity (DLCO) and maximal oxygen uptake (VO2max)], surgical approach, postoperative details, and complications were recorded and analyzed. RESULTS One hundred seventeen patients underwent lung resection by VATS (n=42, 36%; age: 63±9 years old, 57% males) or OPEN (n=75, 64%; age: 61±11 years old, 73% males). Pulmonary function tests decreased just after surgery with a parallel increasing tendency during first 12 months. VATS group tended to recover FEV1 and FVC quicker with significantly less clinical and post-surgical complications (31% vs. 53%, P=0.015). Costs including surgery and associated hospital stay, complications and costs in the 12 months after surgery were significantly lower for VATS (P<0.05). CONCLUSIONS The VATS approach surgery allowed earlier recovery at a lower cost than OPEN with a better cost-effectiveness profile.
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Affiliation(s)
- Juan J Mafé
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Beatriz Planelles
- Neuropharmacology on Pain (NED), Research Unit, Department of Health of Alicante-General Hospital, ISABIAL, Spain
| | - Santos Asensio
- Department of Pneumology, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Jorge Cerezal
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - María-Del-Mar Inda
- Neuropharmacology on Pain (NED), Research Unit, Department of Health of Alicante-General Hospital, ISABIAL, Spain
| | - Javier Lacueva
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | | | - Luis Hernández
- Department of Pneumology, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Concepción Martín
- Department of Pneumology, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Benno Baschwitz
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Ana M Peiró
- Neuropharmacology on Pain (NED), Research Unit, Department of Health of Alicante-General Hospital, ISABIAL, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
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Olland A, Reeb J, Sauleau E, Meyer N, Bernard-Schweitzer M, Falcoz C, Falcoz PE, Massard G. Video-assisted thoracoscopic lobectomy versus open thoracotomy conventional lobectomy for stage I non-small cell lung cancer. Hippokratia 2017. [DOI: 10.1002/14651858.cd012641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Anne Olland
- Nouvel Hôpital Civil, University Hospital Strasbourg; Thoracic Surgery and Lung Transplantation; 1 place de l'Hôpital - BP 426 Strasbourg France 67091
| | - Jeremie Reeb
- Nouvel Hôpital Civil, University Hospital Strasbourg; Thoracic Surgery and Lung Transplantation; 1 place de l'Hôpital - BP 426 Strasbourg France 67091
| | - Erik Sauleau
- Nouvel Hôpital Civil, University Hospital Strasbourg; Medical Information Department; Service de Santé Publique 1 place de l'Hôpital - BP 426 Strasbourg France 67091
| | - Nicolas Meyer
- Nouvel Hôpital Civil, University Hospital Strasbourg; Medical Information Department; Service de Santé Publique 1 place de l'Hôpital - BP 426 Strasbourg France 67091
| | - Marion Bernard-Schweitzer
- Bibliothèque de Médecine et Odontologie; Service Commun de la Documentation, Université de Strasbourg; 4 rue Kirschleger Strasbourg France 67000
| | - Celine Falcoz
- Lucie Berger; Middle School; 1 rue des Greniers Strasbourg France 67000
| | - Pierre Emmanuel Falcoz
- Nouvel Hôpital Civil, University Hospital Strasbourg; Thoracic Surgery and Lung Transplantation; 1 place de l'Hôpital - BP 426 Strasbourg France 67091
| | - Gilbert Massard
- Nouvel Hôpital Civil, University Hospital Strasbourg; Thoracic Surgery and Lung Transplantation; 1 place de l'Hôpital - BP 426 Strasbourg France 67091
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Video-Assisted Thoracic Surgery in Patients with Previous Sternotomy and Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:15-20. [DOI: 10.1097/imi.0000000000000344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Although video-assisted thoracic surgery (VATS) lobectomy has become a standard approach for early-stage 1 lung cancer, concerns exist regarding potential damage to the heart or bypass grafts when VATS is performed after cardiac surgery via median sternotomy. We could find only case reports regarding VATS lobectomy after sternotomy for cardiac surgery. Therefore, we reviewed our series of patients who underwent VATS anatomic resections after sternotomy for cardiac surgery. Methods Between 1996 and 2010, there were 87 patients who underwent 88 pulmonary resections after sternotomy for coronary artery bypass grafting (64), valve replacement or repair (12), coronary artery bypass graft and valve replacement (6), and transplant (5). There were 10 women (11.5%) and 77 men (88.5%) with a mean age of 76.2 years. Diagnoses included lung cancer (83), pulmonary metastases (4), and benign disease (1). Results Dense adhesions between the lung and the mediastinum sometimes occur after cardiac surgery. Compared with the total series of 2684 VATS lobectomies, operations after sternotomy are associated with greater mortality (12, 0.4% vs 5, 5.7%), myocardial infarction (13, 0.5% vs 2, 2.3%), transfusion (45, 1.7% vs 12, 13.6), conversion to thoracotomy (188, 7% vs 14, 15.9%). Injury occurred to the left main pulmonary artery (1, 1%) and internal mammary artery graft (1, 1%). There were no intraoperative deaths. Conclusions Previous sternotomy for cardiac surgery does increase the risk for VATS lobectomy. Conversion to thoracotomy should be considered if dense adhesions are found. Techniques to reduce the risk for the heart are discussed.
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Serna-Gallegos DR, Merry HE, McKenna RJ. Video-Assisted Thoracic Surgery in Patients with Previous Sternotomy and Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Heather E. Merry
- Department of Cardiothoracic Surgery, Providence Health and Services, Portland, OR USA
| | - Robert J. McKenna
- Department of Cardiothoracic Surgery, Saint John's Health Center, Santa Monica, CA USA
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29
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Igai H, Kamiyoshihara M, Ibe T, Kawatani N, Osawa F, Yoshikawa R. Troubleshooting for bleeding in thoracoscopic anatomic pulmonary resection. Asian Cardiovasc Thorac Ann 2016; 25:35-40. [PMID: 27920230 DOI: 10.1177/0218492316683062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The objective of this study was to evaluate intraoperative vessel injury and assess troubleshooting during thoracoscopic anatomic pulmonary resection. Methods Between April 2012 and March 2016, 240 patients underwent thoracoscopic anatomic lung resection, 26 of whom were identified as having massive bleeding intraoperatively. We analyzed the injured vessel and the hemostatic procedure employed, then compared the perioperative outcomes in patients with ( n = 26) and without ( n = 214) vessel injury. In addition, we compared perioperative results based on the period when surgery was performed: early period: April 2012 to March 2014 ( n = 93) or late period: April 2014 to March 2016 ( n = 146). Results The surgical procedures included 20 lobectomies and 6 segmentectomies. One of the 26 patients had vessel injury at 2 points, giving a total of 27 points of injury. Hemostasis was mostly achieved by application of thrombostatic sealant (63.0%). There were no significant differences in the length postoperative hospitalization ( p = 0.67) or morbidity rate ( p = 0.43) between the vessel injury and the no-vessel injury groups. There were no significant differences in the incidence of significant intraoperative bleeding ( p = 0.13) and total blood loss ( p = 0.13) between the early and late periods. Conclusions Application of thrombostatic sealant is one of the useful methods to achieve hemostasis during thoracoscopic anatomic pulmonary resection. Vascular hazards are inherent to a thoracoscopic approach. Therefore, thoracic surgeons should always be concerned about significant intraoperative bleeding and treat it appropriately.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
| | | | - Takashi Ibe
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
| | - Natsuko Kawatani
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
| | - Fumi Osawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
| | - Ryohei Yoshikawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
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Poupalou A, Kontos M, Felekouras E, Papalois A, Kavantzas N, Agrogiannis G, Yagoubi F, Tomos P. Open versus Thoracoscopic RFA-Assisted Lung Resection. J INVEST SURG 2016; 30:403-409. [PMID: 27875060 DOI: 10.1080/08941939.2016.1240272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to evaluate Radio Frequency Ablation (RFA)-assisted lung parenchymal transection through thoracotomy and thoracoscopy. Twelve domestic pigs underwent RFA-assisted lingulectomy: six through thoracotomy (group A), and six with thoracoscopy (group B). There was no mortality, no bleeding, or air leak intra- or postoperatively in either of the groups, and no conversion to open thoracotomy in group B. Group A had longer operating period and more pleural adhesions. A barotrauma, a skin burn, and a localized infection were observed in this group. Histopathology confirmed a sharply demarcated area of coagulation necrosis without damage to adjacent structures. RFA-assisted lung resection through thoracotomy bears the inherent problems of an open approach, and the use of RFA device does not add to morbidity. The thoracoscopic use of RFA probe by experienced surgeons is considered safe, maintaining the advantages of key-hole surgery.
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Affiliation(s)
- Anna Poupalou
- a Department of Pediatric Surgery , Hopital Universitaire Des Enfants Reine Fabiola (IRIS Group), CHU St Pierre , Brussels , Belgium
| | - Michael Kontos
- b 1st Department of Surgery , University of Athens , Athens , Greece
| | | | | | | | | | | | - Periklis Tomos
- f 2nd Department of Propaedeudic Surgery , University of Athens , Athens , Greece
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Korasidis S, Menna C, Andreetti C, Maurizi G, D'Andrilli A, Ciccone AM, Cassiano F, Rendina EA, Ibrahim M. Lymph node dissection after pulmonary resection for lung cancer: a mini review. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:368. [PMID: 27826571 DOI: 10.21037/atm.2016.09.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
An accurate staging of a malignant disease is imperative in order to plan pre- and post-operative therapy, define prognosis and compare studies. According to the European Society of Thoracic Surgeons (ESTS) guidelines a systematic lymph node (LN) dissection is recommended in all cases of pulmonary resection for non-small cell lung cancer (NSCLC). The current lung cancer staging system considers the lymphatic stations involved but not the number of LNs. Up to date, published scientific studies on hilar and mediastinal lymphadenectomy mainly have been regarded the type of LN dissection procedure after pulmonary resection (selected LN biopsy, LN sampling, systematic nodal dissection, lobe specific nodal dissection and extended LN dissection) focusing particularly on the comparison between mediastinal LN dissection (MLND) and mediastinal LN sampling (MLNS). Recently, further investigations have been concentrated on surgical approach (videothoracoscopic vs. thoracotomic approach) used to perform pulmonary resection and following LN dissection in order to achieve a complete mediastinal lymphadenectomy. This short synthesis aims to present the current experiences in this setting.
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Affiliation(s)
- Stylianos Korasidis
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
| | - Cecilia Menna
- Division of Thoracic Surgery, 'G. Mazzini' Hospital of Teramo, University of L'Aquila, Teramo, 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
| | - Antonio D'Andrilli
- 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
| | - Francesco Cassiano
- 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
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
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Toker A. Robotic Versus Video-Assisted Thoracoscopic Lobectomy (VATS) for Lung Cancer. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reichert M, Kerber S, Pösentrup B, Bender J, Schneck E, Augustin F, Öfner D, Padberg W, Bodner J. Anatomic lung resections for benign pulmonary diseases by video-assisted thoracoscopic surgery (VATS). Langenbecks Arch Surg 2016; 401:867-75. [PMID: 27456676 DOI: 10.1007/s00423-016-1478-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Based on increasing evidence of its benefits regarding perioperative and oncologic outcome, video-assisted thoracoscopic surgery (VATS) has gained increasing acceptance in the surgical treatment of early stage non-small cell lung cancer (NSCLC). However, the evidence for a VATS approach in anatomic lung resection for benign pulmonary diseases is still limited. METHODS Between March 2011 and May 2014, data from 33 and 63 patients who received VATS anatomic lung resection for benign diseases (VATS-B) and early stage NSCLC (VATS-N), respectively, were analyzed retrospectively. For subgroup analyses, VATS-B was subdivided by operation time and underlying diseases. Subgroups were compared to VATS-N. RESULTS Three patients from VATS-B and four from VATS-N experienced conversion to open surgery. Causes of conversion in VATS-B were intraoperative complications, whereas conversions in VATS-N were elective for oncological concerns (p < 0.05). Operation time and duration of postoperative mechanical ventilation were longer by tendency; postoperative stay on intensive care unit and chest tube duration were significantly longer in VATS-B. Subgroup analyses showed a longer operation time as a predictor for worse perioperative outcome regarding postoperative mechanical ventilation, postoperative stay on intensive care unit, chest tube duration, and length of hospital stay. Patients with longer operation time suffered from more postoperative complications. Differences in perioperative outcome data were not significantly dependent on the underlying benign diseases compared to VATS-N. CONCLUSIONS VATS is feasible and safe in anatomic lung resection for benign pulmonary diseases. Not the underlying disease, but a longer operation time is a factor for worse postoperative outcome.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.
| | - Stefanie Kerber
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Bernd Pösentrup
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Julia Bender
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Winfried Padberg
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany
| | - Johannes Bodner
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.,Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.,Department of Thoracic Surgery, Klinikum Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany
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Video-assisted thoracoscopic anatomic lung resections in Germany—a nationwide survey. Langenbecks Arch Surg 2016; 401:877-84. [DOI: 10.1007/s00423-016-1481-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/15/2016] [Indexed: 12/26/2022]
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Abstract
Video-assisted thoracoscopic surgery (VATS) has revolutionized the practice of thoracic surgeons and improved patient experiences and outcomes worldwide. The VATS approach has matured over the past decades and now accounts for approximately 50 % of all operations in specialized thoracic surgery units. The VATS procedure is less invasive and therefore allows a faster recovery of patients. Over the last 20 years VATS has developed into a safe and effective technique for the diagnostics and therapy of many thoracic diseases. With increasing experience thoracic surgeons can carry out more advanced and technically challenging interventions. Nowadays, VATS is the superior technique in many cases of thoracotomy.
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Affiliation(s)
- H-S Hofmann
- Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeningerstraße 86, 93049, Regensburg, Deutschland,
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Baste JM, Rinieri P, Sarsam M, Peillon C. Place de la chirurgie robotique dans les pathologies tumorales thoraciques. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lobectomy versus stereotactic body radiotherapy in healthy patients with stage I lung cancer. J Thorac Cardiovasc Surg 2016; 152:44-54.e9. [PMID: 27131846 DOI: 10.1016/j.jtcvs.2016.03.060] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/04/2016] [Accepted: 03/13/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Stereotactic body radiotherapy is an effective treatment for patients with early-stage non-small cell lung cancer who are not healthy enough to undergo surgery; however, the relative efficacy versus surgery in healthy patients is unknown. The National Cancer Database contains information on patient health and eligibility for surgery, allowing the long-term survival associated with lobectomy and stereotactic body radiotherapy to be compared in healthy patients with clinical stage I disease. METHODS The National Cancer Database was queried for patients who underwent lobectomy or stereotactic body radiotherapy for clinical stage I lung cancer between 2008 and 2012. Healthy patients were selected by excluding patients not offered surgery because of health-related reasons and only including patients documented to be free of comorbidities. RESULTS A total of 13,562 comorbidity-free patients with clinical stage I lung cancer treated with lobectomy were compared with 1781 patients treated with stereotactic body radiotherapy. Time-stratified Cox proportional hazards models found lobectomy to be associated with a significantly better outcome than stereotactic body radiotherapy for both T1N0M0 tumors (hazard ratio, 0.38; 95% confidence interval, 0.33-0.43; P < .001) and T2N0M0 tumors 5 cm or less (hazard ratio, 0.38; confidence interval, 0.31-0.46; P < .001). In a propensity-matched analysis of 1781 pairs, lobectomy remained superior to stereotactic body radiotherapy (5-year survival 59% vs 29%, P < .001). Furthermore, when the subset of stereotactic patients who had refused a recommended surgery (n = 229) were propensity matched to lobectomy patients, lobectomy was associated with improved survival (5-year survival 58% vs 40%, P = .010). CONCLUSIONS Among healthy patients with clinical stage I non-small cell lung cancer in the National Cancer Database, lobectomy is associated with a significantly better outcome than stereotactic body radiotherapy. Further study is warranted to clarify the comparative effectiveness of surgery and stereotactic body radiotherapy across various strata of patient health.
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Wu CF, Fu JY, Yeh CJ, Liu YH, Hsieh MJ, Wu YC, Wu CY, Tsai YH, Chou WC. Recurrence Risk Factors Analysis for Stage I Non-small Cell Lung Cancer. Medicine (Baltimore) 2015; 94:e1337. [PMID: 26266381 PMCID: PMC4616676 DOI: 10.1097/md.0000000000001337] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related death worldwide. Even early-stage patients might encounter disease recurrence with relative high risk. Effective postoperative therapy is based on an accurate assessment of treatment failure after surgery. The aim of this study is to construct a disease-free survival (DFS) prediction model and stratify patients into different risk score groups.A total of 356 pathological stage I patients (7th American Joint Committee on Cancer) who underwent lung resection from January 2005 through June 2011 were retrospectively reviewed. Of these patients, 63 patients were eliminated for this study. A total of 293 p-stage I patients were included for further univariate and multivariate analysis. Clinical, surgical, and pathological factors associated with high risk of recurrence were analyzed, including age, gender, smoking status, additional primary malignancy (APM), operation method, histology, visceral pleural invasion, angiolymphatic invasion, tumor necrosis, and tumor size.Of the 293 p-stage I non-small cell lung cancer (NSCLC) patients examined, 143 were female and 150 were male, with a mean age of 62.8-years old (range: 25-83-years old). The 5-year DFS and overall survival rates after surgery were 58.9% and 75.3%, respectively. On multivariate analysis, current smoker (hazards ratio [HR]: 1.63), APM (HR: 1.86), tumor size (HR: 1.54, 2.03), nonanatomic resections (HR: 1.81), adenocarcinoma histology (HR: 2.07), visceral pleural invasion (HR: 1.54), and angiolymphatic invasion (HR: 1.53) were found to be associated with a higher risk of tumor recurrence. The final model showed a fair discrimination ability (C-statistic = 0.68). According to the difference risk group, we found patients with intermediate or higher risk group had a higher distal relapse tendency as compared with low risk group (P = 0.016, odds ratio: 3.31, 95% confidence interval: 1.21-9.03).Greater than 30% of disease recurrences occurred after surgery for stage I NSCLC patients. That is why we try to establish an effective DFS predicting model based on clinical, pathological, and surgical covariates. However, our initial results still need to be validated and refined into greater population for better application in clinical use.
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Affiliation(s)
- Ching-Feng Wu
- From the Division of Thoracic and Cardiovascular Surgery, Department of Surgery (C-FW, Y-HL, M-JH, Y-CW, C-YW); Division of Pulmonary and Critical Care, Department of Internal Medicine (J-YF); Division of Pathology, Chang Gung Memorial Hospital, Taoyuan (C-JY); Division of Pulmonary and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi (Y-HT); and Division of Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (W-CC)
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Chen HW, Du M. Video-assisted thoracoscopic pneumonectomy. J Thorac Dis 2015; 7:764-6. [PMID: 25973245 PMCID: PMC4419327 DOI: 10.3978/j.issn.2072-1439.2015.04.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 03/20/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Lung cancer often requires pneumonectomy. This procedure is challenging and usually performed by thoracotomy, which is traumatic and may involve complications. Video-assisted thoracoscopic surgery (VATS) lobectomy is a recognized procedure that has been accepted by surgeons. There is no standard procedure to perform a pneumonectomy using VATS. The aim of this paper is to share our experiences and to show our technique for performing a pneumonectomy using VATS. METHODS A 65-year-old man was admitted to the First Affiliated Hospital of Chongqing Medical University. A thoracic computed tomography (CT) scan revealed a 56 mm × 45 mm × 40 mm lesion in the left upper lung lobe. Lesions involving the left lower lung lobe were also identified and the subcarinal and hilar lymph nodes were enlarged. A VATS pneumonectomy was performed. RESULTS The total surgery time was approximately 90 min, the intraoperative blood loss was 100 mL, the number of resected lymph nodes was 15; and the postoperative hospital stay was 8 days. Follow-up revealed no recurrence or metastasis for 6 months. CONCLUSIONS Video-assisted thoracoscopic pneumonectomy is a safe and effective treatment procedure.
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Affiliation(s)
- Huan-Wen Chen
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ming Du
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Shintani Y, Inoue M, Funaki S, Kawamura T, Minami M, Okumura M. Clinical usefulness of free subcutaneous fat pad for reduction of intraoperative air leakage during thoracoscopic pulmonary resection in lung cancer cases. Surg Endosc 2014; 29:2910-3. [PMID: 25537378 DOI: 10.1007/s00464-014-4019-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Intraoperative alveolar air leaks remain a significant problem in thoracoscopic surgery (TS) cases. We examined the usefulness of covering damaged lung tissue with a subcutaneous fat pad for preventing postoperative air leakage in patients with non-small cell lung cancer (NSCLC). METHODS Patients with NSCLC underwent a thoracoscopic lobectomy or segmentectomy. When alveolar air leakage from the superficial pulmonary parenchyma was found, fibrin glue in combination with an absorbable mesh sheet was applied (S group; n = 100). When leakage originated from deep within the pulmonary parenchyma, a subcutaneous fat pad about 2 × 2 cm in size was harvested from the utility incision and placed on the damaged lung tissue with fibrin glue and sutures (F group; n = 66). Patient characteristics, air leak duration, and chest-tube removal time were analyzed. RESULTS The homogeneity of each group was consistent, with no statistical differences for age, respiratory function, surgical procedures, pathologic stage, and histological type. The air leak duration was significantly shorter (p = 0.015), and the chest tube was removed significantly earlier (p = 0.002) in patients in the F group. CONCLUSION Use of a free subcutaneous fat pad during pulmonary resection for TS patients with NSCLC reduced the duration of air leakage and chest tube drainage. The present method is easy, safe, and effective for repairing an air leak from remaining lung tissues in such cases.
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Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Masayoshi Inoue
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomohiro Kawamura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5 Yamadaoka, Suita, Osaka, 565-0871, Japan
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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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Reichert M, Kerber S, Amati AL, Bodner J. Total video-assisted thoracoscopic (VATS) resection of a left-sided sulcus superior tumor after induction radiochemotherapy: video and review. Surg Endosc 2014; 29:2407-9. [PMID: 25424366 DOI: 10.1007/s00464-014-3952-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 10/01/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has gained increasing acceptance for surgical therapy of early stage non small cell lung cancer (NSCLC). Even for extended pulmonary resections in advanced tumor stages, increasing evidence suggests feasibility and safety of the VATS approach. However, so far very little experience has been reported on VATS management of sulcus superior tumors. METHODS We report on a 56-year-old female patient with a left-sided anterior sulcus superior adenocarcinoma (cT3 cN1 cM0), which was completely resected by VATS after induction radiochemotherapy. RESULTS The surgical procedure was performed completely minimally invasively via a three-incision anterior thoracoscopic approach. The total operating time was 285 min (composed of 116 min for hilar lobectomy, 103 min for sulcus superior preparation and chest wall resection, and 26 min for systematic en-bloc lymph node dissection). The single chest tube was removed on postoperative day two and the patient was discharged on postoperative day six. No intraoperative and no postoperative complications were observed. Histopathology confirmed a complete (R0) resection of an ypT2aN0M0 bronchogenic adenocarcinoma. CONCLUSION With increasing experience even extended pulmonary resections are safe and feasible by a video-assisted thoracoscopic approach. We propose that in sulcus superior tumors without tumor invasion of vascular structures VATS can be considered.
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Affiliation(s)
- Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Street 7, 35392, Giessen, Germany,
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Battoo A, Jahan A, Yang Z, Nwogu CE, Yendamuri SS, Dexter EU, Hennon MW, Picone AL, Demmy TL. Thoracoscopic Pneumonectomy. Chest 2014; 146:1300-1309. [DOI: 10.1378/chest.14-0058] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Dujon A, Mordant P, Saab M, Riquet M. [Major pulmonary resections for lung cancer and thoracoscopic approach: some reflections on published data]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:286-292. [PMID: 25131371 DOI: 10.1016/j.pneumo.2014.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 06/03/2023]
Abstract
Video-assisted thoracic surgery has a renewed topicality in treating early stage non-small cell lung cancer. Numerous publications show the benefits of this surgical technique in comparison with conventional thoracotomy. However, some surgeons are still apprehensive for its validity in lung cancer. Few works were dedicated to the critical aspect of this new technique which generates silent controversy and is far from having the general approval of all surgical teams. A critical review of several papers disclosed some concerns related to this approach, notably the risk of intra-operative technical problems and the possibility of questionable results concerning cancer dissection and clearance. A randomized clinical trial is now mandatory to confirm the safety and usefulness of this technique.
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Affiliation(s)
- A Dujon
- Centre médico-chirurgical du Cèdre, Bois-Guillaume, France
| | - P Mordant
- Service de chirurgie thoracique, hôpital Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France
| | - M Saab
- Centre médico-chirurgical du Cèdre, Bois-Guillaume, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France.
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Morimoto D, Takashima S, Sakashita N, Sato Y, Jiang B, Hakucho T, Miyake C, Takahashi Y, Tomita Y, Nakanishi K, Hosoki T, Higashiyama M. Differentiation of lung neoplasms with lepidic growth and good prognosis from those with poor prognosis using computer-aided 3D volumetric CT analysis and FDG-PET. Acta Radiol 2014; 55:563-9. [PMID: 24003260 DOI: 10.1177/0284185113502336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Many studies have reported that transverse computed tomography (CT) imaging findings correlate with prognosis of patients with small peripheral lung neoplasm with lepidic growth. However, no studies have examined this correlation with the aid of three-dimensional (3D) CT data. PURPOSE To determine the most efficacious imaging factor for differentiation of lepidic growth type lung neoplasms with good prognosis from those with poor prognosis. MATERIAL AND METHODS We evaluated CT findings, nodule patterns, SUVmax on FDG-PET/CT, as well as nodule volume and ratios of solid parts to nodule volume that were semi-automatically measured on CT images of 64 pulmonary nodules of ≤ 2 cm in 60 consecutive patients (24 men and 36 women; mean age, 65 years). For logistic modeling, we used all of the significant factors observed between the neoplasms with good and with poor prognosis as independent variables to estimate the statistically significant factors for discriminating invasive adenocarcinomas with lepidic growth (lesions with poor prognosis, n=42) from the other neoplasms, including preinvasive lesions (lesions with good prognosis, n=22), resulting in a recommendation for the optimal criterion for predicting lesions with poor prognosis. RESULTS The logistic regression model identified the ratio of the solid part to the whole volume of a pulmonary nodule as the only significant factor (P=0.04) for differentiating lepidic growth type lung neoplasms with good prognosis from those with poor prognosis. A ratio of 0.238 or more showed the highest discriminatory accuracy of 84% with 91% sensitivity and 76% specificity. CONCLUSION Computer-aided analyses of pulmonary nodules proved most useful for establishing the optimal criterion for differentiation of lepidic growth type lung neoplasms with good prognosis from those with poor prognosis.
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Affiliation(s)
- Daisuke Morimoto
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Shodayu Takashima
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Naohiro Sakashita
- Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yoshinobu Sato
- Osaka University Graduate School of Medicine, Department of Radiology, Osaka, Japan
| | - Binghu Jiang
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Tomoaki Hakucho
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Chie Miyake
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Yoshiyuki Takahashi
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Yasuhiko Tomita
- Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Baste JM, Orsini B, Rinieri P, Melki J, Peillon C. Résections pulmonaires majeures par vidéothoracoscopie : 20ans après les premières réalisations. Rev Mal Respir 2014; 31:323-35. [DOI: 10.1016/j.rmr.2013.10.650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 10/07/2013] [Indexed: 11/27/2022]
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Nagai S, Imanishi N, Matsuoka T, Matsuoka K, Ueda M, Miyamoto Y. Video-assisted thoracoscopic pneumonectomy: retrospective outcome analysis of 47 consecutive patients. Ann Thorac Surg 2014; 97:1908-13. [PMID: 24681033 DOI: 10.1016/j.athoracsur.2014.02.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/28/2014] [Accepted: 02/04/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although video-assisted thoracoscopic surgery (VATS) lobectomy is widely accepted, VATS pneumonectomy remains an uncommon procedure in patients with complicated diseases. METHODS Of 47 consecutive patients who were planned to undergo VATS pneumonectomy from May 2000 to May 2012 at the National Hospital Organization Himeji Medical Center, VATS pneumonectomy was completed successfully in 46 patients (2.1% conversion rate). Appropriate tissue retraction and cooperative dissection of hilum structures under only thoracoscopic visualization were applied to all candidates. We retrospectively reviewed morbidity, mortality, local disease control, and surgical considerations to evaluate the validity of this procedure. RESULTS All patients had malignant tumors, including 45 with primary lung cancer. One patient with a severe adhesion around a tumor required conversion to open thoracotomy, with no subsequent specific complications. Of 46 patients in whom VATS pneumonectomy was completed, the mean operation time was 159 minutes and the mean blood loss was 258 g. Surgery-related death occurred in 1 patient (mortality rate: 2.2%) with recurrent heart failure after discharge. Seven patients (15.2%) had major complications defined as grade 3 or higher (Common Terminology Criteria for Adverse Effects, version 4.0) within 30 days postoperatively; however, no patients exhibited secretion retention that required bronchoscopy. There were no patients with locoregional recurrence within usual lymph node dissection areas and the ipsilateral thoracic cavity among 44 patients with primary lung cancer who underwent VATS pneumonectomy, with the median follow-up time of 27 months. CONCLUSIONS Video-assisted thoracoscopic surgery pneumonectomy has developed into a common procedure with acceptable damage and lower morbidity among selected patients with complicated diseases.
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Affiliation(s)
- Shinjiro Nagai
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan.
| | - Naoko Imanishi
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Takahisa Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
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Fournel L, Zaimi R, Grigoroiu M, Stern JB, Gossot D. Totally Thoracoscopic Major Pulmonary Resections: An Analysis of Perioperative Complications. Ann Thorac Surg 2014; 97:419-24. [DOI: 10.1016/j.athoracsur.2013.09.091] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/24/2013] [Accepted: 09/27/2013] [Indexed: 11/15/2022]
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Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: Are there outcomes advantages? J Thorac Cardiovasc Surg 2014; 147:724-9. [DOI: 10.1016/j.jtcvs.2013.10.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/07/2013] [Accepted: 10/06/2013] [Indexed: 11/23/2022]
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50
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Shintani Y, Inoue M, Nakagiri T, Okumura M. Use of free subcutaneous fat pad for reduction of intraoperative air leak in thoracoscopic pulmonary resection cases with lung cancer. Eur J Cardiothorac Surg 2014; 46:324-6. [PMID: 24459217 DOI: 10.1093/ejcts/ezt608] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intraoperative alveolar air leaks occur in patients with non-small-cell lung cancer (NSCLC) following a pulmonary resection using thoracoscopic surgery. We showed the efficacy of covering damaged lung tissue with a subcutaneous fat pad for preventing postoperative air leak. Thoracoscopic surgery was performed for NSCLC patients with three incisions along with a 3-4 cm anterior utility incision. When an air leak originated from deep within the pulmonary parenchyma or was large, a subcutaneous fat pad ∼2 × 2 cm in size was harvested from the utility incision and placed on the damaged lung tissue with fibrin glue and 2-3 mattress sutures. Subcutaneous fat pads were used for 50 patients with NSCLC during thoracoscopic surgery procedures. There were no intraoperative complications in any of the patients. A prolonged air leak (>7 days) was noted in 3 (6%) of the 50 patients. Air leak was diminished at 1.5 ± 2.6 postoperative days and the chest tubes removed at 3.2 ± 2.8 postoperative days. Reinforcement of damaged lung tissues by use of subcutaneous free fat pads is a safe and intriguing procedure in NSCLC patients who underwent a pulmonary resection in thoracoscopic surgery.
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Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayoshi Inoue
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoyuki Nakagiri
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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