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Kang D, Lei C, Zhang Y, Wei X, Dai W, Xu W, Zhang J, Yu Q, Su X, Huang Y, Shi Q. Shortness of breath on the day of discharge: an early alert for post-discharge complications in patients undergoing lung cancer surgery. J Cardiothorac Surg 2024; 19:398. [PMID: 38937786 PMCID: PMC11210099 DOI: 10.1186/s13019-024-02845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE Symptom assessment based on patient-reported outcome (PRO) can correlate with disease severity, making it a potential tool for threshold alerts of postoperative complications. This study aimed to determine whether shortness of breath (SOB) scores on the day of discharge could predict the development of post-discharge complications in patients who underwent lung cancer surgery. METHODS Patients were from a study of a dynamic perioperative rehabilitation cohort of lung cancer patients focusing on patient-reported outcomes. Patients were assessed using the Perioperative Symptom Assessment Scale for Lung surgery (PSA-Lung). Logistic regression model was used to examine the potential association between SOB on the day of discharge and complications within 3 months after discharge. The post-discharge complications were taken as the anchor variable to determine the optimal cutpoint for SOB on the day of discharge. RESULTS Complications within 3 months post-discharge occurred in 71 (10.84%) of 655 patients. Logistic regression analysis revealed that being female (OR 1.764, 95% CI 1.006-3.092, P < 0.05) and having two chest tubes (OR 2.026, 95% CI 1.107-3.710, P < 0.05) were significantly associated with post-discharge complications. Additionally, the SOB score on the day of discharge (OR 1.125, 95% CI 1.012-1.250, P < 0.05) was a significant predictor. The optimal SOB cutpoint was 5 (on a scale of 0-10). Patients with an SOB score ≥ 5 at discharge experienced a lower quality of life 1 month later compared to those with SOB score<5 at discharge (73 [50-86] vs. 81 [65-91], P < 0.05). CONCLUSION SOB on the day of discharge may serve as an early warning sign for the timely detection of 3 month post-discharge complications.
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Affiliation(s)
- Dan Kang
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Cheng Lei
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yong Zhang
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Xu
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Jingyu Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
| | - Qingsong Yu
- Chengdu Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, China
| | - Xueyao Su
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yanyan Huang
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China.
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China.
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China.
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Chen J, Song D, Sun Z, Zhang Y, Zhang L. Effects of lung resection on heart structure and function: A tissue Doppler ultrasound survey of 43 cases. Biomed Rep 2024; 20:11. [PMID: 38124772 PMCID: PMC10731166 DOI: 10.3892/br.2023.1699] [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: 12/11/2022] [Accepted: 11/06/2023] [Indexed: 12/23/2023] Open
Abstract
Changes in heart structure and function after lung resection in patients with lung cancer are challenging to manage. Therefore, a non-invasive and reliable measurement tool to gauge such changes is critical. The purpose of the present study was to compare cardiological changes before and after lung resection using tissue Doppler imaging (TDI). A total of 43 patients (19 men and 24 women) with primary non-small cell lung cancer (n=37) and metastatic cancer in the lungs (n=6) were enrolled in the study.nTDI was used to determine the thickness of the ascending aorta, the open size of the ascending valve, the anterior-oposterior diameters of the left atrium and left ventricle, and the thickness of the ventricular septum and right ventricle before and after lung resection. Left ventricular (LV) ejection fraction (EF), pulmonary valve flow rate, tricuspid annular or mitral leaflet tip early (E) peak/late (A) diastolic blood flow velocities, tricuspid regurgitation flow, the lateral mitral annulus early (e') diastolic velocity and mitral E/e' ratio were used to determine LV filling pressure. Results revealed no significant differences between male and female patients in terms of the open size of the ascending valve, the anterior-posterior diameter of the left ventricle and the mitral E/e' ratio. Significant differences were found in the width of the ascending aorta, anterior-posterior diameter of the left atrium, width of the LV septum and right ventricular (RV) diameter before and after lung resection. Finally, there were significantchanges in EF and tricuspid pressure. The results indicated that TDI was useful as a non-invasive method for assessing left and right heart function following lung resection. The LV and RV dimensions were affected, but LV filling pressure was preserved after lobectomy.
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Affiliation(s)
- Jinfeng Chen
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Dongdong Song
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Zhiying Sun
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Yunxiao Zhang
- Department of Anesthesia, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Lijian Zhang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
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Szabo Z, Fabo C, Szarvas M, Matuz M, Oszlanyi A, Farkas A, Paroczai D, Lantos J, Furak J. Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years. J Clin Med 2023; 12:6457. [PMID: 37892595 PMCID: PMC10607362 DOI: 10.3390/jcm12206457] [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: 09/10/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Non-intubated thoracic surgery has not achieved widespread acceptance despite its potential to improve postoperative outcomes. To ensure airway safety, our institute has developed a technique combining spontaneous ventilation with double-lumen tube intubation (SVI). This study aimed to verify the feasibility and limitations of this SVI technique. METHODS For the SVI method, anesthesia induction involves fentanyl and propofol target-controlled infusion, with mivacurium administration. Bispectral index monitoring was used to ensure the optimal depth of anesthesia. Short-term muscle relaxation facilitated double-lumen tube intubation and early surgical steps. Chest opening preceded local infiltration, followed by a vagal nerve blockade to prevent the cough reflex and a paravertebral blockade for pain relief. Subsequently, the muscle relaxant was ceased. The patient underwent spontaneous breathing without coughing during surgical manipulation. RESULTS Between 10 March 2020 and 28 October 2022, 141 SVI surgeries were performed. Spontaneous respiration with positive end-expiratory pressure was sufficient in 65.96% (93/141) of cases, whereas 31.21% (44/141) required pressure support ventilation. Only 2.84% (4/141) of cases reversed to conventional anesthetic management, owing to technical or surgical difficulties. Results of the 141 cases: The mean maximal carbon dioxide pressure was 59.01 (34.4-92.9) mmHg, and the mean lowest oxygen saturation was 93.96% (81-100%). The mean one-lung, mechanical and spontaneous one-lung ventilation time was 74.88 (20-140), 17.55 (0-115) and 57.73 (0-130) min, respectively. CONCLUSIONS Spontaneous ventilation with double-lumen tube intubation is safe and feasible for thoracic surgery. The mechanical one-lung ventilation time was reduced by 76.5%, and the rate of anesthetic conversion to relaxation was low (2.8%).
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Affiliation(s)
- Zsolt Szabo
- Doctoral School of Multidisciplinary Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Csongor Fabo
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Matyas Szarvas
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Maria Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, H-6720 Szeged, Hungary
| | - Adam Oszlanyi
- Department of Anesthesiology and Intensive Therapy, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Attila Farkas
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, H-9700 Szombathely, Hungary
| | - Dora Paroczai
- Department of Medical Microbiology, University of Szeged, H-6720 Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Jozsef Furak
- Department of Surgery, University of Szeged, H-6720 Szeged, Hungary
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Downey AC, Mayhew PD, Massari F, Van Goethem B. Evaluation of long-term outcome after lung lobectomy for canine non-neoplastic pulmonary consolidation via thoracoscopic or thoracoscopic-assisted surgery in 12 dogs. Vet Surg 2023; 52:909-917. [PMID: 36574343 DOI: 10.1111/vsu.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/23/2022] [Accepted: 12/03/2022] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To report outcomes of thoracoscopic (TL) and thoracoscopic-assisted lung lobectomy (TAL) for treatment of non-neoplastic pulmonary consolidation (PC) in dogs. STUDY DESIGN Retrospective case series. ANIMALS Twelve client-owned dogs. METHODS The medical records of 12 dogs that underwent TL or TAL for PC at 3 veterinary institutions between 2011 and 2020 were reviewed. Signalment, history, physical examination, diagnostics, days in hospital, anesthetic and procedure times, intraoperative/postoperative complications, conversion rates, duration of indwelling thoracic drain, and long-term outcomes were recorded. RESULTS Nine patients underwent a TL approach and 3 underwent TAL. In those that underwent TL, conversion to an intercostal thoracotomy was performed in 4 out of 9 dogs. Conversion was performed due to adhesions (n = 3) or poor visualization (1). Histopathologic examination was consistent with pneumonia due to an infectious process (n = 10), bronchioalveolar malformation with abnormal cilia (1), and left-sided cardiac insufficiency vs. pulmonary alveolar proteinosis (1). The mean duration of hospital stay was 4 days (range, 1-6 days). Complications occurred postoperatively in 7 dogs and included self-limiting hemorrhage (n = 3), self-resolving pneumothorax (2), incisional dehiscence (1), and severe dyspnea in a brachycephalic breed leading to euthanasia (1). For the 11 dogs that survived the perioperative period, there was no evidence of recurrence with a median follow up of 24 months (range, 5-120 months). CONCLUSION Thoracoscopic (TL) and thoracoscopic-assisted lung lobectomy (TAL) is a reasonable surgical approach in select dogs with PC. CLINICIAL RELEVANCE Conversion rates were higher than those historically reported for dogs undergoing thoracoscopic lung lobectomy for primary lung tumors.
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Affiliation(s)
- Amy C Downey
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Philipp D Mayhew
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | | | - Bart Van Goethem
- Small Animal Teaching Hospital, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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Diong NC, Liu CC, Shih CS, Wu MC, Huang CJ, Hung CF. Is there a role for lung surgery in initially unresectable non-small cell lung cancer after tyrosine kinase inhibitor treatment? World J Surg Oncol 2022; 20:370. [PMID: 36434641 PMCID: PMC9701021 DOI: 10.1186/s12957-022-02833-6] [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: 06/05/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The role of lung surgery in initially unresectable non-small cell lung cancer (NSCLC) after tyrosine kinase inhibitor (TKI) treatment remains unclear. We aimed to assess the survival benefits of patients who underwent surgery for regressed or regrown tumors after receiving TKI treatment. METHODS The details of patients diagnosed with unresectable NSCLC treated with TKI followed by lung resection from 2010 to 2020 were retrieved from our database. The primary endpoint was 3-year overall survival (OS), whereas the secondary endpoints were a 2-year progression-free survival (PFS), feasibility, and the safety of pulmonary resection. The statistical tests used were Fisher's exact test, Kruskal Wallis test, Kaplan-Meier method, Cox proportional hazards model, and Firth correction. RESULTS Nineteen out of thirty-two patients were selected for the study. The patients underwent lung surgery after confirmed tumor regression (17 [89.5%]) and regrowth (two [10.5%]). All surgeries were performed via video-assisted thoracoscopic surgery: 14 (73.7%) lobectomies and five (26.3%) sublobar resections after a median duration of 5 months of TKI. Two (10.5%) postoperative complications and no 30-day postoperative mortality were observed. The median postoperative follow-up was 22 months. The 2-year PFS and 3-year OS rates were 43.9% and 61.5%, respectively. Patients who underwent surgery for regressed disease showed a significantly better OS than for regrowth disease (HR=0.086, 95% CI 0.008-0.957, p=0.046). TKI-adjuvant demonstrated a better PFS than non-TKI adjuvant (HR=0.146, 95% CI 0.027-0.782, p=0.025). CONCLUSION Lung surgery after TKI treatment is feasible and safe and prolongs survival via local control and directed consequential therapy. Lung surgery should be adopted in multimodality therapy for initially unresectable NSCLC.
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Affiliation(s)
- Nguk Chai Diong
- grid.412516.50000 0004 0621 7139Division of Thoracic Surgery, Department of Surgery, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Chia-Chuan Liu
- grid.418962.00000 0004 0622 0936Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, 125, Lide Road, Beitou District, Taipei, 11259 Taiwan
| | - Chih-Shiun Shih
- grid.418962.00000 0004 0622 0936Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, 125, Lide Road, Beitou District, Taipei, 11259 Taiwan
| | - Mau-Ching Wu
- grid.418962.00000 0004 0622 0936Department of Medical Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chun-Jen Huang
- grid.418962.00000 0004 0622 0936Department of Pulmonary Medicine and Intensive Care Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chen-Fang Hung
- grid.418962.00000 0004 0622 0936Department of Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
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Pang H, Wu Y, Qi S, Li C, Shen J, Yue Y, Qian W, Wu J. A fully automatic segmentation pipeline of pulmonary lobes before and after lobectomy from computed tomography images. Comput Biol Med 2022; 147:105792. [PMID: 35780601 DOI: 10.1016/j.compbiomed.2022.105792] [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: 04/14/2022] [Revised: 06/18/2022] [Accepted: 06/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Lobectomy is a curative treatment for localized lung cancer. The study aims to construct an automatic pipeline for segmenting pulmonary lobes before and after lobectomy from CT images. MATERIALS AND METHODS Six datasets (D1 to D6) of 865 CT scans were collected from two hospitals and public resources. Four nnU-Net-based segmentation models were trained. A lobectomy classification was proposed to automatically recognize the category of the input CT images: before lobectomy or one of five types after lobectomy. Finally, the lobe segmentation before and after lobectomy was realized by integrating the four models and lobectomy classification. The dice similarity coefficient (DSC), 95% Hausdorff distance (HD95) and average symmetric surface distance (ASSD) were used to evaluate the segmentations. RESULTS The pre-operative model achieved an average DSC of 0.964, 0.929, 0.934, and 0.891 in the four datasets. In D1 and D2, the average HD95 was 4.18 and 7.74 mm and the average ASSD was 0.86 and 1.32 mm, respectively. The lobectomy classification achieved an accuracy of 100%. After lobectomy, an average DSC of 0.973 and 0.936, an average HD95 of 2.70 and 6.92 mm, an average ASSD of 0.57 and 1.78 mm were obtained in D1 and D2, respectively. The postoperative segmentation pipeline outperformed other counterparts and training strategies. CONCLUSIONS The proposed pipeline can automatically segment pulmonary lobes before and after lobectomy from CT images and be applied to manage patients with lung cancer after lobectomy.
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Affiliation(s)
- Haowen Pang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Yanan Wu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Chen Li
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Jing Shen
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
| | - Yong Yue
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Wei Qian
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China; Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
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Motono N, Ishikawa M, Iwai S, Yamagata A, Iijima Y, Uramoto H. Analysis of risk factors for postoperative complications in non-small cell lung cancer: comparison with the Japanese National Clinical Database risk calculator. BMC Surg 2022; 22:180. [PMID: 35568860 PMCID: PMC9107161 DOI: 10.1186/s12893-022-01628-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although the risk calculator of the National Clinical Database (RC-NCD) has been widely used to predict the occurrence of mortality and major morbidity in Japan, it has not been demonstrated whether a correlation between the calculated RC-NCD risk score and the actual occurrence of mortality and severe morbidity exists. Methods The clinical data of 585 patients who underwent pulmonary resection for non-small cell lung cancer were collected, and the risk factors for postoperative morbidity were analyzed to verify the validity of the RC-NCD. Results The coexistence of asthma (p = 0.02), nutrition lymphocyte ratio (p = 0.04), and pulmonary lobe (p < 0.01) were significant risk factors for postoperative morbidity in the present study, and the percent-predicted vital capacity (p < 0.01), pulmonary lobe (p = 0.03), and type of operative procedure (p = 0.01) were significant risk factors for severe postoperative morbidity. Furthermore, in patients received lobectomy, coexistence of asthma (p = 0.01) and pulmonary lobe (p < 0.01) were identified as significant risk factors for postoperative morbidity. Meanwhile, male sex (p = 0.01), high BMI (p < 0.01), low vital capacity (p = 0.04), and pulmonary lobe (p = 0.03) were identified as significant risk factors for severe postoperative morbidity. Conclusions Given that the pulmonary lobe was a significant risk factor for postoperative morbidity in patients received pulmonary resection and for severe postoperative morbidity in patients received lobectomy, the RC-NCD for postoperative morbidity needs to be modified according to high-risk lobes. Trial registration: The Institutional Review Board of Kanazawa Medical University approved the protocol of this retrospective study (approval number: I392), and written informed consent was obtained from all patients.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Aika Yamagata
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
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Muslim Z, Stroever S, Poulikidis K, Weber JF, Connery CP, Herrera LJ, Bhora FY. Conversion to Thoracotomy in Non-Small Cell Lung Cancer: Risk Factors and Perioperative Outcomes. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:148-155. [DOI: 10.1177/15569845221091979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We aimed to identify predictors of conversion to thoracotomy and test the hypothesis that conversion is associated with inferior perioperative outcomes in non-small cell lung cancer (NSCLC). Methods: We queried the National Cancer Database for patients with stage I to III NSCLC undergoing minimally invasive surgery (MIS) during 2010 to 2016. We compared clinicopathologic factors between patients undergoing MIS with and without conversion. We fitted multivariable regression models to identify independent predictors of conversion and compare perioperative outcomes between the 2 groups. Results: A rising trend in the use of MIS was accompanied by a declining trend in the rate of conversion to thoracotomy. A total of 11.3% of the 83,219 cases were converted. Conversion was associated with a higher Charlson-Deyo score, squamous histology, nodal involvement, high tumor grade, tumor size ≥5 cm, and a higher T stage ( P < 0.05). Successful MIS without conversion was predicted by advanced age, sublobar resection, robotic approach, and treatment at an academic high-volume facility ( P < 0.05). Conversion was linked to longer hospital stays, higher 30-day and 90-day mortality, and unplanned readmission ( P < 0.05), irrespective of the type of MIS approach. Conclusions: Conversion rates for video-assisted and robot-assisted thoracoscopic surgery have seen a decline in recent years. Irrespective of the type of MIS approach, conversion was associated with inferior perioperative outcomes. The robotic approach and treatment at an academic high-volume facility were associated with a lower likelihood of conversion. Early recognition of the individual risk factors for conversion may help to counsel patients about the likelihood of, and detriments associated with, conversion and ultimately reduce conversion rates.
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Affiliation(s)
- Zaid Muslim
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, CT, USA
| | | | - Kostantinos Poulikidis
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, CT, USA
- Division of Thoracic Surgery, Nuvance Health, Danbury, CT, USA
| | - Joanna F. Weber
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, CT, USA
| | - Cliff P. Connery
- Division of Thoracic Surgery, Nuvance Health, Poughkeepsie, NY, USA
| | - Luis J. Herrera
- Thoracic Surgery Section, Orlando Health, University of Florida, Gainesville, FL, USA
| | - Faiz Y. Bhora
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, CT, USA
- Division of Thoracic Surgery, Nuvance Health, Danbury, CT, USA
- Division of Thoracic Surgery, Nuvance Health, Poughkeepsie, NY, USA
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9
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Heiden BT, Subramanian MP, Liu J, Keith A, Engelhardt KE, Meyers BF, Puri V, Kozower BD. Long-term patient-reported outcomes after non-small cell lung cancer resection. J Thorac Cardiovasc Surg 2022; 164:615-626.e3. [PMID: 35430080 DOI: 10.1016/j.jtcvs.2021.11.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/07/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Patient-reported outcomes (PROs) are critical tools for evaluating patients before and after lung cancer resection. In this study, we assessed patient-reported pain, dyspnea, and functional status up to 1 year postoperatively. METHODS This study included patients who underwent surgery for non-small cell lung cancer at a single institution (2017-2020). We collected PROs using the National Institutes of Health Patient Reported Outcome Measurement Information System (PROMIS). Data were prospectively collected and merged with our institutional Society of Thoracic Surgeons data. Using multivariable linear mixed effect models, we compared PROMIS scores for preoperative and several postoperative visits. RESULTS From 2017 until 2020, 334 patients underwent lung cancer resection with completed PROMIS assessments. Pain interference, physical function, and dyspnea severity scores were worse 1 month after surgery (P < .001). Pain interference and physical function scores returned to baseline by 6 months after surgery. However, dyspnea severity scores remained persistently worse up to 1 year after surgery (1-month difference, 8.8 ± 1.9; 6-month difference, 3.6 ± 2.2; 1-year difference, 4.9 ± 2.8; P < .001). Patients who received a thoracotomy had worse physical function and pain interference scores 1 month after surgery compared with patients who received a minimally invasive operation; however, there were no differences in PROs by 6 months after surgery. CONCLUSIONS PROs are important metrics for assessing patients before and after lung cancer resection. Patients may report persistent dyspnea up to 1 year after resection. Additionally, patients undergoing thoracotomy initially report worse pain and physical function but these impairments improve by 6 months after surgery.
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Affiliation(s)
- Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Melanie P Subramanian
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Angela Keith
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Kathryn E Engelhardt
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo.
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10
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Jeon JH, Seong YW, Han JE, Cho S, Kim JH, Jheon S, Kim K. Randomized trial of poloxamer 407-based ropivacaine hydrogel after thoracoscopic pulmonary resection. Ann Thorac Surg 2021; 114:1189-1196. [PMID: 34653384 DOI: 10.1016/j.athoracsur.2021.08.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/29/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We conducted a comparative study to evaluate the efficacy of poloxamer 407-based ropivacaine hydrogel at the wound site (Gel) and continuous thoracic paravertebral block (On-Q) for postoperative pain following thoracoscopic pulmonary resection. METHODS This prospective, randomized, noninferiority study included 89 patients randomized into the two groups; Gel (poloxamer 407-based 0.75% ropivacaine, 22.5 mg) and On-Q (0.2% ropivacaine, 4 mg/hour for 48 hours). The primary outcome measure was total fentanyl consumption and secondary outcome measures were the need for rescue analgesia and pain intensity using the numeric rating scale (NRS). RESULTS There was no significant difference in total fentanyl consumption between the Gel group and the On-Q group (1504.29 ± 315.72 mcg vs 1560.32 ± 274.81 mcg, p = 0.374). Pain intensity using the NRS between the Gel group and the On-Q group demonstrated no statistical differences (6 hours: 3.56 vs 3.55, p = 0.958; 24 hours: 3.21 vs 3.00, p = 0.250; 48 hours: 2.75 vs 2.49, p = 0.233; and 72 hours: 2.39 vs 2.33, p = 0.811), and there was no significant difference in the frequency of analgesic rescue medication use (3.70 vs 3.33, p = 0.417). CONCLUSIONS We confirm the noninferiority of Gel compared with On-Q for acute postoperative pain following thoracoscopic pulmonary resection. Considering a technical simplicity and low systemic toxicity of the local injection of Gel, this analgesic modality may be worthy of further research and is thus considered to have potential as a viable alternative to On-Q for regional analgesia.
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Affiliation(s)
- Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Won Seong
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Eun Han
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Hee Kim
- Department of Anesthesiology and Pain Medicine, 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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11
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Zhao H, Wu Y, Zhang X, Feng Y. The Effect of Preoperative Serratus Anterior Muscle Plane Block on Persistent Postsurgical Pain After Video-assisted Thoracic Surgery: A Retrospective Cohort Study. Clin J Pain 2021; 37:759-765. [PMID: 34334692 DOI: 10.1097/ajp.0000000000000969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 07/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Acute pain intensity is a strong indicator for the occurrence of persistent postsurgical pain (PPP) after video-assisted thoracic surgery (VATS). The effect of preoperative serratus anterior muscle plane block (SAPB) on PPP was investigated. MATERIALS AND METHODS In this retrospective cohort study, data of 148 patients who underwent VATS for lung nodules in 2019 were collected. Seventy-four patients received a single-shot of SAPB with 0.33% ropivacaine 30 mL after anesthesia induction and another 74 patients received intercostal blocks using 1% ropivacaine 10 mL at the fifth to seventh intercostal spaces after surgery. Postoperative analgesia was accomplished by continuous infusion of flurbiprofen (8 mg/h), and intravenous oxycodone rescue (1 mg) given on demand. Pain intensity was recorded at 24 and 48 hours after surgery and all patients were followed up 3 months after surgery investigating the occurrence of PPP. RESULTS Intraoperative sufentanil in the SAPB group was significantly decreased in comparison with Control group (0.34±0.09 vs. 0.43±0.14 ug/kg, P<0.001). The incidence of PPP was comparable between 2 groups (20.2% [15/74] vs. 14.8% [11/74], P=0.078). All patients who experienced PPP rated their PPP as mild, except 1 patient in Control group rated her pain as moderate. Multivariate logistic regression showed that pain score at 24 hours (odds ratio 1.646, 95% confidence interval [1.058, 2.560], P=0.027) and female (odds ratio 3.711, 95% confidence interval [1.274, 10.810], P=0.026) were independent risk factors for the development of PPP. DISCUSSION When SAPB was combined with continuous infusion of nonsteroidal anti-inflammatory drugs, no patient had moderate chronic pain. Pain score at 24 hours after surgery and female were risk factors for PPP after VATS.
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Affiliation(s)
- Hong Zhao
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
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12
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Motono N, Ishikawa M, Iwai S, Iijima Y, Usuda K, Uramoto H. Individualization of risk factors for postoperative complication after lung cancer surgery: a retrospective study. BMC Surg 2021; 21:311. [PMID: 34261455 PMCID: PMC8278712 DOI: 10.1186/s12893-021-01305-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The risk factors for postoperative complications after pulmonary resection in patients with non-small cell lung cancer (NSCLC) have not been elucidated. METHODS Clinical data of 956 patients with NSCLC were analyzed. Patient factors such as sex, age, comorbidities, smoking history, respiratory function, and the lobe involved in lung cancer and operative factors such as operative approach and operative procedures were collected and analyzed. RESULTS Male sex (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.09-2.75, p = 0.01), coexistence of asthma (OR 2.68, 95% CI 1.19-6.02, p = 0.01), low percentage of forced expiratory volume in 1 s (FEV1) (OR 1.41, 95% CI 1.02-1.95, p = 0.03), and lobectomy or greater resection (OR 2.47, 95% CI 1.66-3.68, p < 0.01) were identified as significant risk factors for postoperative complications. Male sex (OR 1.98; 95% CI 1.03-3.81, p = 0.03) and complete video-assisted thoracic surgery and robot-assisted thoracic surgery (OR 1.64; 95% CI 1.09-2.45; p = 0.01) were identified as significant risk factors for postoperative air leakage. Coexistence of asthma (OR 9.97; 95% CI 3.66-27.38; p < 0.01) was identified as a significant risk factor for postoperative atelectasis or pneumonia. Lobectomy or greater resection (OR 19.71; 95% CI 2.70-143.57; p < 0.01) was identified as a significant risk factor for postoperative arrhythmia. CONCLUSION Male sex, coexistence of asthma, low percentage of FEV1, and operative procedure were significant risk factors for postoperative complications. Furthermore, risk factors varied according to postoperative complications.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
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13
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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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14
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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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15
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Furák J, Paróczai D, Burián K, Szabó Z, Zombori T. Oncological advantage of nonintubated thoracic surgery: Better compliance of adjuvant treatment after lung lobectomy. Thorac Cancer 2020; 11:3309-3316. [PMID: 32985138 PMCID: PMC7606006 DOI: 10.1111/1759-7714.13672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Video-assisted thoracoscopic (VATS) surgery contributes to improved survival, adjuvant chemotherapy delivery and less postoperative complications. Nonintubated thoracic surgery (NITS) VATS procedures improves immunological responses in lung cancer patients; however, there is no data regarding adjuvant chemotherapy delivery effectiveness following NITS lobectomies. In this study, we aimed to compare protocol compliance and toxic complications during adjuvant chemotherapy after intubated and nonintubated VATS lobectomies in non-small cell lung cancer (NSCLC). METHODS We retrospectively reviewed the medical records of 66, stage IB-IIIB NSCLC patients who underwent intubated or nonintubated VATS lobectomy and received adjuvant chemotherapy. RESULTS A total of 38 patients (17 males, mean age 64 years) underwent conventional VATS and 28 (7 males; mean age 63 years) uniportal VATS NITS. Both groups had comparable demographic data, preoperative pulmonary function, and Eastern Cooperative Oncology Group (ECOG) status. Among the intubated and nonintubated patients, 82% and 75% were diagnosed with adenocarcinoma, respectively. The incidence of adenocarcinoma and squamous cell carcinoma cases were similar in both groups; however, the pathological staging showed significant differences, as 5 (18%) nonintubated patients had stage IB lung cancer, compared with the intubated group (P = 0.01). Further distribution of stages was similar between the groups. We observed significant differences in chest tube duration and operation time in the nonintubated group (P < 0.01). Among nonintubated patients, 92% completed the planned chemotherapy protocol, compared to 71% of the intubated group (P = 0.035). Grade 1/2 toxicity occurred significantly more often in the intubated group (16% vs. 0%, P = 0.03) and there was a lower incidence of grade 4 neutropenia in the nonintubated group (0% vs. 16%, P = 0.03). CONCLUSIONS Our results showed that the nonintubated procedure resulted in improved adjuvant chemotherapy compliance and lower toxicity rates after lobectomy. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Oncological advantage of the non-intubated thoracic surgery: better compliance with therapy protocol. What this study adds NITS lobectomies contribute to better administration of adjuvant chemotherapy with the planned cycle number and dosage.
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Affiliation(s)
- József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Dóra Paróczai
- Department of Pulmonology, University of Szeged, Deszk, Hungary.,Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Szeged, Hungary
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16
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Sihoe ADL. Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology 2020; 25 Suppl 2:49-60. [PMID: 32734596 DOI: 10.1111/resp.13920] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
Surgical resection remains the only effective means of cure in the vast majority of patients with early-stage lung cancer. It can be performed via a traditional open approach (particularly thoracotomy) or a minimally invasive approach. VATS is 'keyhole' surgery in the chest, and was first used for lung cancer resection in the early 1990s. Since then, a large volume of evolving clinical evidence has confirmed that VATS lung cancer resection offered proven safety and feasibility, better patient-reported post-operative outcomes, less surgical trauma as quantified by objective outcome measures and equivalent or better survival than open surgery. This has firmly established VATS as the surgical approach of choice for early-stage lung cancer today. Although impressive new non-surgical lung cancer therapies have emerged in recent years, VATS is also being constantly rejuvenated by the development of 'next generation' VATS techniques, the refinement of VATS sublobar resection for selected patients, the utilization of bespoke post-operative recovery programmes for VATS and the synthesis of VATS into multi-modality lung cancer therapy. There is little doubt that VATS will remain as the gold standard for lung cancer surgery for the foreseeable future.
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Affiliation(s)
- Alan D L Sihoe
- Gleneagles Hong Kong Hospital, Hong Kong SAR, China.,International Medical Centre, Hong Kong SAR, China
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17
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Oh DS, Cho I, Karamian B, DeMeester SR, Hagen JA. Early Adoption of Robotic Pulmonary Lobectomy: Feasibility and Initial Outcomes. Am Surg 2020. [DOI: 10.1177/000313481307901024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the published benefits of minimally invasive video-assisted thoracoscopic surgery (VATS) for lobectomy, the majority of lobectomies in the United States continue to be performed through a thoracotomy. The low adoption rate of VATS has been attributed to its technical challenges and ergonomic inefficiencies. Robotic surgery has been proposed as an alternative minimally invasive technique that allows the replication of open lobectomy with wristed instruments and three-dimensional vision. Our aim was to analyze the transition from open to robotic lobectomy at our hospital where there had been no significant VATS lobectomy experience. We analyzed 88 open and 43 robotic lobectomies that met criteria for inclusion. Operative times were significantly longer with the robotic group but decreased with experience. The resection time of the latter half of the robotic cases decreased to within 20 minutes of the open cases. There were no conversions in the robotic cases to either VATS or open. Robotic lobectomy was associated with faster postoperative recovery with a 60 per cent decrease in length of stay. Complications were uncommon and there were no deaths in the robotic group. We conclude that the transition from open to robotic lobectomy can be achieved safely with excellent postoperative outcomes. This new technique is a viable alternative to VATS lobectomy.
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Affiliation(s)
- Daniel S. Oh
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Isaac Cho
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Brian Karamian
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Steven R. DeMeester
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jeffrey A. Hagen
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
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18
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Siwachat S, Lertprasertsuke N, Tanatip N, Kongkarnka S, Euathrongchit J, Wannasopha Y, Suksombooncharoen T, Chewaskulyong B, Lieberman-Cribbin W, Taioli E, Saeteng S, Tantraworasin A. Effect of Insurance Type on Stage at Presentation, Surgical Approach, Tumor Recurrence and Cancer-Specific Survival in Resectable Non-Small Lung Cancer Patients. Risk Manag Healthc Policy 2020; 13:559-569. [PMID: 32607024 PMCID: PMC7297449 DOI: 10.2147/rmhp.s244344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/24/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose The aim of this study was to identify the association between Thailand’s insurance types and stage at presentation, surgical approach, tumor recurrence and cancer-specific survival in resectable non-small cell lung cancer (NSCLC) patients in northern Thailand. Patients and Methods Medical records of patients with NSCLC who underwent pulmonary resection at Chiang Mai University Hospital from January 2007 through December 2015 were retrospectively reviewed. Patients were divided into two groups: patients with the Universal Coverage Scheme (UCS) or Social Security Scheme (SSS) and patients with the Civil Servant Medical Benefit Scheme (CSMBS) or private insurance (PI). Patient characteristics were assessed. The primary outcome was cancer-specific survival while the secondary outcome was tumor recurrence. Cox’s regression and matching propensity score analysis was used to analyze data. Results This study included 583 patients: 344 with UCS or SSS and 239 with CSMBS or PI. Patients with UCS or SSS were more likely to be active smokers, have a lower percent predicted FEV1, present with higher-stage tumors and worse differentiated tumors, present with tumor necrosis, and undergo an open surgical approach than those with CSMBS or PI. At multivariable analysis of all patients cohort, there were no significant differences in terms of early stage at presentation (adjusted odds ratio (ORadj) = 0.94, 95% confidence interval (CI) = 0.65–1.37), undergoing lobectomy (ORadj = 0.59, 95% CI = 0.24–1.46), and recurrent-free survival (adjusted hazard ratio (HRadj) =1.20, 95% CI = 0.88–1.65) between groups (UCS/SSS versus CSMBS/PI). However, patients with UCS or SSS had shorter cancer-specific survival (HRadj = 1.61, 95% CI = 1.22–2.15). The results from the propensity score matched patient cohort were not different from those analyses on the full patient cohort. Conclusion Thai insurance types have an effect on cancer-specific survival. The Thai government should recognize the importance of these differences, and further multi-center studies with a larger sample size are warranted to confirm this result.
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Affiliation(s)
- Sophon Siwachat
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nirush Lertprasertsuke
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narumon Tanatip
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sarawut Kongkarnka
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juntima Euathrongchit
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yutthaphan Wannasopha
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Busayamas Chewaskulyong
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wil Lieberman-Cribbin
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn Medical School at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn Medical School at Mount Sinai, New York, NY, USA
| | - Somcharoen Saeteng
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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19
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Zhao H, Xin L, Feng Y. The effect of preoperative erector spinae plane vs. paravertebral blocks on patient-controlled oxycodone consumption after video-assisted thoracic surgery: A prospective randomized, blinded, non-inferiority study. J Clin Anesth 2020; 62:109737. [DOI: 10.1016/j.jclinane.2020.109737] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/22/2019] [Accepted: 01/25/2020] [Indexed: 12/30/2022]
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20
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Gu Q, Qi S, Yue Y, Shen J, Zhang B, Sun W, Qian W, Islam MS, Saha SC, Wu J. Structural and functional alterations of the tracheobronchial tree after left upper pulmonary lobectomy for lung cancer. Biomed Eng Online 2019; 18:105. [PMID: 31653252 PMCID: PMC6815003 DOI: 10.1186/s12938-019-0722-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
Abstract
Background Pulmonary lobectomy has been a well-established curative treatment method for localized lung cancer. After left upper pulmonary lobectomy, the upward displacement of remaining lower lobe causes the distortion or kink of bronchus, which is associated with intractable cough and breathless. However, the quantitative study on structural and functional alterations of the tracheobronchial tree after lobectomy has not been reported. We sought to investigate these alterations using CT imaging analysis and computational fluid dynamics (CFD) method. Methods Both preoperative and postoperative CT images of 18 patients who underwent left upper pulmonary lobectomy are collected. After the tracheobronchial tree models are extracted, the angles between trachea and bronchi, the surface area and volume of the tree, and the cross-sectional area of left lower lobar bronchus are investigated. CFD method is further used to describe the airflow characteristics by the wall pressure, airflow velocity, lobar flow rate, etc. Results It is found that the angle between the trachea and the right main bronchus increases after operation, but the angle with the left main bronchus decreases. No significant alteration is observed for the surface area or volume of the tree between pre-operation and post-operation. After left upper pulmonary lobectomy, the cross-sectional area of left lower lobar bronchus is reduced for most of the patients (15/18) by 15–75%, especially for 4 patients by more than 50%. The wall pressure, airflow velocity and pressure drop significantly increase after the operation. The flow rate to the right lung increases significantly by 2–30% (but there is no significant difference between each lobe), and the flow rate to the left lung drops accordingly. Many vortices are found in various places with severe distortions. Conclusions The favorable and unfavorable adaptive alterations of tracheobronchial tree will occur after left upper pulmonary lobectomy, and these alterations can be clarified through CT imaging and CFD analysis. The severe distortions at left lower lobar bronchus might exacerbate postoperative shortness of breath.
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Affiliation(s)
- Qingtao Gu
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China.,Key Laboratory of Medical Image Computing of Northeastern University (Ministry of Education), Shenyang, China
| | - Shouliang Qi
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China. .,Key Laboratory of Medical Image Computing of Northeastern University (Ministry of Education), Shenyang, China.
| | - Yong Yue
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Shen
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Baihua Zhang
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China
| | - Wei Sun
- The Graduate School, Dalian Medical University, Dalian, China
| | - Wei Qian
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China.,College of Engineering, University of Texas at El Paso, El Paso, USA
| | - Mohammad Saidul Islam
- School of Mechanical and Mechatronic Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Brisbane, Australia
| | - Suvash C Saha
- School of Mechanical and Mechatronic Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Brisbane, Australia
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
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21
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Uniportal VATS for non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2019; 68:707-715. [PMID: 31617147 DOI: 10.1007/s11748-019-01221-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/13/2022]
Abstract
The video-assisted thoracic surgery (VATS) technique has evolved from its multiport origins to even less invasive approaches grounded in its proven benefits over open surgery for the treatment of early stage lung cancer. In this evolution process, the Uniportal VATS (UniVATS) strategy emerged. This technique is giving some evidence of benefits when compared to the multiport VATS and has been embraced by the surgical community spreading its geographical and surgical boundaries. Moreover, UniVATS has proven its feasibility for numerous and more complex procedures for lung cancer diagnosis and treatment, which are reviewed in this document as well as its current and future development.
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Hendriksen BS, Reed MF, Taylor MD, Hollenbeak CS. Readmissions After Lobectomy in an Era of Increasing Minimally Invasive Surgery: A Statewide Analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:453-462. [DOI: 10.1177/1556984519874064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Utilization of minimally invasive surgical modalities for lobectomy is increasing. Lobectomy can be associated with notable rates of readmission. As use of these modalities increases, evaluation of the impact on readmission is warranted. Methods Data from the Pennsylvania Health Care Cost Containment Council were used to identify lobectomy operations performed in Pennsylvania from 2011 through 2014. Operations were stratified by approach: open, video-assisted thoracoscopic surgery (VATS) or robotic. Differences in patient characteristics were assessed with analysis of variance and chi-squared tests. Logistic regression modeled risk of 30-day readmission and linear regression modeled length of stay (LOS) after controlling for confounders. Results We evaluated 4,939 lobectomy operations (2,501 open, 1,944 VATS, 494 robotic) with 583 readmissions (11.8%). Robotic cases increased 333% over 4 years. VATS and open cases increased 38% and 22%, respectively. Surgical approach was not associated with hospital readmission (VATS odds ratio (OR) = 0.95; P = 0.632; and robotic OR = 1.02; P = 0.916). Longer LOS was associated with a greater likelihood of readmission (OR = 1.58; P = 0.002). LOS was 1 day less for VATS ( P < 0.001) and 1.5 days less for robotic lobectomy ( P < 0.001) when compared to an open approach. The most common reasons for readmission were respiratory complications and nonrespiratory infection. Conclusions Surgical approach does not directly affect readmission. However, minimally invasive lobectomy appears to be associated with shorter LOS and results in more patients discharged home. Decreased LOS and discharge home are associated with fewer readmissions.
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Affiliation(s)
- Brandon S. Hendriksen
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Michael F. Reed
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Matthew D. Taylor
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Christopher S. Hollenbeak
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Nakada T, Noda Y, Kato D, Shibasaki T, Mori S, Asano H, Matsudaira H, Hirano J, Odaka M, Ohtsuka T. Risk factors and cancer recurrence associated with postoperative complications after thoracoscopic lobectomy for clinical stage I non-small cell lung cancer. Thorac Cancer 2019; 10:1945-1952. [PMID: 31436042 PMCID: PMC6775224 DOI: 10.1111/1759-7714.13173] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 12/25/2022] Open
Abstract
Background Minimally invasive thoracoscopic lobectomy is the recommended surgery for clinical stage I non‐small cell lung cancer (NSCLC). The purpose of this study was to identify the risk factors, including sarcopenia, for postoperative complications in patients undergoing a complete single‐lobe thoracoscopic lobectomy for clinical stage I NSCLC, as well as the impact of complications on disease‐free survival. Methods We retrospectively investigated 173 patients with pathologically‐diagnosed NSCLC who underwent curative thoracoscopic lobectomies between April 2013 and March 2018. Sarcopenia was assessed using the psoas muscle index calculated from preoperative computed tomography images at the third lumbar vertebral level. Results Complications developed in 38 (22%) patients, including 21 with prolonged air leak. In univariate analysis, the significant risk factors for complications were advanced age, male sex, higher Charlson Comorbidity Index (CCI) score, lower cholinesterase, lower albumin, higher creatinine level, pleural adhesion, operative time ≥ five hours, nonadenocarcinoma cancer, and larger tumor size. Multivariate analysis showed that age ≥ 75 years (P = 0.002) and pleural adhesion (P = 0.026) were significant independent risk factors for complications. Compared with the patient group without complications, postoperative complications were independently associated with shorter disease‐free survival (P = 0.01). Conclusions Advanced age and pleural adhesion were independent risk factors for complications after complete single‐lobe thoracoscopic lobectomies for clinical stage I NSCLC, and postoperative complications were statistically associated with poor prognosis. Surgical teams should ensure an experienced surgeon leads the operation for patients at higher risk to avoid prolonged postoperative hospitalization and a possible poor prognosis.
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Affiliation(s)
- Takeo Nakada
- The Jikei University School of Medicine, Department of Surgery, Division of Thoracic Surgery, Tokyo, Japan
| | - Yuki Noda
- The Jikei University School of Medicine, Department of Surgery, Division of Thoracic Surgery, Tokyo, Japan
| | - Daiki Kato
- The Jikei University School of Medicine, Department of Surgery, Division of Thoracic Surgery, Tokyo, Japan
| | - Takamasa Shibasaki
- The Jikei University School of Medicine, Department of Surgery, Division of Thoracic Surgery, Tokyo, Japan
| | - Shohei Mori
- The Jikei University School of Medicine, Department of Surgery, Division of Thoracic Surgery, Tokyo, Japan
| | - Hisatoshi Asano
- The Jikei University School of Medicine, Department of Surgery, Division of Thoracic Surgery, Tokyo, Japan
| | - Hideki Matsudaira
- The Jikei University School of Medicine, Department of Surgery, Division of Thoracic Surgery, Tokyo, Japan
| | - Jun Hirano
- The Jikei University School of Medicine, Department of Surgery, Division of Thoracic Surgery, Tokyo, Japan
| | - Makoto Odaka
- The Jikei University School of Medicine, Department of Surgery, Division of Thoracic Surgery, Tokyo, Japan
| | - Takashi Ohtsuka
- The Jikei University School of Medicine, Department of Surgery, Division of Thoracic Surgery, Tokyo, Japan
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Zhang K, Chen HG, Wu WB, Li XJ, Wu YH, Xu JN, Jia YB, Zhang J. Non-intubated video-assisted thoracoscopic surgery vs. intubated video-assisted thoracoscopic surgery for thoracic disease: a systematic review and meta-analysis of 1,684 cases. J Thorac Dis 2019; 11:3556-3568. [PMID: 31559062 DOI: 10.21037/jtd.2019.07.48] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Non-intubated video-assisted thoracoscopic surgery (NIVATS) has been increasingly used in lobectomy, bullectomy, wedge resection, lung volume reduction, sympathectomy and talc pleurodesis, which may reduce postoperative complications. However, the benefits of non-intubated and intubated methods of VATS remain controversial. Methods We comprehensively searched PubMed, Web of Science, Embase and the Cochrane Library, and performed a systematic review to assess the two techniques. Random and fixed-effects meta-analytical models were used based on the low between-study heterogeneity. Study quality, publication bias, and heterogeneity were assessed. Results Compared to intubated methods, NIVATS had a lower postoperative complications rate [odds ratio (OR): 0.63; 95% confidence interval (CI), 0.46-0.86; P<0.01], shorter global in-operating time [weighted mean difference (WMD): -35.96 min; 95% CI, -48.00 to -23.91; P<0.01], shorter hospital stay (WMD: -1.35 days; 95% CI, -1.72 to -0.98; P<0.01), shorter anesthesia time (WMD: -7.29 min; 95% CI, -13.30 to -1.29; P<0.01), shorter chest-tube placement time (WMD: -1.04 days; 95% CI, -1.75 to -0.33; P<0.01), less chest pain (WMD: -1.31; 95% CI, -2.45 to -0.17; P<0.05) and lower perioperative mortality rate (OR: 0.13; 95% CI, 0.02-0.99; P=0.05). Conclusions NIVATS is a safe, efficient and feasible technique for thoracic surgery and may be a better alternative procedure owing to its advantage in reducing postoperative complications rate, hospital stay, and chest pain.
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Affiliation(s)
- Kai Zhang
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Hui-Guo Chen
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Wei-Bin Wu
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Xiao-Jun Li
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Yong-Hui Wu
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Jian-Nan Xu
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Yu-Bin Jia
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Jian Zhang
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
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Hendriksen BS, Hollenbeak CS, Taylor MD, Reed MF. Minimally Invasive Lobectomy Modality and Other Predictors of Conversion to Thoracotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:342-352. [PMID: 31099278 DOI: 10.1177/1556984519849037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Minimally invasive approaches to lobectomy are increasing. Rates of conversion to thoracotomy are well reported but risk factors are poorly understood. This study aimed to determine the impact of surgical modality (video-assisted thoracoscopic surgery [VATS] and robotic) on conversion as well as to identify other risk factors for conversion. METHODS The National Cancer Database (NCDB) was used to identify patients who underwent minimally invasive lobectomy between 2010 and 2015. Patient characteristics were compared between VATS and robotic approaches using chi-squared tests and t-tests. Logistic regression models were used to control for covariates and identify factors associated with all minimally invasive conversion, VATS conversion, and robotic conversion. Propensity score matching was used to compare conversion rates of VATS and robotic lobectomy. RESULTS The study included 51,723 patients with lung cancer who underwent minimally invasive lobectomy (VATS or robotic). Conversion was identified in 7,109 (7.3%) operations. The odds of VATS conversions were nearly twice that of robotic conversions (OR 1.94 P < 0.0001). After controlling for VATS and robotic patient imbalances with propensity score matching, there was a 5% difference in conversion rates (14% vs. 9%, P < 0.0001). Other predictors of minimally invasive conversion included community hospitals, tumor size 4.5 cm or greater, and an increasing Charlson comorbidity index (P < 0.03 for all). CONCLUSIONS VATS is associated with nearly twice the odds of conversion as robotic lobectomy. Identifying specific risk factors for both VATS and robotic conversions may aid in appropriate modality selection and reduction of conversions.
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Affiliation(s)
- Brandon S Hendriksen
- 1 Department of Surgery, the Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Christopher S Hollenbeak
- 1 Department of Surgery, the Pennsylvania State University, College of Medicine, Hershey, PA, USA.,2 Department of Health Policy and Administration, the Pennsylvania State University, University Park, PA, USA.,3 Department of Public Health Sciences, the Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Matthew D Taylor
- 1 Department of Surgery, the Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Michael F Reed
- 1 Department of Surgery, the Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Laohathai S, Cho S, Yum S, Jang HJ, Seong YW, Kim K, Jheon S. Clinical and functional outcomes after curative resection in octogenarians with clinical stage I non-small cell lung cancer. J Geriatr Oncol 2019; 10:436-438. [DOI: 10.1016/j.jgo.2018.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/09/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
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Li Z, Li Y, Wang L, Duan L, Gonzalez-Rivas D, Jiang G, Chen C. Management of calcified hilar lymph nodes during thoracoscopic lobectomies: avoidance of conversions. J Thorac Dis 2019; 11:657-663. [PMID: 31019752 DOI: 10.21037/jtd.2019.02.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Our objective in this paper is to introduce a new method for handling calcified hilar lymph nodes during lobectomies by video-assisted thoracoscopy that effectively avoids arterial injury and possible conversions. Methods The 12 cases in this study were initially evaluated as eligible and were subsequently scheduled for thoracoscopic lobectomies. However, calcification of the hilar lymph nodes was discovered during the operations, and its presence hampered the conventional process of pulmonary artery dissection. To avoid vessel injuries and subsequent massive bleeding, we developed two techniques specific to the position and exposure of the target vessels and nodes. The space between the bronchus and lymph nodes is exposed by sharp dissection ("scissor first") either before or after suturing the artery. These techniques are illustrated in detail. Results Seven male and five female patients participated in this study, with an average age of 72.5 years. We performed five right-upper lobectomies, three right-middle lobectomies, three right-lower lobectomies, and a left-lower lobectomy. Using this new technique, no conversions to thoracotomy occurred. The average operation time was 125 minutes, the mean blood loss was 275 mL, and no intra-operative massive bleeding occurred. Two patients experienced minor complications, one pulmonary infection and another postoperative subcutaneous emphysema. Conclusions The proposed "scissor first" technique provides an effective solution for the thoracoscopic management of calcified hilar lymph nodes, and is a safe and effective method for avoiding arterial injury and conversion.
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Affiliation(s)
- Zeyao Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yingze Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Long Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Liang Duan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.,Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Kamalanathan K, Knight T, Rasburn N, Joshi N, Molyneux M. Early Versus Late Paravertebral Block for Analgesia in Video-Assisted Thoracoscopic Lung Resection. A Double-Blind, Randomized, Placebo-Controlled Trial. J Cardiothorac Vasc Anesth 2019; 33:453-459. [DOI: 10.1053/j.jvca.2018.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Indexed: 11/11/2022]
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Long-term outcomes of video-assisted thoracoscopic surgery lobectomy vs. thoracotomy lobectomy for stage IA non-small cell lung cancer. Surg Today 2018; 49:369-377. [PMID: 30511319 DOI: 10.1007/s00595-018-1746-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Video-assisted thoracoscopic surgery (VATS) lobectomy is performed widely for patients with clinical stage I non-small cell lung cancer (NSCLC) because of its superior short-term outcomes to those of thoracotomy lobectomy. However, the long-term outcomes of VATS lobectomy vs. thoracotomy lobectomy remain controversial. METHODS We reviewed the clinical data of 202 consecutive patients who underwent lobectomy for clinical stage IA NSCLC at our institution between January, 2008 and December, 2013. Stage IA NSCLC was confirmed pathologically in 162 of these patients, 60 of whom underwent VATS lobectomy and 102 of whom underwent thoracotomy lobectomy. We compared the perioperative clinical factors and outcomes of these two groups, using a propensity score-matched analysis. RESULTS In an analysis of 58 matched cases, the VATS group showed less blood loss, a shorter duration of chest tube placement, a shorter postoperative hospital stay, and a lower peak C-reactive protein value, despite a longer operative time. The VATS group also had significantly longer survival than the thoracotomy group [5-year overall survival, 100% vs. 87%, respectively (p = 0.01); 5-year disease-free survival, 100% vs. 86% (p = 0.03)]. CONCLUSIONS These findings suggest that VATS may have better long-term as well as short-term outcomes than thoracotomy for patients with early-stage NSCLC.
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Wu CF, de la Mercedes T, Fernandez R, Delgado M, Fieira E, Wu CY, Hsieh MJ, Paradela M, Liu YH, Chao YK, Gonzalez-Rivas D. Management of intra-operative major bleeding during single-port video-assisted thoracoscopic anatomic resection: two-center experience. Surg Endosc 2018; 33:1880-1889. [PMID: 30259160 DOI: 10.1007/s00464-018-6467-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 09/18/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Our objective is to report on two centers' experience of intra-operative management of major vascular injury during single-port video-assisted thoracoscopic (SPVATS) anatomic resections, including bleeding control techniques, incidence, results, and risk factor analysis. METHODS Consecutive patients (n = 442) who received SPVATS anatomic lung resections in two centers were enrolled. The different clinical parameters studied included age, previous thoracic surgery, obesity (BMI > 30), tumor location, neoadjuvant therapy, and pleural symphysis. In addition, peri-operative outcomes were compared between the groups, with or without vessel injury. RESULTS There were no intra-operative deaths in our study. Overall major bleeding incidence was 4.5%, whereby 70% of major bleeding episodes could be managed with SPVATS techniques. In order to determine risk factors possibly related to intra-operative bleeding, we used case control matching to homogenize our study population. After case control matching, pleural symphysis was significantly related in the univariate (p = 0.005, Odds ratio 4.415, 95% CI 1.424-13.685) and multivariate analysis (p = 0.006, Odds ratio 4.926, 95% CI 1.577-15.384). Operative time (p < 0.001), blood loss (p < 0.001), and post-operative hospital stay (p = 0.012) were longer in patients with major vascular injury. There were no differences in 30-day mortality and 90-day morbidity. CONCLUSIONS In summary, major intra-operative bleeding episodes during SPVATS anatomic lung resections are acceptable and most such bleeding episodes can be safely managed with SPVATS techniques.
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Affiliation(s)
- Ching Feng Wu
- Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
- Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Torre de la Mercedes
- Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
- Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Ricardo Fernandez
- Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
- Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Maria Delgado
- Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
- Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Eva Fieira
- Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
- Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Ching Yang Wu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Ming Ju Hsieh
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Marina Paradela
- Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
- Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Yun Hen Liu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Yin Kai Chao
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain.
- Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
- Coruña University Hospital, Xubias 84, 15006, Coruña, Spain.
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The Persistent Problem of Local/Regional Failure After Surgical Intervention for Early-Stage Lung Cancer. Ann Thorac Surg 2018; 106:382-389. [DOI: 10.1016/j.athoracsur.2018.03.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
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Yeo HL, Kaushal R, Kern LM. The Adoption of Surgical Innovations at Academic Versus Nonacademic Health Centers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:750-755. [PMID: 28953563 DOI: 10.1097/acm.0000000000001932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE The value of the health care services provided by academic health centers (AHCs) in the United States increasingly is being questioned. AHCs play a prominent role in developing new surgical innovations, including new minimally invasive techniques, which are costly up front but can lead to significant benefits like decreased morbidity and lengths of stays. This study explored the role of AHCs in the adoption of these surgical innovations as a novel measure of their value. METHOD The authors combined data from the American Hospital Association and the State Inpatient Databases from California, Florida, Washington State, and New York. They compared the number and percentage of patients who received four new, innovative surgical procedures (vs. those who received the traditional procedures) at Council of Teaching Hospitals (COTH) hospitals to those at non-COTH hospitals from 2009 to 2011. RESULTS Overall, 61.1% (27,175) of the procedures performed at COTH hospitals used new techniques, compared with 47.2% (41,680) at non-COTH hospitals, across all years (P < .0001). The number and percentage of procedures using the new techniques increased in all years and for all procedures. CONCLUSIONS Not only do AHCs play a role in developing surgical innovations but they also adopt these new techniques more quickly than other hospitals, and thereby they provide additional benefits to patients. These findings provide an important and understudied perspective on the value of AHCs.
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Affiliation(s)
- Heather L Yeo
- H.L. Yeo is assistant professor of surgery, Departments of Surgery and Healthcare Policy and Research, Weill Cornell Medical College, and assistant attending surgeon, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York. R. Kaushal is chair, Department of Healthcare Policy and Research, executive director, Center for Healthcare Informatics and Policy, and Nanette Laitman Distinguished Professor of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York. She is also chief, Healthcare Policy and Research, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York. L.M. Kern is associate professor of medicine, Joan and Sanford I. Weill Department of Medicine, and associate professor of healthcare policy and research, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
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Ma D, Song X, Li S, Liu H, Cui Y, Huang C, Zhou X, Qin Y, Li L, Chen Y. Video-Assisted Thoracoscopic Surgery Lobectomy Performed Satisfaction and Complications of Patients During Hands-On Training Courses. J Laparoendosc Adv Surg Tech A 2018; 28:804-810. [PMID: 29658824 DOI: 10.1089/lap.2017.0661] [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: 11/12/2022] Open
Abstract
AIM It was aimed to concern about the satisfaction and procedural complications of patients during the thoracoscopy exist of hands-on training in this present study. PATIENTS AND METHODS The patients with non-small-cell carcinoma underwent video-assisted thoracoscopic surgery (VATS) lobectomy during hands-on training courses at thoracoscopic center in our hospital and collected from January 2009 and December 2014. The rates of satisfaction and complications of patients were compared from hands-on training group and control group. Potential risk factors associated with post-VATS complications of patients and thoracoscopist-related variables were analyzed. There were 54 patients join in six meetings with hands-on thoracoscopy training in our center. RESULTS There was no significant difference between patients for hands-on training group (n = 54) and control group (n = 54), including sex, age, BMI, smoking, PpoFEV1 and comorbidities. The satisfaction rate and the incidence of complication were similar between the two groups. CONCLUSION Univariate analyses showed that elder age, heart disease, chronic obstructive pulmonary disease, long operative time, and first-time mentorship were significantly associated with post-VATS complications of patients in hands-on training group. We should pay more attention to the characteristics of patent and the experience of mentor before VATS hands-on training courses.
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Affiliation(s)
- Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Xiaonan Song
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Yushang Cui
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Xiaoyun Zhou
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Li Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
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Jang HJ, Song JW, Cho S, Kim K, Jheon S. Prognostic Implications of Postoperative Infectious Complications in Non-Small Cell Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:41-52. [PMID: 29430428 PMCID: PMC5796617 DOI: 10.5090/kjtcs.2018.51.1.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 01/08/2023]
Abstract
Background Few studies have evaluated the long-term impact of postoperative infectious complications in patients with non-small cell lung cancer (NSCLC). We aimed to determine the impact of infectious complications on long-term outcomes after surgical resection for NSCLC. Methods We performed a retrospective study of 1,380 eligible patients who underwent pulmonary resection for NSCLC from 2003 to 2012. Complications were divided into infectious complications and non-infectious complications. Kaplan-Meier survival analysis was used to compare unadjusted 5-year cancer-specific survival (CSS) rates and recurrence-free survival (RFS) rates. Cox regression was used to determine the impact of infectious complications on 5-year CSS and RFS. Results The rate of total complications and infectious complications was 24.3% and 4.3%, respectively. In the node-negative subgroup, the 5-year CSS and RFS rates were 75.9% and 57.1% in patients who had infectious complications, compared to 87.9% and 78.4% in patients who had no complications. Infectious complications were a negative prognostic factor for 5-year RFS (hazard ratio, 1.92; 95% confidence interval, 1.00–3.69; p=0.049). In the node-positive subgroup, the 5-year CSS rate and RFS were 44.6% and 48.4% in patients who had infectious complications, compared to 70.5% and 48.4% for patients who had no complications. Conclusion Postoperative infectious complications had a negative impact on CSS and RFS in node-negative NSCLC. Our findings may help improve risk assessment for tumor recurrence after pulmonary resection for node-negative NSCLC.
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Affiliation(s)
- Hyo-Jun Jang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Jae Won Song
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine
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Long H, Tan Q, Luo Q, Wang Z, Jiang G, Situ D, Lin Y, Su X, Liu Q, Rong T. Thoracoscopic Surgery Versus Thoracotomy for Lung Cancer: Short-Term Outcomes of a Randomized Trial. Ann Thorac Surg 2017; 105:386-392. [PMID: 29198623 DOI: 10.1016/j.athoracsur.2017.08.045] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 08/18/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Safety and short-term efficacy of video-assisted thoracoscopic surgery (VATS) for early-stage non-small lung cancer (NSCLC) has been demonstrated by observational studies previously. However, these outcomes have never been verified by a large randomized controlled trial (RCT). The aim of our RCT was to confirm that VATS is not inferior or even superior to open operation for early-stage NSCLC in terms of short-term and oncologic efficacy. METHODS The trial was undertaken at five tertiary hospitals. Patients aged between 18 and 75 years with clinically early-stage NSCLC were randomly assigned to the VATS and axillary thoracotomy groups. Lobectomy plus mediastinal lymph node dissection was standard surgical intervention. Because patients continue to be followed up for oncologic outcome, the short-term perioperative outcomes would be reported here. RESULTS Between 2008 and 2014, 508 patients were recruited and 425 were eligible for analyses (215 VATS and 210 axillary thoracotomy). Eight VATS procedures were converted to open operation intraoperatively (3.72%). Median operation time with VATS was significantly less than axillary thoracotomy (150 versus 166 minutes, p = 0.009). In addition, VATS was associated with less intraoperative blood loss (p = 0.001). There was no difference for postoperative pleural drainage, length of hospitalization, and rates of morbidity and mortality. Cancer residual margins were found in 1 patient with VATS and 5 with axillary thoracotomy (p = 0.128). The yield of lymph nodes from either surgical approach was similar (p = 0.389). CONCLUSIONS Our study demonstrates that VATS lobectomy is safe and reliable to treat NSCLCs, and it may be superior to axillary thoracotomy for operation time and intraoperative blood loss. ClinicalTrials.gov identifier: NCT01102517.
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Affiliation(s)
- Hao Long
- Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Qunyou Tan
- Department of Thoracic Surgery, Daping Hospital of the Third Military Medical University, Chongqing, China
| | - Qingquan Luo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zheng Wang
- Department of Thoracic Surgery, Shenzhen People's Hospital, Jinan University, Shenzhen, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Dongrong Situ
- Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yongbin Lin
- Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiaodong Su
- Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qing Liu
- Department of Preventive Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tiehua Rong
- Lung Cancer Research Institute, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Yu Z, Xie Q, Guo L, Chen X, Ni C, Luo W, Li W, Ma L. Perioperative outcomes of robotic surgery for the treatment of lung cancer compared to a conventional video-assisted thoracoscopic surgery (VATS) technique. Oncotarget 2017; 8:91076-91084. [PMID: 29207626 PMCID: PMC5710907 DOI: 10.18632/oncotarget.19533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 07/11/2017] [Indexed: 11/25/2022] Open
Abstract
Aim To conduct a meta-analysis to determine the relative merits between robotic video-assisted thoracoscopic surgery (R-VATS) and conventional video-assisted thoracoscopic surgery (VATS) for lung cancer. Results Fifteen studies matched the selection criterion, which reported 8827 subjects, of whom 1704 underwent R-VATS and 7123 underwent VATS. Compared the perioperative outcomes with VATS, reports of R-VATS indicated unfavorable outcomes considering the operative time (SMD = 0.48, 95% CI 0.15 to 0.81). Meanwhile, the number of dissected lymph nodes (SMD = 0.12, 95% CI -0.27 to 0.51) and hospital stay following surgery (SMD = -0.1; 95% CI -0.27 to 0.07), conversion (RR = 0.68; 95% CI 0.42 to 1.11), morbidity (RR = 0.99, 95% CI 0.92 to 1.07) and mortality (RR = 0.33, 95% CI 0.1 to 1.09) were similar for both procedures. Materials and Methods A literature search was performed to identify comparative studies reporting perioperative outcomes for R-VATS and VATS for lung cancer. Pooled risk ratio (RR) and standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or the random effects model. Conclusions There is no difference in terms of perioperative outcomes between R-VATS and VATS except for the operative time which is significantly high for R-VATS. Further studies are required to confirm these results.
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Affiliation(s)
- Zipu Yu
- Department of Thoracic Surgery, 2nd Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Qiong Xie
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Lei Guo
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xin Chen
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chenyao Ni
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Wenzong Luo
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Weidong Li
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Liang Ma
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, Zhejiang University, Hangzhou, China
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Huang X, Yue S, Wang C, Wang H. Optimal three-dimensional reconstruction for lung cancer tissues. Technol Health Care 2017; 25:423-434. [DOI: 10.3233/thc-171345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Park SY, Suh JW, Narm KS, Lee CY, Lee JG, Paik HC, Chung KY, Kim DJ. Feasibility of four-arm robotic lobectomy as solo surgery in patients with clinical stage I lung cancer. J Thorac Dis 2017; 9:1607-1614. [PMID: 28740675 DOI: 10.21037/jtd.2017.05.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study was performed to investigate the feasibility of four-arm robotic lobectomy (FARL) as a solo surgical technique in patients with non-small cell lung cancer (NSCLC). Early outcome and long-term survival of FARL were compared with those of video-assisted thoracoscopic lobectomy (VATL). METHODS Prospective enrollment of patients with clinical stage I NSCLC undergoing FARL or VATL (20 patients in each group) was planned. Interim analysis for early postoperative outcome was performed after the initial 10 cases in each group. RESULTS The study was terminated early because of safety issues in the FARL group after enrollment of 12 FARL and 17 VATL patients from 2011 to 2012. There were no differences in clinical characteristics between groups. Lobectomy time and total operation time were significantly longer in the FARL group (P=0.003). There were three life-threatening events in the FARL group (2 bleedings, 1 bronchus tear) that necessitated thoracotomy conversion in 1 patient. There were no differences in other operative outcomes including pain score, complications, or length of hospital stay. Pathologic stage and number of dissected lymph nodes (LNs) were also comparable. During a follow-up of 48.9±9.5 months, recurrence was identified in 2 (16.7%) patients in FARL group and 3 (23.5%) in VATL group. Five-year overall survival (100% vs. 87.5%, P=0.386) and disease-free survival (82.5% vs. 75.6%, P=0.589) were comparable. CONCLUSIONS FARL as solo surgery could not be recommended because of safety issues. It required a longer operation time and had no benefits over VATL in terms of early postoperative outcome or long-term survival.
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Affiliation(s)
- Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Won Suh
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Sik Narm
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Young Chung
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Guerrero WG, González-Rivas D. Multiportal video-assisted thoracic surgery, uniportal video-assisted thoracic surgery and minimally invasive open chest surgery-selection criteria. J Vis Surg 2017; 3:56. [PMID: 29078619 DOI: 10.21037/jovs.2017.03.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/06/2017] [Indexed: 11/06/2022]
Abstract
Thoracic surgery started the path to minimally invasive surgery over a hundred years ago, with the first thoracoscopic procedure performed by Jacobeus in 1910. Interestingly, these first procedures were performed using a single port approach and were used for diagnostic and minor procedures only. For a long period of time, the progress for minimally invasive thoracic surgery was considerably slow until the early 90s, when video assisted thoracic surgery started to be used for major pulmonary resections. Since then, video-assisted thoracic surgery (VATS) had a widespread use around the world and an ongoing search for a less invasive procedures evolved into uniportal VATS. Now, thoracic surgeons have a variety of choices for minimally invasive thoracic surgery and must be trained in these approaches to keep up with the evolution of the specialty and be up to date with the recommended treatments for diseases needing surgical intervention. The approach chosen by each surgeon is a matter of preference, while keeping in mind certain characteristics specific to the pathology and patient to be treated, the level of training of the surgeon, and the healthcare resources available. As more evidence is collected, the choice for video-assisted procedures, which have currently been proven safe, effective, less invasive and, in general, show good results, will prevail.
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Affiliation(s)
- William Guido Guerrero
- Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica
| | - Diego González-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Chen K, Wang X, Yang F, Li J, Jiang G, Liu J, Wang J. Propensity-matched comparison of video-assisted thoracoscopic with thoracotomy lobectomy for locally advanced non–small cell lung cancer. J Thorac Cardiovasc Surg 2017; 153:967-976.e2. [DOI: 10.1016/j.jtcvs.2016.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 10/29/2016] [Accepted: 12/05/2016] [Indexed: 12/17/2022]
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Standardizing Robotic Lobectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:77-81. [DOI: 10.1097/imi.0000000000000352] [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 Single-surgeon cohorts assessing robotically assisted video-assisted thoracic (RA-VATS) lobectomy have reported good outcomes, but there are little data regarding multiple surgeons applying a standard technique in separate hospitals. The purpose of this study was to show how a standardized robotic technique is both safe and reproducible between surgeons and institutions. Methods From July 1, 2012, to October 1, 2013, patients undergoing RA-VATS lobectomy for both benign and malignant disease were identified from a prospectively collected database of two thoracic surgeons from different hospitals within the same healthcare system and retrospectively analyzed. Each surgeon employed an identical “rule of 10” completely port-based approach through all 128 cases. The primary end points of the study were in-hospital and 30-day mortality. Secondary end points were differences in morbidity and perioperative outcomes between the two surgeons based on their “rule of 10” technique. Results A total of 128 cases were performed with 121 lobectomies, 3 bilobectomies, and 4 pneumonectomies for both malignant and benign disease. Each surgeon had 64 cases without a single in-hospital or 30-day mortality. Overall morbidity was 16.4%. Each surgeon had one readmission and take back to operating room (a washout and a mechanical pleurodesis). The most common complication was prolonged air leak (38.1%, 8/21 patients). There was no statistical difference in length of stay, complications, severity of illness, and clinical staging between the two surgeons. There was a significant difference in resected lymph nodes (11.79 vs 14.45, P = 0.0086). Compared with published national meta-analysis on RA-VAT lobectomies, there was a significantly reduced length of stay (4.2 vs 6 days, P = 0.0436) and bleeding (0.8 vs 1.8%, P = 0.0003). Nodal upstaging from cN0 to pN1 was 8% and cN0 to pN2 was 2% for an overall nodal upstaging of 10% for stage I nonsmall cell lung cancer. Conclusions By standardizing how a robotic lobectomy is performed, we were able to show that RA-VATS lobectomy is safe and may allow for the expansion of minimally invasive lobectomy to surgeons who otherwise have failed to adopt traditional VATS. When compared with the most recent national meta-analysis, we had reduced morbidity, mortality, bleeding, and length of stay. Robotic nodal upstaging for stage I nonsmall lung cancer was consistent with larger multicenter study. We hope that these results will help lead to the standardization robotic lobectomy and a larger multisurgeon/institutional study that could pave the way for greater adoption of minimally invasive lobectomy.
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Lazar JF, Spier LN, Hartman AR, Lazzaro RS. Standardizing Robotic Lobectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John F. Lazar
- Division of Thoracic Surgery, PinnacleHealth CardioVascular Institute, Harrisburg, PA USA
| | - Laurence N. Spier
- Division of Cardiothoracic Surgery, Northwell Health, Manhasset, NY USA
| | - Alan R. Hartman
- Division of Cardiothoracic Surgery, Northwell Health, Manhasset, NY USA
| | - Richard S. Lazzaro
- Division of Cardiothoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY USA
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Montané B, Toosi K, Velez-Cubian FO, Echavarria MF, Thau MR, Patel RA, Rodriguez K, Moodie CC, Garrett JR, Fontaine JP, Toloza EM. Effect of Obesity on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy. Surg Innov 2017; 24:122-132. [PMID: 28128014 DOI: 10.1177/1553350616687435] [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: 11/16/2022]
Abstract
OBJECTIVE We investigated whether higher body mass index (BMI) affects perioperative and postoperative outcomes after robotic-assisted video-thoracoscopic pulmonary lobectomy. METHODS We retrospectively studied all patients who underwent robotic-assisted pulmonary lobectomy by one surgeon between September 2010 and January 2015. Patients were grouped according to the World Health Organization's definition of obesity, with "obese" being defined as BMI >30.0 kg/m2. Perioperative outcomes, including intraoperative estimated blood loss (EBL) and postoperative complication rates, were compared. RESULTS Over 53 months, 287 patients underwent robotic-assisted pulmonary lobectomy, with 7 patients categorized as "underweight," 94 patients categorized as "normal weight," 106 patients categorized as "overweight," and 80 patients categorized as "obese." Because of the relatively low sample size, "underweight" patients were excluded from this study, leaving a total cohort of 280 patients. There was no significant difference in intraoperative complication rates, conversion rates, perioperative outcomes, or postoperative complication rates among the 3 groups, except for lower risk of prolonged air leaks ≥7 days and higher risk of pneumonia in patients with obesity. CONCLUSIONS Patients with obesity do not have increased risk of intraoperative or postoperative complications, except for pneumonia, compared with "normal weight" and "overweight" patients. Robotic-assisted pulmonary lobectomy is safe and effective for patients with high BMI.
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Affiliation(s)
| | | | | | | | | | - Raj A Patel
- 1 University of South Florida, Tampa, FL, USA
| | | | | | | | - Jacques P Fontaine
- 1 University of South Florida, Tampa, FL, USA.,2 Moffitt Cancer Center, Tampa, FL, USA
| | - Eric M Toloza
- 1 University of South Florida, Tampa, FL, USA.,2 Moffitt Cancer Center, Tampa, FL, USA
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Gonfiotti A, Bongiolatti S, Viggiano D, Borgianni S, Borrelli R, Tancredi G, Jaus MO, Politi L, Comin CE, Voltolini L. Does videomediastinoscopy with frozen sections improve mediastinal staging during video-assisted thoracic surgery pulmonary resections? J Thorac Dis 2016; 8:3496-3504. [PMID: 28149542 DOI: 10.21037/jtd.2016.12.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To assess if video-mediastinoscopy (VM) with frozen sections (FS) combined with a video-assisted thoracic surgery major pulmonary resection (VMPRS) is able to improve VATS mediastinal intraoperative staging. METHODS From June 2012 to March 2015 a total of 146 patients underwent VMPRS lymphadenectomy. NCCN guidelines were followed for pre-operative staging, including VM with FS in 27 patients (19%). Procedural time, dissected nodal stations, complications related to VM and VATS lymphadenectomy and definitive histology, were evaluated. RESULTS Operative time for VATS resection with VM (group 1) and VATS pulmonary resection alone (group 2) was 198±64 vs. 167±43 min (P=0.003). Mean/median numbers of dissected nodal stations were 4.93±1.1/5 (range, 4-8) in group 1 and 3.25±0.5/5 (range, 3-8) in group 2 (P<0.001). Group 1 vs. group 2 right-sided lymphadenectomy (n=86) was performed at station 2R/4R in 18 (90%) and 46 (69.7%); at station 3a/3p in 14 (51.8%) and 22 (31%); at station 7 in 18 (90%) and 44 (66.7%); at station 8/9 in 11 (55%) and 24 (36.4%) respectively. On the left side (n=60) group 1 vs. group 2 lymphadenectomy resulted at station 4 in 6 (85.7%) and 38 (71.7%); at station 5/6 in 6 (85.7%) and 26 (49%); at station 7 in 6 (85.7%) and 33 (62.3%), and at station 8/9 in 1 (14.3%) and 18 (34%). There were no early deaths and recurrent laryngeal nerve palsy occurred in 1 (0.8%) in group 2. Pathological upstaging (pN1; pN2) was found in 5 patients (17%) in group 1, and 13 (11%) in group 2 (P=0.23). About FS (n=29), formal paraffin histology resulted in 0% of both, false negative and false positive results. CONCLUSIONS Based on our experience, the combination "VM with FS followed by VMPRS in sequence", seems to be effective and offers an alternative approach to improve intraoperative mediastinal staging.
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Affiliation(s)
| | | | | | - Sara Borgianni
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Roberto Borrelli
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Giorgia Tancredi
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Massimo O Jaus
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Leonardo Politi
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Camilla E Comin
- Department of Experimental and Clinical Medicine, Section of Surgery, Histopathology and Molecular Pathology, University of Florence, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
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Allen MS. Video-assisted thoracoscopic surgery versus open lobectomy for lung cancer: time for a randomized trial. Eur J Cardiothorac Surg 2016; 51:175. [DOI: 10.1093/ejcts/ezw312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Borro JM, Regueiro F, Pértega S, Constenla M, Pita S. Comparative Study of Survival following Videothoracoscopic Lobectomy Procedures for Lung Cancer: Single- versus Multiple-port Approaches. Arch Bronconeumol 2016; 53:199-205. [PMID: 27614811 DOI: 10.1016/j.arbres.2016.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Video-assisted thoracoscopic surgery has become the technique of choice in the early stages of lung cancer in many centers although there is no evidence that all of the surgical approaches achieve the same long-term survival. METHOD We carried out a retrospective review of 276 VATS lobectomies performed in our department, analyzing age, sex, comorbidities, current smoker, FEV1 and FCV, surgical approach, TNM and pathological stage, histologic type, neoadjuvant or coadjuvant chemotherapy, relapse and metastasis time, with the main aim of evaluating the survival rate and disease-free time, especially with regard to the two/three versus single port approach. RESULT The one/four year global survival rate was 88.1 and 67.6% respectively. Bivariate analysis found that the variables associated with survival are comorbidity, histological type, stage, surgical approach and need for chemotherapy. When we independently analyzed the surgical approach, we found a lower survival rate in the single-port group vs. the two/three-port group (VATS). Stratifying by tumoral stage (stage I) and by tumor size (T2) survival was significantly lower for patients with single-port group in comparison to VATS approach. In the multivariate analysis, single-port group is associated with a higher risk of death (HR=1.78). In analyzing disease-free survival, differences were found in both cases in favor of two/three port VATS: p=.093 for local relapses and p=.091 for the development of metastasis. CONCLUSIONS These results challenge the use of the single port technique in malignant lung pathologies, suggesting the need for clinical trials in order to identify the role this technique may have in lung cancer surgery.
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Affiliation(s)
- José M Borro
- Departamento de Cirugía Torácica, Hospital Universitario de A Coruña, A Coruña, España.
| | | | - Sonia Pértega
- Departamento de Epidemiología Clínica y Bioestadística, Hospital Universitario de A Coruña, A Coruña, España
| | - Manuel Constenla
- Departamento de Oncología Médica, Hospital de Pontevedra, Pontevedra, España
| | - Salvador Pita
- Departamento de Epidemiología Clínica y Bioestadística, Hospital Universitario de A Coruña, A Coruña, España
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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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Wang BY, Huang JY, Lin CH, Ko JL, Chou CT, Wu YC, Lin SH, Liaw YP. Thoracoscopic Lobectomy Produces Long-Term Survival Similar to That with Open Lobectomy in Cases of Non-Small Cell Lung Carcinoma: A Propensity-Matched Analysis Using a Population-Based Cancer Registry. J Thorac Oncol 2016; 11:1326-1334. [PMID: 27257134 DOI: 10.1016/j.jtho.2016.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/11/2016] [Accepted: 04/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a lack of large, prospective, randomized studies comparing thoracoscopic and open lobectomy in terms of long-term survival in the setting of NSCLC. Additionally, large case series evaluating the issue are limited. Until now, whether thoracoscopic lobectomy entails a long-term survival benefit compared with open lobectomy not been determined. METHODS Data were obtained from the National Health Insurance Research Database published in Taiwan. We included patients treated with open lobectomy or thoracoscopic lobectomy. In this retrospective review, the clinicopathologic characteristics of 5222 patients with lung cancer during the period 2004-2010 were analyzed. Patients were stratified according to clinical stage. Overall survival (OS) was compared between patients treated with open and those treated with thoracoscopic lobectomy and was also compared between patients in the three different clinical stages. Propensity-matching analysis and multivariate analysis were performed. RESULTS Open lobectomy was performed on 3058 patients (58.6%) and thoracoscopic lobectomy on 2164 (41.4%). Propensity matching produced 1848 patients in each group. The 1-year, 3-year, and 5-year OS rates for propensity-matched patients treated with open lobectomy were 93.4%, 79.3%, and 65.5%, respectively. The 1-year, 3-year, and 5-year OS rates for propensity-matched patients treated with thoracoscopic lobectomy were 94.1%, 80.9%, and 68.7%, respectively. The difference was not statistically significant. In multivariate analysis, surgical resection (open versus thoracoscopic) was not an independent prognostic factor. CONCLUSIONS This propensity-matched study suggests that open and thoracoscopic lobectomy are associated with similar long-term survival in the setting of lung cancer. Thoracoscopic lobectomy is an acceptable surgical treatment of lung cancer.
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Affiliation(s)
- Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Republic of China; Chung Shan Medical University, Taichung, Republic of China; School of Medicine, Kaohsiung Medical University, Kaohsiung, Republic of China; Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Republic of China
| | - Jing-Yang Huang
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Republic of China
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Republic of China; Chung Shan Medical University, Taichung, Republic of China; Department of respiratory care, College of health sciences, Chang Jung Christian University, Tainan, Republic of China
| | - Jiunn-Liang Ko
- Institute of Medicine, Chung Shan Medical University, Taichung, Republic of China
| | - Chen-Te Chou
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Republic of China; Department of Radiology, Chang-Hua Christian Hospital, Changhua City, Republic of China
| | - Yu-Chung Wu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Republic of China
| | - Sheng-Hao Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Republic of China; Chung Shan Medical University, Taichung, Republic of China; Department of respiratory care, College of health sciences, Chang Jung Christian University, Tainan, Republic of China
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Republic of China; Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Republic of China.
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Abstract
The uniportal video assisted thoracic surgery (VATS) approach to lung lobectomy has generated phenomenal interest in recent years. It promises to offer patients less morbidity and faster recovery, even when compared to conventional multiportal VATS. However, critics of the uniportal VATS approach may raise concerns about whether this most minimally invasive surgical approach for lung surgery may compromise safety and treatment efficacy. This debate has great potential importance not only in determining how patients are operated on, but in understanding how 'success' is gauged in major pulmonary surgery. This article explores both sides of this debate, drawing on the experience of how clinical research in multiportal VATS evolved over the years. Systematic generation of clinical evidence with progressively increasing sophistication is required to fairly evaluate the uniportal VATS approach. A review of the current literature suggests that there remain many large gaps in the evidence surrounding uniportal VATS. Hence, at the present time, the reasons voiced by critics as to why uniportal VATS should not be performed should not be lightly dismissed. Instead, it behoves surgeons on both sides of the debate to continue to generate good clinical evidence to resolve it.
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Affiliation(s)
- Alan D L Sihoe
- 1 Department of Surgery, The University of Hong Kong, Hong Kong, China ; 2 Department of Thoracic Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China ; 3 Department of Thoracic Surgery, Tongji University, Shanghai Pulmonary Hospital, Shanghai 200030, China
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50
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Bleakley S, Duncan CG, Monnet E. Thoracoscopic Lung Lobectomy for Primary Lung Tumors in 13 Dogs. Vet Surg 2015; 44:1029-35. [DOI: 10.1111/vsu.12411] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Seth Bleakley
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins Colorado
| | - Colleen G. Duncan
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins Colorado
| | - Eric Monnet
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; Fort Collins Colorado
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