1
|
Herrera LJ, Schumacher LY, Hartwig MG, Bakhos CT, Reddy RM, Vallières E, Kent MS. Pulmonary Open, Robotic, and Thoracoscopic Lobectomy study: Outcomes and risk factors of conversion during minimally invasive lobectomy. J Thorac Cardiovasc Surg 2022:S0022-5223(22)01236-3. [PMID: 36509569 DOI: 10.1016/j.jtcvs.2022.10.050] [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: 05/13/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Conversion to thoracotomy continues to be a concern during minimally invasive lobectomy. The aim of this propensity-matched cohort study is to analyze the outcomes and risk factors of intraoperative conversion during video-assisted thoracoscopic surgery (VATS) and robotic lobectomy (RL). METHODS Data from consecutive lobectomy cases performed for clinical stage IA to IIIA lung cancer was retrospectively collected from the Pulmonary Open, Robotic, and Thoracoscopic Lobectomy study consortium of 21 institutions from 2011 to 2019. The propensity-score method of inverse-probability of treatment weighting was used to balance the baseline characteristics across surgical approaches. Univariate logistic regression models were applied to test risk factors for conversion. Multivariable logistic regression analysis was conducted using a stepwise model selection method. RESULTS Seven thousand two hundred sixteen patients undergoing lobectomy were identified: RL (n = 2968), VATS (n = 2831), and open lobectomy (n = 1417). RL had lower conversion rate compared with VATS (3.6% vs 12.9%; P < .0001). In the multivariable regression model, tumor size and neoadjuvant therapy were the most significant risk factors for conversion, followed by prior cardiac surgery, congestive heart failure, chronic obstructive pulmonary disease, VATS approach, male gender, body mass index, and forced expiratory volume in 1 minute. Conversions for anatomical reasons were more common in VATS than RL (66.6% vs 45.6%; P = .0002); however, conversions for vascular reasons were more common in RL than VATS (24.8% vs 14%; P = .01). The rate of emergency conversions was comparable between RL and VATS (0.5% vs 0.7%; P = .25) with no intraoperative mortalities. CONCLUSIONS Converted minimally invasive lobectomies were not associated with worse perioperative mortality compared with open lobectomy. Compared with VATS lobectomy, RL is associated with a lower probability of conversion in this propensity-score matched cohort study.
Collapse
Affiliation(s)
- Luis J Herrera
- Division of Thoracic Surgery, Orlando Health, Orlando, Fla.
| | - Lana Y Schumacher
- Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | | | - Charles T Bakhos
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pa
| | - Rishindra M Reddy
- Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, Mich
| | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Wash
| | - Michael S Kent
- Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Division of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| |
Collapse
|
2
|
Abdelghany K, Robinson LA, Tanvetyanon T. Impact of Robotic-Assisted Thoracic Surgery on the Completion of Adjuvant Chemotherapy Following Lung Cancer Resection. Cureus 2022; 14:e30364. [DOI: 10.7759/cureus.30364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
|
3
|
Video-assisted thoracoscopic lobectomy after neoadjuvant chemotherapy for non-small cell lung cancer: a multicenter propensity-matched study. Surg Endosc 2021; 36:1466-1475. [PMID: 33742272 PMCID: PMC8758629 DOI: 10.1007/s00464-021-08431-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/05/2021] [Indexed: 11/08/2022]
Abstract
Background The role of video-assisted thoracoscopic surgery for the treatment of non-small-cell lung cancer after neoadjuvant chemotherapy remains controversial. The aim of this study is to demonstrate the reliability of video-assisted lobectomy compared to the open approach by evaluating perioperative and long-term outcomes. Methods In this retrospective, multicentric study from January 2010 to December 2018, we included all patients with non-small-cell lung cancer who underwent lobectomy through the video-assisted or open approach after neoadjuvant chemotherapy. The perioperative outcomes, including data concerning the feasibility of the surgical procedure, the occurrence of any medical and surgical complications and long-term oncological evidence, were collected and compared between the two groups. To minimize selection bias, propensity score matching was performed. Results A total of 286 patients were enrolled: 193 underwent thoracotomy lobectomy, and 93 underwent VATS lobectomy. The statistical analysis showed that surgical time (P < 0.001), drainage time (P < 0.001), days of hospitalization (P < 0.001) and VAS at discharge (P = 0.042) were lower in the VATS group. The overall survival and disease-free survival were equivalent for the two techniques on long-term follow-up. Conclusions VATS lobectomy represents a valid therapeutic option in patients affected by non-small-cell lung cancer after neoadjuvant chemotherapy. The VATS approach in our experience seems to be superior in terms of the perioperative outcomes, while maintaining oncological efficacy. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08431-z.
Collapse
|
4
|
Li Z, Xia M, Liu C, Wang T, Ren Y, Liu Y. A meta-analysis of minimally invasive surgery versus thoracotomy for centrally located non-small cell lung cancer. J Thorac Dis 2021; 13:252-261. [PMID: 33569205 PMCID: PMC7867798 DOI: 10.21037/jtd-20-3273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Surgery is established as the most effective treatment for central lung cancer. Minimally invasive surgery (MIS) is gaining popularity. The decision of whether surgical treatment of central lung cancer should be minimally invasive or a conventional thoracotomy is a critical decision for the thoracic surgeon. However, whether MIS is more advantageous than other surgical treatments for central lung cancer. This study aimed to compare the short- and long-term results of MIS and conventional thoracotomy in patients with central lung cancer. Methods This meta-analysis was conducted using the PubMed, Embase, Wiley Online Library, Google Scholar, Wanfang, and China National Knowledge Infrastructure databases. Searches for relevant studies were conducted in strict accordance with research protocols detailed in the Cochrane handbook. The primary endpoints for comparison between the two surgical methods were perioperative and long-term survival. A 95% confidence interval (CI) for relative risk (RR)/mean difference (MD) was calculated to assess the strength of the correlation. Results Nine studies that met the inclusion and exclusion criteria were eventually included in this meta-analysis. These studies involved a total of 5,869 patients [MIS, n =1,140 versus thoracotomy (TH), n =4,729]. The 3- and 5-year disease-free survival (DFS) and the 2-, 3-, and 5-year overall survival (OS) were similar for the MIS and TH groups [OR: 0.86 (95% CI: 0.51–1.43); P=0.55; OR: 1.01 (95% CI: 0.43–2.36); P=0.99, OR: 0.91 (95% CI: 0.78–1.05); P=0.18; OR: 0.90 (95% CI: 0.77–1.06); P=0.22; OR: 0.95 (95% CI: 0.25–1.53); P=0.30]. A subgroup analysis of 8 articles revealed no statistical difference in the pathological type of non-small cell lung cancer (squamous cell carcinoma or adenocarcinoma) between the two groups [OR: 0.99 (95% CI: 0.89–1.09); P =0.81]. However, the MIS group had a lower incidence of blood loss, duration of hospital stay, and fewer complications [MD: −46.25 (95% CI: −85.05 to −7.46); P=0.02; MD: −1.93 (95% CI: −3.15 to −0.7); P=0.002; MD: 0.73 (95% CI: 0.61–0.88); P=0.001]. Conclusions MIS was shown to be a more effective option to conventional thoracotomy for the treatment of central lung cancer.
Collapse
Affiliation(s)
- Zhengjun Li
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Mozhu Xia
- Department of Operation Room, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Chang Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Tao Wang
- Department of Anesthesia, Shenyang Chest Hospital, Shenyang, China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Nelson DB, Mehran RJ, Mitchell KG, Correa AM, Sepesi B, Antonoff MB, Rice DC. Enhanced recovery after thoracic surgery is associated with improved adjuvant chemotherapy completion for non–small cell lung cancer. J Thorac Cardiovasc Surg 2019; 158:279-286.e1. [DOI: 10.1016/j.jtcvs.2019.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/05/2019] [Accepted: 03/02/2019] [Indexed: 02/03/2023]
|
7
|
Let's just do what we must. J Thorac Cardiovasc Surg 2018; 156:374-375. [PMID: 29580657 DOI: 10.1016/j.jtcvs.2018.02.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 02/28/2018] [Indexed: 11/22/2022]
|
8
|
Sakane T, Matsuoka K, Kumata S, Watanabe R, Yamada T, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. The outcomes of anatomical lung resection for nontuberculous mycobacterial lung disease. J Thorac Dis 2018; 10:954-962. [PMID: 29607168 DOI: 10.21037/jtd.2018.01.60] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The number of cases of nontuberculous mycobacterial (NTM) lung disease has been increasing in recent years, and the efficacy of surgical treatment has been recognized. We investigated the clinical characteristics and behavior of NTM lung disease and analyzed the outcomes of surgery. Methods The data of 25 patients who underwent anatomical resection for NTM lung disease in our institution between January 2004 and December 2014 were retrospectively examined. Results The patients included 10 men and 15 women (mean age, 63.1 years). Twenty patients had Mycobacterium avium, and 5 had Mycobacterium intracellular. The indications for lung resection in 20 definitively diagnosed patients included a remaining or worsening lesion despite medical treatment (n=16), massive hemoptysis or bloody sputum (n=5), and prolonged smear positivity (n=1); multiple reasons were allowed. In five cases without a definitive diagnosis, surgery was performed due to the suspicion of lung cancer. The surgical procedures included pneumonectomy, n=4; lobectomy, n=13; and segmentectomy, n=8. Complete resection was achieved in 10 cases (40.0%). Video-assisted thoracoscopic surgery (VATS) was performed in 17 cases (68.0%), especially in 6 of 8 cases (75.0%) that underwent segmentectomy and in 10 of 11 cases (90.9%) that received simple lobectomy. There was one case of hospital mortality. Among the 22 patients who were followed at our institution, relapse occurred in 4 patients, and new infection occurred in 1 patient. NTM lung disease was controlled in 17 patients (77.3%). In the four cases that relapsed, the median relapse-free interval was 29.5 months. Conclusions Surgical resection was a feasible treatment for NTM lung disease and was associated with favorable outcomes, although there was 1 case of hospital mortality. VATS procedures were considered adequate for the treatment of NTM lung disease; however, the surgical indications must be carefully considered.
Collapse
Affiliation(s)
- Tadashi Sakane
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Sakiko Kumata
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Risa Watanabe
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Tetsu Yamada
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Takahisa Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Shinjiro Nagai
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Hyogo, Japan
| |
Collapse
|
9
|
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]
|
10
|
Numan RC, Berge MT, Burgers JA, Klomp HM, van Sandick JW, Baas P, Wouters MW. Peri- and postoperative management of stage I-III Non Small Cell Lung Cancer: Which quality of care indicators are evidence-based? Lung Cancer 2016; 101:129-136. [PMID: 27794401 DOI: 10.1016/j.lungcan.2016.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 05/30/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
Abstract
Quality of care (QoC) has a central role in our health care system. The aim of this review is to present a set of evidence-based quality indicators for the surgical treatment and postoperative management of lung cancer. A search was performed through PubMed, Embase and the Cochrane library database, including English literature, published between 1980 and 2012. Search terms regarding 'lung neoplasms', 'surgical treatment' and 'quality of care' were used. Potential QoC indicators were divided into structure, process or outcome measures and a final selection was made based upon the level of evidence. High hospital volume and surgery performed by a thoracic surgeon, were identified as important structure indicators. Sleeve resection instead of pneumonectomy and the importance of treatment within a clinical care path setting were identified as evidence-based process indicators. A symptom-based follow-up regime was identified as a new QoC indicator. These indicators can be used for registration, benchmarking and ultimately quality improvement in lung cancer surgery.
Collapse
Affiliation(s)
- Rachel C Numan
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands.
| | - Martijn Ten Berge
- Department of Surgical Oncology, Leids Universitair Medisch Centrum, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jacobus A Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Houke M Klomp
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Johanna W van Sandick
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Paul Baas
- Department of Thoracic Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| | - Michel W Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Plesmanlaan 161, 1066CX Amsterdam, The Netherlands
| |
Collapse
|
11
|
Louie BE, Wilson JL, Kim S, Cerfolio RJ, Park BJ, Farivar AS, Vallières E, Aye RW, Burfeind WR, Block MI. Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database. Ann Thorac Surg 2016; 102:917-924. [PMID: 27209613 DOI: 10.1016/j.athoracsur.2016.03.032] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 01/25/2016] [Accepted: 03/08/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data from selected centers show that robotic lobectomy is safe and effective and has 30-day mortality comparable to that of video-assisted thoracoscopic surgery (VATS). However, widespread adoption of robotic lobectomy is controversial. We used The Society of Thoracic Surgeons General Thoracic Surgery (STS-GTS) Database to evaluate quality metrics for these 2 minimally invasive lobectomy techniques. METHODS A database query for primary clinical stage I or stage II non-small cell lung cancer (NSCLC) at high-volume centers from 2009 to 2013 identified 1,220 robotic lobectomies and 12,378 VATS procedures. Quality metrics evaluated included operative morbidity, 30-day mortality, and nodal upstaging, defined as cN0 to pN1. Multivariable logistic regression was used to evaluate nodal upstaging. RESULTS Patients undergoing robotic lobectomy were older, less active, and less likely to be an ever smoker and had higher body mass index (BMI) (all p < 0.05). They were also more likely to have coronary heart disease or hypertension (all p < 0.001) and to have had preoperative mediastinal staging (p < 0.0001). Robotic lobectomy operative times were longer (median 186 versus 173 minutes; p < 0.001); all other operative measurements were similar. All postoperative outcomes were similar, including complications and 30-day mortality (robotic lobectomy, 0.6% versus VATS, 0.8%; p = 0.4). Median length of stay was 4 days for both, but a higher proportion of patients undergoing robotic lobectomy had hospital stays less than 4 days (48% versus 39%; p < 0.001). Nodal upstaging overall was similar (p = 0.6) but with trends favoring VATS in the cT1b group and robotic lobectomy in the cT2a group. CONCLUSIONS Patients undergoing robotic lobectomy had more comorbidities and robotic lobectomy operative times were longer, but quality outcome measures, including complications, hospital stay, 30-day mortality, and nodal upstaging, suggest that robotic lobectomy and VATS are equivalent.
Collapse
Affiliation(s)
- Brian E Louie
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington.
| | - Jennifer L Wilson
- Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sunghee Kim
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bernard J Park
- Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - Ralph W Aye
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington
| | - William R Burfeind
- Division of Thoracic Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Mark I Block
- Division of Thoracic Surgery, Memorial Healthcare System, Hollywood, Florida
| |
Collapse
|
12
|
Irie M, Nakanishi R, Yasuda M, Fujino Y, Hamada K, Hyodo M. Risk factors for short-term outcomes after thoracoscopic lobectomy for lung cancer. Eur Respir J 2016; 48:495-503. [DOI: 10.1183/13993003.01939-2015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/07/2016] [Indexed: 12/13/2022]
Abstract
Few studies have analysed postoperative risk factors in patients undergoing thoracoscopic lobectomy, including assessments of preoperative physical function. The objectives of this study were to identify predictors of postoperative deterioration of performance status and cardiopulmonary complications in cases of thoracoscopic lobectomy.Between June 2005 and October 2012, we retrospectively reviewed 188 consecutive subjects who underwent thoracoscopic lobectomy for preoperative stage I nonsmall cell lung cancer. The demographic and clinical parameters, including physical function, were analysed using a multivariate logistic regression to clarify the determinants.The percent predicted diffusing capacity of the lung for carbon monoxide, quadriceps muscle strength and pathologic stage were independent risk factors for deterioration of performance status after surgery in the multivariate analyses. Chronic obstructive pulmonary disease, 6-min walking distance and pathologic stage were also independent risk factors for postoperative cardiopulmonary complications.Our data suggest that, in addition to a greater pathologic stage, lower diffusing capacity and comorbid chronic obstructive pulmonary disease, poor physical function was associated with worse short-term outcomes after thoracoscopic lobectomy. An evaluation of preoperative quadriceps muscle strength and 6-min walk test is easily performed and may therefore be a useful predictor in cases of thoracoscopic lobectomy.
Collapse
|
13
|
Yu WS, Jung HS, Lee JG, Kim DJ, Chung KY, Lee CY. Safety of thoracoscopic surgery for lung cancer without interruption of anti-platelet agents. J Thorac Dis 2015; 7:2024-32. [PMID: 26716042 DOI: 10.3978/j.issn.2072-1439.2015.11.40] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Perioperative bleeding concerns have led to the general recommendation that antiplatelet agents (APAs) be discontinued 7-10 days preoperatively, but this could increase the risk of perioperative cardiovascular events. This retrospective study aimed to evaluate the safety of APA continuation during thoracoscopic surgery for lung cancer. METHODS Between January 2009 and February 2015, 164 patients taking APAs underwent curative resection. Comparisons were conducted between two groups: preoperatively interrupted APA administration (group I, n=106) and continued APA administration (group N, n=58). RESULTS Group N had a significantly higher revised cardiac risk index (rCRI) (P=0.001). Lobectomy was performed in the majority of patients [95 (89.6%) in group I; 52 (89.7%) in group N]. There were no significant differences in intraoperative outcomes, such as the thoracotomy conversion rate, operating time, intraoperative transfusion, and amount of blood loss during the operation, or postoperative outcomes, such as postoperative bleeding and thrombotic complications, postoperative transfusions, and operative mortality. Within group N, the patients taking aspirin + clopidogrel (n=11) had significantly greater postoperative bleeding (P=0.005), and more postoperative transfusions (P=0.003) and chest tube drainage over a 3-day period (P=0.049) compared with other antiplatelet regimens. CONCLUSIONS Continued use of APAs during thoracoscopic surgery for lung cancer could be safely done in patients at high risk of cardiac or thrombotic events. However, in patients administered aspirin + clopidogrel, it may be the best to continue aspirin only because of an increased risk of postoperative bleeding and transfusion requirements.
Collapse
Affiliation(s)
- Woo Sik Yu
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Suk Jung
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Lee
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Young Chung
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Young Lee
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
14
|
Tane S, Nishio W, Okuma H, Ogawa H, Hokka D, Tane K, Tanaka Y, Uchino K, Yoshimura M, Maniwa Y. Operative outcomes of thoracoscopic lobectomy for non-small-cell lung cancer. Asian Cardiovasc Thorac Ann 2015. [DOI: 10.1177/0218492315596657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim We examined the advantages of thoracoscopy over thoracotomy in terms of perioperative outcomes and toleration of adjuvant chemotherapy. Methods Between April 2010 and March 2013, 657 patients with non-small-cell lung cancer who underwent lobectomy were classified into thoracoscopy (308 patients) and thoracotomy (349 patients) groups and compared. Results The thoracoscopy group had less blood loss compared to the thoracotomy group ( p < 0.001). When limiting the analysis to pathological stage I patients, the results were similar ( p < 0.001). In addition, the difference in blood loss between the 2 groups was greater in patients with severe pleural adhesions. The postoperative morbidity of the thoracoscopy group was significantly less than that of the thoracotomy group (13.3% vs. 21.2%, p < 0.001), and this result was similar when analyzing the pathological stage I patients (12.6% vs. 20.6%, p = 0.001). A higher percentage of the thoracoscopy group received both the full planned course and dose of adjuvant chemotherapy compared to the thoracotomy group (84.2% vs. 65.8%, p = 0.032). Conclusions These results indicate that totally thoracoscopic lobectomy is the more beneficial surgical approach with regard to the incidence of postoperative complications and toleration of adjuvant chemotherapy.
Collapse
Affiliation(s)
- Shinya Tane
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Nishio
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Hiromichi Okuma
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Ogawa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Hokka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenta Tane
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuya Uchino
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | | | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
15
|
Coleman BK, Curtis LH, Onaitis MW, D'Amico TA, Berry MF. Adjuvant chemotherapy after resection of N1 non-small cell lung cancer: differential impact of new evidence on physician and patient decisions. J Thorac Dis 2015; 7:243-51. [PMID: 25922700 DOI: 10.3978/j.issn.2072-1439.2015.01.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 01/05/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Adjuvant cisplatin-based chemotherapy (ACT) after resection of stages II-IIIA non-small cell lung cancer (NSCLC) modestly increased survival in several clinical trials. This study evaluated the subsequent impact of those trials on ACT use in clinical practice. METHODS Patients who underwent lobectomy or more extensive lung resection without induction chemotherapy for pathologically confirmed N1 positive NSCLC between 2000 and 2012 were reviewed. Referrals to medical oncology, oncologist recommendations for ACT, and initiation of ACT were evaluated. Because major trials supporting ACT were published in 2004 and 2005, analysis was stratified into two eras: 2000-2005 and 2006-2012. RESULTS During the study period, 272 patients met inclusion criteria (110 in the 2000-2005 cohort, 162 in the 2006-2012 cohort). Referrals to medical oncology increased from 74.5% (n=82) in the 2000-2005 cohort to 90.1% (n=146) in the 2006-2012 cohort (P=0.002). Due to lack of referral or missed appointments, 35.5% (n=39) of the 2000-2005 patients and 17.9% (n=32) of the 2006-2012 patients did not have a documented conversation with an oncologist regarding ACT. The proportion of patients recommended for ACT increased from 61% (n=50) to 81.5% (n=119) between the eras (P<0.001). Of patients recommended for chemotherapy, 14% (7/50) in 2000-2005 and 13.4% (16/119) in 2006-2012 declined ACT (P=0.666). CONCLUSIONS Publication of supporting evidence increased recommendations for ACT but did not change the percentage of patients who ultimately agreed to receive ACT. Additional research is needed to better understand patient decision-making in this situation.
Collapse
Affiliation(s)
- Brooke K Coleman
- 1 Duke Clinical Research Institute, 2 Department of Medicine, 3 Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Lesley H Curtis
- 1 Duke Clinical Research Institute, 2 Department of Medicine, 3 Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mark W Onaitis
- 1 Duke Clinical Research Institute, 2 Department of Medicine, 3 Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Thomas A D'Amico
- 1 Duke Clinical Research Institute, 2 Department of Medicine, 3 Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mark F Berry
- 1 Duke Clinical Research Institute, 2 Department of Medicine, 3 Department of Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
16
|
Yamashita SI, Goto T, Mori T, Horio H, Kadota Y, Nagayasu T, Iwasaki A. Video-assisted thoracic surgery for lung cancer: republication of a systematic review and a proposal by the guidelines committee of the Japanese Association for Chest Surgery 2014. Gen Thorac Cardiovasc Surg 2014; 62:701-5. [DOI: 10.1007/s11748-014-0467-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Indexed: 11/29/2022]
|
17
|
Licht PB, Schytte T, Jakobsen E. Adjuvant Chemotherapy Compliance Is Not Superior After Thoracoscopic Lobectomy. Ann Thorac Surg 2014; 98:411-5; discussion 415-6. [DOI: 10.1016/j.athoracsur.2014.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/17/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
|
18
|
What is the extent of the advantage of video-assisted thoracoscopic surgical resection over thoracotomy in terms of delivery of adjuvant chemotherapy following non-small-cell lung cancer resection? Interact Cardiovasc Thorac Surg 2014; 19:656-60. [DOI: 10.1093/icvts/ivu206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
19
|
Gonzalez-Rivas D, Fieira E, Delgado M, Mendez L, Fernandez R, de la Torre M. Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small cell lung cancer? J Thorac Dis 2014; 6:641-8. [PMID: 24976985 DOI: 10.3978/j.issn.2072-1439.2014.05.17] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/22/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Conventional video-assisted thoracoscopic (VATS) lobectomy for advanced lung cancer is a feasible and safe surgery in experienced centers. The aim of this study is to assess the feasibility of uniportal VATS approach in the treatment of advanced non-small cell lung cancer (NSCLC) and compare the perioperative outcomes and survival with those in early-stage tumors operated through the uniportal approach. METHODS From June 2010 to December 2012, we performed 163 uniportal VATS major pulmonary resections. Only NSCLC cases were included in this study (130 cases). Patients were divided into two groups: (A) early stage and (B) advanced cases (>5 cm, T3 or T4, or tumors requiring neoadjuvant treatment). A descriptive and retrospective study was performed, comparing perioperative outcomes and survival obtained in both groups. A survival analysis was performed with Kaplan-Meier curves and the log-rank test was used to compare survival between patients with early and advanced stages. RESULTS A total of 130 cases were included in the study: 87 (A) vs. 43 (B) patients (conversion rate 1.1 vs. 6.5%, P=0.119). Mean global age was 64.9 years and 73.8% were men. The patient demographic data was similar in both groups. Upper lobectomies (A, 52 vs. B, 21 patients) and anatomic segmentectomies (A, 4 vs. B, 0) were more frequent in group A while pneumonectomy was more frequent in B (A, 1 vs. B, 6 patients). Surgical time was longer (144.9±41.3 vs. 183.2±48.9, P<0.001), and median number of lymph nodes (14 vs. 16, P=0.004) were statistically higher in advanced cases. Median number of nodal stations (5 vs. 5, P=0.165), days of chest tube (2 vs. 2, P=0.098), HOS (3 vs. 3, P=0.072), and rate of complications (17.2% vs. 14%, P=0.075) were similar in both groups. One patient died on the 58th postoperative day. The 30-month survival rate was 90% for the early stage group and 74% for advanced cases. CONCLUSIONS Uniportal VATS lobectomy for advanced cases of NSCLC is a safe and reliable procedure that provides perioperative outcomes similar to those obtained in early stage tumours operated through this same technique. Further long term survival analyses are ongoing on a large number of patients.
Collapse
Affiliation(s)
- Diego Gonzalez-Rivas
- 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Eva Fieira
- 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Maria Delgado
- 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Lucía Mendez
- 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Ricardo Fernandez
- 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Mercedes de la Torre
- 1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| |
Collapse
|
20
|
Matsuoka K, Imanishi N, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Video-assisted thoracoscopic surgery for nontuberculous mycobacterial infection. Asian Cardiovasc Thorac Ann 2014; 22:1066-71. [PMID: 24622645 DOI: 10.1177/0218492314527594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The number of patients with nontuberculous mycobacterium infection is increasing in Japan, and therefore surgical treatment is also being applied with increasing frequency. Although the effectiveness of surgery for nontuberculous mycobacterium disease has been established and reported by a number of authors, the role of video-assisted thoracoscopic surgery in the surgical treatment of nontuberculous mycobacterium disease has not been sufficiently investigated. PATIENTS AND METHODS We retrospectively investigated 10 patients, comprising 5 males and 5 females, who underwent video-assisted thoracoscopic lobectomy or segmentectomy for nontuberculous mycobacterium disease at our institution between February 2006 and November 2012. The average patient age was 59.5 years (range 53-65 years). We performed lobectomy in 6 cases and segmentectomy in 4. RESULTS All surgical procedures were completed under video-assisted thoracoscopic surgery and none required conversion to thoracotomy. Postoperatively, air leakage continuing for 7 days occurred in 2 patients but there was no severe postoperative complication. The median periods of postoperative drainage and hospitalization were 4.0 and 5.5 days, respectively. Among 8 cases followed up at our institution, reactivation of nontuberculous mycobacterium disease occurred in one case 4 years after surgery. CONCLUSION Video-assisted thoracoscopic surgery is a safe and useful procedure for lobectomy and segmentectomy in patients with nontuberculous mycobacterium disease.
Collapse
Affiliation(s)
- Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
| | - Naoko Imanishi
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
| | - Takahisa Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
| | - Shinjiro Nagai
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Japan
| |
Collapse
|
21
|
Dunning J, Walker WS. Pulmonary artery bleeding caused during VATS lobectomy. Ann Cardiothorac Surg 2013; 1:109-10. [PMID: 23977478 DOI: 10.3978/j.issn.2225-319x.2012.03.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 03/21/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | |
Collapse
|
22
|
Dunning J, Walker WS. How to set up a VATS lobectomy program. Ann Cardiothorac Surg 2013; 1:43-6. [PMID: 23977464 DOI: 10.3978/j.issn.2225-319x.2012.03.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/23/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | |
Collapse
|
23
|
Park SY, Lee JG, Kim J, Byun GE, Bae MK, Lee CY, Kim DJ, Chung KY. Efficacy of platinum-based adjuvant chemotherapy in T2aN0 stage IB non-small cell lung cancer. J Cardiothorac Surg 2013; 8:151. [PMID: 23759129 PMCID: PMC3684513 DOI: 10.1186/1749-8090-8-151] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/06/2013] [Indexed: 12/25/2022] Open
Abstract
Background Although overall survival for non-small cell lung cancer (NSCLC) has increased, survival rate for pathologically staged T2aN0M0 stage IB NSCLC remains low. Adjuvant chemotherapy is not a standard treatment for stage IB NSCLC. Our purpose was to determine the efficacy of platinum-based adjuvant chemotherapy in stage IB NSCLC. Methods We retrospectively reviewed the medical records of 119 stage IB patients who underwent lobectomy and mediastinal lymph node dissection. Among these, 60 patients underwent platinum-based adjuvant chemotherapy (adjuvant group) and 59 did not receive chemotherapy (observation group). Results Participants had a mean age of 62.12 ± 11.51 years and 73 (61.3%) were male. The median follow-up period was 49.04 months. Mean age was higher in the observation group whereas patients in the adjuvant group had larger tumors, more dissected lymph nodes, and better performance status. The 5-year overall survival was 64.7% in the observation group and 88.2% in the adjuvant group (p = 0.010). The 5-year disease-free survival was 51.3% in the observation group and 74.0% in the adjuvant group (p = 0.011). In multivariate analysis, only platinum-based adjuvant chemotherapy was a risk factor for overall survival [hazard ratio (HR) = 0.428, p = 0.049] and disease-free survival (HR = 0.57, p = 0.043). In subset analysis, patients with a larger tumor (greater than 3.2 cm), moderate to poor differentiation, and good performance status (Eastern Cooperative Oncology Group, 0) benefitted from platinum-based adjuvant chemotherapy. Conclusions Platinum-based adjuvant chemotherapy for surgically treated stage IB NSCLC might offer better survival than observation alone. A large-scale randomized clinical trial is needed to validate these findings.
Collapse
Affiliation(s)
- Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Louie BE. Robotic lobectomy for non-small cell lung cancer. Indian J Surg Oncol 2013; 4:125-31. [PMID: 24426713 PMCID: PMC3693146 DOI: 10.1007/s13193-013-0212-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022] Open
Abstract
Over the last 5 years, there has been a tremendous increase in the interest in and use of robotics in thoracic surgery. The focus of this review is on the use of robotics for pulmonary lobectomy, which is being approached with 3 or 4 arm techniques. Early experiences suggest that the learning curve is approximately 20 cases for most surgeons but could be shortened with previous advanced thoracoscopic skills. Robotic lobectomy is feasible and safe in limited reports from experienced centers. Operative and clinical outcomes favor robotic lobectomy over open and appear to be similar to VATS. Limited data on oncologic effectiveness and survival suggest that robotics is similar to VATS. Widespread adoption and integration into practice will require future research efforts to prove oncologic and survival benefits in concert with cost effectiveness evaluation.
Collapse
Affiliation(s)
- Brian E. Louie
- Minimally Invasive Thoracic Surgery Program, Swedish Cancer Institute and Medical Center, Suite 850, 1101 Madison Street, Seattle, WA 98104 USA
| |
Collapse
|
25
|
Video-Assisted Thoracic Surgery Lobectomy versus Lobectomy by Thoracotomy for Lung Cancer: Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 8:6-11. [DOI: 10.1097/imi.0b013e31828d5f15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Video-assisted thoracic surgery lobectomy (VATS-L) has become accepted as a safe and effective procedure to treat early-stage non–small cell lung carcinoma (NSCLC). However, the advantages of VATS-L compared with lobectomy by thoracotomy (TL) remain controversial. The aim of this study was to compare the outcomes of patients who underwent VATS-L with those who underwent TL. Methods We studied 103 patients who underwent surgery for operable NSCLC between October 2009 and March 2012. All operations were performed by a single surgeon. The inclusion and exclusion criteria for VATS-L and TL were formulated before the study was initiated. Data on age, sex, preoperative comorbidities, intraoperative and postoperative complications, hospital stay, morbidity, mortality, and other characteristics were recorded preoperatively, in real time intra-operatively, and during hospitalization and were statistically compared. Comorbidities were scaled according to the Charlson Comorbidity Index, and propensity scores between the patients who underwent TL and VATS-L were compared. Results Sixty-three VATS-L operations and 40 TL operations were performed. There were no postoperative complications in 39 patients (61.9%) who underwent VATS-L compared with 25 patients (62.5%) who underwent TL. The patients who underwent TL were significantly younger than the patients who underwent VATS-L (mean ± SD, 64.7 ± 12.6 vs 70.9 ± 8.4; P = 0.003). Hospital stay was not found to be related to the type of surgery (mean ± SD, 8.43 ± 3.15 days vs 8.32 ± 4.13 days; P = 0.888). There were no significant differences when comparing postoperative complications. Conclusions Our initial data suggest that VATS-L is a safe procedure in patients with resectable IA/IB NSCLC and may be the preferred strategy for treatment of the older patient population.
Collapse
|
26
|
Papiashvilli M, Sasson L, Azzam S, Hayat H, Schreiber L, Ezri T, Priel IE. Video-Assisted Thoracic Surgery Lobectomy versus Lobectomy by Thoracotomy for Lung Cancer: Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Michael Papiashvilli
- Department of Cardiothoracic Surgery, Edith Wolfson Medical Center, Holon, Israel
| | - Lior Sasson
- Department of Cardiothoracic Surgery, Edith Wolfson Medical Center, Holon, Israel
| | - Sharbel Azzam
- Department of Thoracic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Henri Hayat
- Departments of Oncology, Assaf Harofeh Medical Center, Zerifin, Israel
| | | | - Tiberiu Ezri
- Anesthesiology, and Assaf Harofeh Medical Center, Zerifin, Israel
| | - Israel E. Priel
- Pulmonary Medicine, Edith Wolfson Medical Center, Holon, Israel
| |
Collapse
|
27
|
Mitchell JD, Yu JA, Bishop A, Weyant MJ, Pomerantz M. Thoracoscopic Lobectomy and Segmentectomy for Infectious Lung Disease. Ann Thorac Surg 2012; 93:1033-9; discussion 1039-40. [DOI: 10.1016/j.athoracsur.2012.01.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 01/04/2012] [Accepted: 01/06/2012] [Indexed: 10/28/2022]
|
28
|
D'Amico TA. Invited commentary. Ann Thorac Surg 2011; 91:348-9. [PMID: 21256265 DOI: 10.1016/j.athoracsur.2010.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 09/19/2010] [Accepted: 09/24/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Thomas A D'Amico
- Section of General Thoracic Surgery, Duke University Medical Center, Box 3496, Duke South, White Zone, Rm 3589, Durham, NC 27710, USA.
| |
Collapse
|