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Liu CC, Cheng YF, Huang CL, Wang BY. Thoracoscopic S1+2 and S6 bisegmentectomy with 3-dimensional imaging simulation to manage an advanced interlobar tumor. JTCVS Tech 2024; 23:117-119. [PMID: 38352012 PMCID: PMC10859574 DOI: 10.1016/j.xjtc.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
- Chia-Chi Liu
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ya-Fu Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chang-Lun Huang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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2
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Ceylan KC, Batıhan G, Kaya ŞÖ. Three Ports One Lung: Videothoracoscopic Pneumonectomy for Lung Cancer. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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3
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Baig MZ, Razi SS, Agyabeng-Dadzie K, Stroever S, Muslim Z, Weber J, Herrera LJ, Bhora FY. Robotic-assisted thoracoscopic Surgery (RATS) Demonstrates a Lower Rate of Conversion to Thoracotomy Than Video-assisted thoracoscopic Surgery (VATS) for Complex Lobectomies. Eur J Cardiothorac Surg 2022; 62:6584009. [PMID: 35543470 DOI: 10.1093/ejcts/ezac281] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 03/27/2022] [Accepted: 05/08/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Locally advanced lung cancers present a significant challenge to minimally invasive thoracic surgeons. An increasing number of centers have adopted robotic-assisted thoracoscopic surgeries for these complex operations. In this study, we compare surgical margins achieved, conversion rates to thoracotomy, perioperative mortality and thirty-day readmission rates for robotic and video-assisted thoracoscopic surgery (VATS) lobectomy for locally advanced lung cancers. METHODS Using the National Cancer Database (NCDB), we identified patients with Non-small cell lung cancer (NSCLC) who received neoadjuvant chemotherapy/radiotherapy, had clinical N1/N2 disease or in the absence of these two features had a tumour > 5 cm treated with either robotic or VATS lobectomy between 2010 and 2016. Perioperative outcomes and conversion rates were compared between robotic and VATS lobectomy. RESULTS A total of 9,512 patients met our inclusion criteria with 2,123 (22.3%) treated with robotic lobectomy and 7,389 (77.7%) treated with VATS lobectomy. Comparable R0 resections, thirty and ninety-day mortality and thirty-day readmission rates were observed for robotic and VATS lobectomy while a higher rate of conversion to thoracotomy was observed for VATS (aOR = 1.99, 95% CI = 1.65, 2.39, p < 0.001). CONCLUSIONS Our analysis of the NCDB suggests that robotic lobectomy for complex lung resections achieves similar perioperative outcomes and R0 resections as VATS lobectomy with the exception of a lower rate of conversion to thoracotomy.
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Affiliation(s)
- Mirza Zain Baig
- Department of Surgery, Danbury Hospital, Nuvance Health System, Danbury, Connecticut
| | - Syed S Razi
- Division of Thoracic Surgery, Department of Surgery, Memorial Healthcare System, South Broward, Florida
| | - Kojo Agyabeng-Dadzie
- Division of Thoracic Surgery, Department of Surgery, Orlando Health, Orlando, Florida
| | - Stephanie Stroever
- Department of Innovation and Research, Nuvance Health Systems, Danbury, Connecticut
| | - Zaid Muslim
- Division of Thoracic Surgery, Rudy L Ruggles Biomedical Research Institute,Nuvance Health System, Danbury, Connecticut
| | - Joanna Weber
- Division of Thoracic Surgery, Rudy L Ruggles Biomedical Research Institute,Nuvance Health System, Danbury, Connecticut
| | - Luis J Herrera
- Division of Thoracic Surgery, Department of Surgery, Orlando Health, Orlando, Florida
| | - Faiz Y Bhora
- Division of Thoracic Surgery, Rudy L Ruggles Biomedical Research Institute,Nuvance Health System, Danbury, Connecticut
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4
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Essa RA, Ahmed SK, Bapir DH. Uniportal video-assisted thoracoscopic surgery (UVATS) right lower lobectomy for a giant T4 squamous cell lung tumour. J Int Med Res 2022; 50:3000605221097374. [PMID: 35481387 PMCID: PMC9087254 DOI: 10.1177/03000605221097374] [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] [Indexed: 11/15/2022] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) is one of the unique methods that have revolutionized the discipline of minimally-invasive thoracic surgery in the last two decades. Previously, double-port VATS lobectomy has been used for the resection of T4 tumours. This current case report presents a 68-year-old male that presented with a productive cough of 3 months' duration, associated with fever, chest pain and loss of body weight. He was haemodynamically stable. The patient underwent surgery under general anaesthesia using a uniportal VATS (UVATS) approach. A 2-cm incision was made in the mid-axillary line through the right 5th intercostal space with no rib spreading. The tumour was put into a specimen bag, cut into pieces and then removed via the mouth of the bag using a grasper. After good haemostasis, a single chest drain was placed and the small incision was sutured in layers. The postoperative course was uneventful and no complications were observed. On the 6th day postoperative, the patient was discharged home. This current case demonstrated that UVATS resection for T4 tumours might be a viable approach in the hands of skilled surgeons. It should also provide decreased postoperative pain, faster recovery and shorter hospitalization.
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Affiliation(s)
- Rawand Abdulrahman Essa
- Department of Cardiothoracic and Vascular Surgery, Rania Medical City Hospital, Rania, Sulaimani, Kurdistan-region, Iraq.,Department of Cardiac Care Unit, Rania Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq.,Department of Biotechnology, Institute of Science and Modern Technology, Rojava University, Qamishlo, Syria
| | - Sirwan Khalid Ahmed
- Department of Cardiothoracic and Vascular Surgery, Rania Medical City Hospital, Rania, Sulaimani, Kurdistan-region, Iraq.,Department of Cardiac Care Unit, Rania Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq.,Department of Biotechnology, Institute of Science and Modern Technology, Rojava University, Qamishlo, Syria
| | - Dunya Hars Bapir
- Department of Biotechnology, Institute of Science and Modern Technology, Rojava University, Qamishlo, Syria
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5
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Nakanishi R, Okuda K, Yokota K, Tatematsu T, Sakane T, Oda R, Kawano O, Haneda H, Moriyama S. Complex video-assisted thoracoscopic surgery lobectomy for locally advanced lung cancer: a prospective feasibility study. Surg Today 2022; 52:1582-1590. [PMID: 35320417 DOI: 10.1007/s00595-022-02491-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The limitations regarding indications for video-assisted thoracoscopic surgery lobectomy requiring complex surgery remain unclear. A prospective cohort study was conducted to elucidate the safety and feasibility of complex thoracoscopic lobectomy for patients with locally advanced non-small-cell lung cancer. METHODS We planned to enroll patients who were suspected of needing thoracoscopic lobectomy or more with complex surgery, including tracheo-bronchoplasty, pulmonary arterioplasty, and combined resection of adjacent organs. Between February 2016 and January 2019, 28 consecutive patients were prospectively enrolled. RESULTS After excluding 1 patient due to disease progression, 27 patients were included in this study. Three patients underwent thoracoscopic lobectomy without complex surgery. Of the remaining 24 patients, complex thoracoscopic lobectomy was successfully completed in 21 (88%), and the 3 conversions were due to surgery for the great vessels. All 27 patients achieved complete resection. Six patients (22%) suffered grade 2 complications, and the in-hospital, 30-day, and 90-day mortality rates were all 0%. At a median follow-up time of 900 days, the 3-year overall and disease-free survival rates were 75% and 54%, respectively. CONCLUSIONS Complex thoracoscopic lobectomy was shown to be safe and feasible in select patients with locally advanced non-small-cell lung cancer excluding invasion to the great vessels. CLINICAL REGISTRATION NUMBER University Hospital Medical Information Network Clinical Trials Registry, 000,019,441 (JAPAN). Institutional Review Board number: 46-15-0003 (accepted at September 7, 2015).
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Affiliation(s)
- Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Keisuke Yokota
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Tsutomu Tatematsu
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Tadashi Sakane
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Risa Oda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Osamu Kawano
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hiroshi Haneda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Satoru Moriyama
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
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6
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Veronesi G, Novellis P, Perroni G. Overview of the outcomes of robotic segmentectomy and lobectomy. J Thorac Dis 2021; 13:6155-6162. [PMID: 34795966 PMCID: PMC8575815 DOI: 10.21037/jtd-20-1752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
Abstract
Segmentectomy has gained popularity in the latest years as a valid alternative to lobectomy. Initially reserved to patient unfit for lobar lung resection, this procedure is now offered also in selected patient with <2 cm peripheral lung cancer confined to an anatomic segment with no nodal involvement on preoperative evaluation. The introduction of screening with low-dose CT chest scan allowed the identification of lung cancer at early stages, making possible to schedule a more conservative lung surgery. A major improvement came also from minimally invasive surgery (MIS), reducing complication rate with comparable survival rates when compared to open surgery. However, due to long learning curve and uncomfortable instruments handling of video-assisted thoracoscopy, many surgeons still prefer to perform segmentectomies through a thoracotomy and thus increasing perioperative morbidity and leading to post-thoracotomy syndrome due to rib-spreading. Robotic assisted thoracic surgery (RATS) can avoid this throwback, combining the handling of open surgery with lesser invasiveness of thoracoscopy. Although literature has given strong evidences in favour of robotic lobectomies, data are still limited regarding segmentectomies performed with this technique. Moreover, no results are still available from the two ongoing randomized controlled trials comparing segmentectomy to lobectomy and so the latter represent the oncologically proper procedure for lung cancer along with lymph-node dissection. In this review we analyse the literature currently available on outcomes of lobar and sublobar anatomical resection performed by RATS, with a brief mention of the existing surgical techniques of port positioning and the costs of this procedure.
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Affiliation(s)
- Giulia Veronesi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.,Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianluca Perroni
- Department of Thoracic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy
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7
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Cao C, Le A, Bott M, Yang CFJ, Gossot D, Melfi F, Tian DH, Guo A. Meta-Analysis of Neoadjuvant Immunotherapy for Patients with Resectable Non-Small Cell Lung Cancer. Curr Oncol 2021; 28:4686-4701. [PMID: 34898553 PMCID: PMC8628782 DOI: 10.3390/curroncol28060395] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/22/2021] [Accepted: 11/10/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Immunotherapy has created a paradigm shift in the treatment of metastatic non-small cell lung cancer (NSCLC), overcoming the therapeutic plateau previously achieved by systemic chemotherapy. There is growing interest in the utility of immunotherapy for patients with resectable NSCLC in the neoadjuvant setting. The present systematic review and meta-analysis aim to provide an overview of the existing evidence, with a focus on pathological and radiological response, perioperative clinical outcomes, and long-term survival. METHODS A systematic review was conducted using electronic databases from their dates of inception to August 2021. Pooled data on pathological response, radiological response, and perioperative outcomes were meta-analyzed where possible. RESULTS Eighteen publications from sixteen studies were identified, involving 548 enrolled patients who underwent neoadjuvant immunotherapy, of whom 507 underwent surgery. Pathologically, 52% achieved a major pathological response, 24% a complete pathological response, and 20% reported a complete pathological response of both the primary lesion as well as the sampled lymph nodes. Radiologically, 84% of patients had stable disease or partial response. Mortality within 30 days was 0.6%, and morbidities were reported according to grade and frequency. CONCLUSION The present meta-analysis demonstrated that neoadjuvant immunotherapy was feasible and safe based on perioperative clinical data and completion rates of surgery within their intended timeframe. The pathological response after neoadjuvant immunotherapy was superior to historical data for patients who were treated with neoadjuvant chemotherapy alone, whilst surgical and treatment-related adverse events were comparable. The limitations of the study included the heterogenous treatment regimens, lack of long-term follow-up, variations in the reporting of potential prognostic factors, and potential publication bias.
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Affiliation(s)
- Christopher Cao
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney University, Sydney, NSW 2050, Australia; (A.L.); (A.G.)
- Chris O’Brien Lifehouse Hospital, Sydney, NSW 2050, Australia
| | - Anthony Le
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney University, Sydney, NSW 2050, Australia; (A.L.); (A.G.)
| | - Matthew Bott
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Dominique Gossot
- Department of Thoracic Surgery, Institut du Thorax Curie-Montsouris, 75014 Paris, France;
| | - Franca Melfi
- Robotic Multispecialty Center for Surgery Robotic, Minimally Invasive Thoracic Surgery, University of Pisa, 56124 Pisa, Italy;
| | - David H. Tian
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, NSW 2145, Australia;
| | - Allen Guo
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney University, Sydney, NSW 2050, Australia; (A.L.); (A.G.)
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8
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Matsuoka K, Yamada T, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Case report of thoracoscopic resection for broncholithiasis with severe obstructive pneumonia. Indian J Thorac Cardiovasc Surg 2020; 36:74-77. [PMID: 33061100 DOI: 10.1007/s12055-019-00870-7] [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: 07/08/2019] [Revised: 08/11/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022] Open
Abstract
Broncholithiasis is a rare disease characterized by bronchial erosion or distortion due to hilar or parenchymatous calcification. When a broncholith has no mobility and there is a risk of major bleeding if removal is attempted, surgical intervention is required. Most operations for broncholithiasis are performed via a thoracotomy, and bronchial lithotripsy under complete video-assisted thoracoscopic surgery has been reported only rarely. We have experienced a case of broncholithiasis with severe obstructive pneumonia that was treated successfully by video-assisted thoracoscopic surgery. Thoracoscopic surgery is an effective treatment for broncholithiasis because it is minimally invasive and aids smooth recovery after surgery. When the adhesion between the pulmonary artery and the bronchus is highly advanced, it is advocated to cut them together using an endostapler.
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Affiliation(s)
- Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, 670-8520 Honmachi 68, Himeji City, Hyogo Japan
| | - Tetsu Yamada
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, 670-8520 Honmachi 68, Himeji City, Hyogo Japan
| | - Takahisa Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, 670-8520 Honmachi 68, Himeji City, Hyogo Japan
| | - Shinjiro Nagai
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, 670-8520 Honmachi 68, Himeji City, Hyogo Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, 670-8520 Honmachi 68, Himeji City, Hyogo Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, 670-8520 Honmachi 68, Himeji City, Hyogo Japan
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9
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Herb JN, Kindell DG, Strassle PD, Stitzenberg KB, Haithcock BE, Mody GN, Long JM. Trends and Outcomes in Minimally Invasive Surgery for Locally Advanced Non-Small-Cell Lung Cancer With N2 Disease. Semin Thorac Cardiovasc Surg 2020; 33:547-555. [PMID: 32979480 PMCID: PMC10715223 DOI: 10.1053/j.semtcvs.2020.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/08/2020] [Indexed: 11/11/2022]
Abstract
Few studies examine outcomes by surgical approach in non-small-cell lung cancer (NSCLC) with N2 disease. We examined time trends in surgical approach and outcomes among patients undergoing minimally invasive (MIS, robotic and video-assisted thoracoscopic surgery [VATS]) vs open lobectomy in this patient population. We performed a retrospective analysis of patients from the National Cancer Database diagnosed with clinical Stage IIIA-N2 NSCLC from 2010 to 2016. We examined the yearly proportion of MIS vs open resections. Multivariable regression was used to assess the association of surgical approach with length of stay, unplanned readmissions, 30-day and 90-day mortality. Multivariable Cox proportional hazards modeling was used to assess the association of surgical approach with 5-year overall mortality. We identified 5741 patients who underwent lobectomy for Stage IIIA-N2 NSCLC (459 robotic, 1403 VATS, 3879 open). From 2010 to 2016, the proportion of minimally invasive procedures increased from 20% to 45%. MIS patients, on average, stayed 1 day less in the hospital (95% confidence interval [CI] 0.7, 1.5) and had lower odds of 90-day (odds ratio [OR] 0.74; 95% CI 0.54, 0.99) and 5-year mortality (OR 0.82; 95% CI 0.75, 0.91), compared to open resections. There was no difference in odds of readmission by surgical approach (OR 0.97; 95% CI 0.71, 1.33). Among MIS procedures, robotic resections had lower odds of 90-day mortality (OR 0.42; 95% CI 0.18, 0.97) than VATS. Among patients undergoing lobectomy for locally advanced N2 NSCLC robotic and VATS techniques appear safe and effective compared to open surgery and may offer short- and long-term advantages.
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Affiliation(s)
- Joshua N Herb
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Daniel G Kindell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paula D Strassle
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karyn B Stitzenberg
- Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Benjamin E Haithcock
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gita N Mody
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jason M Long
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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10
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Veronesi G, Novellis P, Voulaz E, Bruschini P. Robotic assisted lung resection for locally advanced lung cancer. Expert Rev Respir Med 2019; 14:121-124. [PMID: 31779503 DOI: 10.1080/17476348.2020.1697235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Giulia Veronesi
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Pierluigi Novellis
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Emanuele Voulaz
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pietro Bruschini
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
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11
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Veronesi G, Park B, Cerfolio R, Dylewski M, Toker A, Fontaine JP, Hanna WC, Morenghi E, Novellis P, Velez-Cubian FO, Amaral MH, Dieci E, Alloisio M, Toloza EM. Robotic resection of Stage III lung cancer: an international retrospective study. Eur J Cardiothorac Surg 2019; 54:912-919. [PMID: 29718155 DOI: 10.1093/ejcts/ezy166] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/25/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Minimally invasive surgery is accepted for early-stage lung cancer, but its role in locally advanced disease is controversial, especially using a robotic platform. The aim of this retrospective study was to assess the safety and effectiveness of robot-assisted resection in patients with Stage IIIA non-small-cell lung cancer (NSCLC) or carcinoid tumours in the series as a whole and in different subgroups according to adjuvant treatment. METHODS This was a retrospective multicentre study of consecutive patients with clinically evident or occult N2 disease (210 NSCLC and 13 carcinoid) who, in 2007-2016, underwent robot-assisted resection at 7 high-volume centres. Perioperative outcomes, recurrences and overall survival were assessed. RESULTS N2 disease was diagnosed preoperatively in 72 (32%) patients and intraoperatively in 151 (68%) patients. Surgical margins were negative in 98.4% of cases with available data. Thirty-four (15.2%) patients received neoadjuvant treatment, 140 (63%) patients received postoperative treatment, and 49 (22%) patients underwent surgery only. There were 22 (9.9%) conversions to thoracotomy, 23 (10.3%) had serious (Grades III-IV) postoperative morbidity and the mean hospital stay was 5.3 days. Complications and outcomes did not differ significantly between treatment groups. Of the 34 patients who were given neoadjuvant chemotherapy, all had R0 resection, 5 (15%) patients required conversion but none required conversion because of bleeding and 4 (12%) patients had Grade III or IV postoperative complications. After a median of 18 (interquartile range 8-33) months, 3-year overall survival in NSCLC patients was 61.2% and 60.3% (P = 0.6) of patients in the subgroup were given induction treatment. However, overall survival was significantly better (P = 0.012) in NSCLC patients with ≤2 positive nodes (vs >2). Nineteen (8.5%) patients developed local recurrence. CONCLUSIONS Robot-assisted lobectomy is safe and effective in patients with Stage III NSCLC or carcinoid tumours with low conversions and complications. Among patients with NSCLC, including those who were given induction chemotherapy, survival was similar to that reported for open surgery.
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Affiliation(s)
- Giulia Veronesi
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Bernard Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Cerfolio
- Thoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark Dylewski
- Department of Cardiothoracic Surgery, Baptist Health South Florida-South Miami Hospital, South Miami, FL, USA
| | - Alpert Toker
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Jacques P Fontaine
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
| | - Wael C Hanna
- Department of Surgery, Division of Thoracic Surgery, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Frank O Velez-Cubian
- Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
| | - Marisa H Amaral
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Elisa Dieci
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| | - Eric M Toloza
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Surgery, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Health, Tampa, FL, USA
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12
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Matsuoka K, Yamada T, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Analysis of conversion to thoracotomy during thoracoscopic lung resection. Asian Cardiovasc Thorac Ann 2019; 27:381-387. [PMID: 31072106 DOI: 10.1177/0218492319851396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Video-assisted thoracoscopic surgery has been widely adopted. However, conversion to open thoracotomy is still necessary when intraoperative complications are encountered. Methods Between January 2009 and December 2014, 1566 patients underwent anatomical lung resection for lung cancer using video-assisted thoracoscopic surgery at our institution. Among these patients, 39 required conversion to open thoracotomy. We retrospectively examined the current status of conversion to thoracotomy during video-assisted thoracoscopic surgery in a single city hospital. Data were compared with those of 89 patients undergoing a scheduled thoracotomy. Results The main reason for conversion was the need for angioplasty for pulmonary artery invasion by silicotic lymph nodes (12 cases), and metastatic lymph nodes or tumors (9 cases). Univariate analysis demonstrated that the risk factors for conversion were male sex, smoking habit, induction therapy, large tumor size, and advanced stage. Multivariate analysis showed that advanced clinical stage was the only significant predictor of intraoperative conversion. Compared to the video-assisted thoracoscopic surgery group, mortality and morbidity in the conversion group were significantly higher, but there was no significant difference in mortality or morbidity between the conversion and scheduled thoracotomy groups. The conversion group showed a significantly higher rate of lethal acute exacerbation of interstitial pneumonitis than the video-assisted thoracoscopic surgery group. Conclusion The main reason for conversion was angioplasty, and advanced clinical stage was a significant predictor of intraoperative conversion. Conversion was safely performed but postoperative complications, although similar in frequency to scheduled thoracotomy cases, were more frequent than those in thoracoscopic surgery cases.
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Affiliation(s)
- Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Tetsu Yamada
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Takahisa Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Shinjiro Nagai
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
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Mori S, Noda Y, Tsukamoto Y, Shibazaki T, Asano H, Matsudaira H, Yamashita M, Odaka M, Morikawa T. Perioperative outcomes of thoracoscopic lung resection requiring a long operative time. Interact Cardiovasc Thorac Surg 2019; 28:380-386. [PMID: 30212874 DOI: 10.1093/icvts/ivy275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/31/2018] [Accepted: 08/15/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Difficult thoracoscopic surgery sometimes requires a long operative time. It is unclear whether patients benefit from such thoracoscopic surgeries. We investigated whether thoracoscopic surgery for difficult cases contributed to improvements in perioperative outcomes. METHODS We retrospectively reviewed cases of anatomical lung resection with thoracoscopic surgery, including conversion to thoracotomy, between January 2006 and December 2016 and compared patient demographics and perioperative outcomes of the long (≥360 min) and the normal operative time groups (<360 min). RESULTS One hundred and seventy-six patients were in the long operative time group and 655 patients were in the normal operative time group. The long operative time group had more male patients, more progressive clinical stages, bilobectomy or pneumonectomy, conversion to thoracotomy and more blood loss than the normal operative time group. The long operative time group had higher rates of postoperative complications and longer hospital stay (30% vs 16%, P < 0.001 and 9 ± 9 days vs 7 ± 8 days, P < 0.001; respectively). Multivariate analysis showed that in the first half of the operative period, chronic obstructive pulmonary disease and bilobectomy or pneumonectomy were independent predictive factors for postoperative complications. The long operative time as a factor was close to statistical significance (odds ratio 1.689, P = 0.079) unlike the elective conversion to thoracotomy (odds ratio 0.784, P = 0.667) and emergency conversion to thoracotomy (odds ratio 0.938, P = 0.924). CONCLUSIONS In conclusion, when difficult cases are encountered, conversion to thoracotomy should be considered by surgeons if continuation of thoracoscopic surgery increases the operative time.
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Affiliation(s)
- Shohei Mori
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Yuki Noda
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Yo Tsukamoto
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Takamasa Shibazaki
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Hisatoshi Asano
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Hideki Matsudaira
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Makoto Yamashita
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Makoto Odaka
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Toshiaki Morikawa
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
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14
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Tian Z, Sui X, Yang F, Wang J. Is video-assisted thoracoscopy a sufficient approach for mediastinal lymph node dissection to treat lung cancer after neoadjuvant therapy? Thorac Cancer 2019; 10:782-790. [PMID: 30756507 PMCID: PMC6449226 DOI: 10.1111/1759-7714.12999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 12/01/2022] Open
Abstract
Background The role of video‐assisted thoracoscopic surgery (VATS) in mediastinal lymph node dissection (MLND) for non‐small cell lung cancer (NSCLC) following neoadjuvant therapy remains controversial. The aim of this study was to demonstrate the sufficiency of VATS by evaluating perioperative and long‐term outcomes. Methods Patients with locally advanced NSCLC and treated with radical surgery after neoadjuvant therapy were identified in our database. The thoroughness of MLND was compared by approach. Multivariable logistic regression analysis was used to evaluate predictors of sufficient MLND. Propensity score matching was performed. Kaplan–Meier and Cox proportional hazard analyses were used to assess long‐term survival. Results Of the 127 enrolled patients, 56 underwent attempted VATS and 71 underwent thoracotomy. Multivariable logistic regression analysis revealed that approach was not a predictor of sufficient MLND (odds ratio 0.81, 95% confidence interval [CI] 0.364–1.803; P = 0.606). After matching, 28 pairs of patients were selected from the two groups. There was no significant difference between the numbers of dissected lymph nodes (15 vs. 20; P = 0.191) and nodal stations (7 vs. 7; P = 0.315). Recurrence‐free (log‐rank P = 0.613) and overall survival (log‐rank P = 0.379) was similar in both groups. Multivariable Cox proportional hazards model analysis indicated that VATS was not an independent predictor of recurrence‐free (hazard ratio 0.955, 95% CI 0.415–2.198; P = 0.913) or overall survival (hazard ratio 0.841, 95% CI 0.338–2.093; P = 0.709). Conclusion Compared to thoracotomy, VATS is a sufficient approach for MLND to treat locally advanced NSCLC following neoadjuvant therapy without compromising long‐term survival.
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Affiliation(s)
- Zhoujunyi Tian
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Xizhao Sui
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, Beijing, China
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Zhang L. Short- and long-term outcomes in elderly patients with locally advanced non-small-cell lung cancer treated using video-assisted thoracic surgery lobectomy. Ther Clin Risk Manag 2018; 14:2213-2220. [PMID: 30510426 PMCID: PMC6231434 DOI: 10.2147/tcrm.s175846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In recent years, video-assisted thoracic surgery (VATS) lobectomy has been used to treat locally advanced non-small-cell lung cancer (LA-NSCLC). However, VATS has not been reported in elderly patients (≥70 years) with LA-NSCLC. The purpose of this study was to compare short- and long-term outcomes of patients with LA-NSCLC aged ≥70 years and 55-69 years treated with VATS. PATIENTS AND METHODS From January 2012 to January 2018, a total of 83 patients with LA-NSCLC who were ≥55 years of age underwent VATS. Patients were divided into ≥70 years group (37 cases) and 55-69 years group (46 cases), based on their age at the time of VATS. Short- and long-term outcomes of these two groups of patients were compared. RESULTS American Society of Anesthesiologists scores of ≥70 years patients were higher than those of 55-69 years patients. No significant differences were observed when comparing the general preoperative data. For short-term outcomes, there was no significant difference between the two groups of patients in length of surgery, intraoperative blood loss, conversion to thoracotomy, postoperative 30-day complication rate and severity, postoperative 30-day mortality, pathological results, compliance with adjuvant chemotherapy, or other factors. Long-term follow-up results showed that recurrence, overall survival, and disease-free survival were similar in both groups. Furthermore, multivariate analysis showed that age was not an independent predictor of overall and disease-free survival. CONCLUSIONS VATS in elderly patients (≥70 years) with LA-NSCLC can result in short- and long-term outcomes similar to those of 55-69 years patients with LA-NSCLC.
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Affiliation(s)
- Like Zhang
- Department of Thoracic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, People's Republic of China,
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16
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Matsuoka K, Yamada T, Matsuoka T, Nagai S, Ueda M, Miyamoto Y. Video-assisted thoracoscopic surgery for lung cancer after induction therapy. Asian Cardiovasc Thorac Ann 2018; 26:608-614. [DOI: 10.1177/0218492318804413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Although thoracoscopic surgery is widely performed for early-stage lung cancer, only a few small studies have evaluated the role of video-assisted thoracoscopic surgery in patients with locally advanced lung cancer who had received preoperative chemotherapy. Methods Among 1655 patients who underwent anatomical lung resection for lung cancer between January 2009 and December 2014 in our institution, we retrospectively examined the short- and long-term outcomes of 110 (6.6%) who had undergone induction therapy. Thoracoscopic surgery was performed in 79 of these patients and thoracotomy in 31. Results In the thoracoscopic group, conversion to a thoracotomy was required in 4 patients. More combined resections were included in the thoracotomy group, and combined resection of large vessels or the carina was carried out only via a thoracotomy. Postoperative complications of grade 3 or above were found in 15 (13.6%) patients, and there was no significant difference in the incidence of postoperative complications between the 2 groups. The 3- and 5-year survival rates for the patients overall were 58.6% and 50.3%, respectively. Although there was no significant difference in overall outcome between the 2 groups, the patients with postoperative ypN2 status in the thoracoscopic group had a significantly better outcome than those in the thoracotomy group. Conclusion Although video-assisted thoracoscopic surgery was not suitable for central advanced lung cancer requiring angioplasty or carinal resection, it seems to be useful for patients with locally advanced lung cancer who had undergone induction therapy, especially patients with peripheral lung cancer and mediastinal lymph node metastasis.
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Affiliation(s)
- Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
| | - Tetsu Yamada
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
| | - Takahisa Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
| | - Shinjiro Nagai
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji-City, Hyogo, Japan
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17
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Hou GJ, He Y, Zhao P. Video-assisted thoracoscopic left upper lobectomy and broncho-and-angioplasty for a giant central lung cancer complicated with intratumoral abscess: one case report. J Thorac Dis 2018; 10:4484-4486. [PMID: 30174899 DOI: 10.21037/jtd.2018.03.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 70-year-old male patient with chest pain and high fever was diagnosed as lung squamous carcinoma T4N0M0 in the left upper lobe complicated with intratumoral lung abscess. With no improvement resulted from antibiotic treatment for 4 days, to control his infection and resect his large tumor, he received video-assisted thoracoscopic surgery (VATS) left upper lung lobe resection and broncho-and angioplasty. Two-port technique was employed and the utility port was 10 cm long because the tumor's diameter (max) was 12 cm. After the first step to divide the tumor from chest wall and mediastinum, the pericardium was opened and dissection was carried out in a direction from anterior to posterior meticulously. The superior pulmonary vein was divided by a stapler and then the upper bronchus cut open. Then the pulmonary artery was blocked and then its branches were cut open. At last, angioplasty and bronchoplasty was completed by sutures. Without any accidental bleeding, the whole operative time was 350 min and bleeding volume 100 mL. After the operation, fever resolved soon and pathologic stage was pT4N2M0. The patient was discharged from the hospital 20 days after the surgery. Generally, large tumor is still challenging in VATS operation and obstructive lung infection or abscess make the operation harder. However, VATS can still be applied in these patients and provide better vision and better chances for recovery without compromise of tumor principle.
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Affiliation(s)
- Guang-Jie Hou
- Department of Thoracic Surgery, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Yi He
- Department of Thoracic Surgery, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Pu Zhao
- Department of Thoracic Surgery, Henan Provincial People's Hospital, Zhengzhou 450003, China
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18
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Casiraghi M, Spaggiari L. Robotic resection of stage III lung cancer: an international retrospective study. J Thorac Dis 2018; 10:S3081-S3083. [PMID: 30370084 DOI: 10.21037/jtd.2018.07.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Oncologic Equivalence of Minimally Invasive Lobectomy: The Scientific and Practical Arguments. Ann Thorac Surg 2018; 106:609-617. [PMID: 29678519 DOI: 10.1016/j.athoracsur.2018.02.089] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/11/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite the slow adoption of minimally invasive lobectomy (MIL), it is now a preferred approach for early lung cancer. Nevertheless, ongoing concerns about MIL oncologic effectiveness has led to calls for prospective, randomized trials. METHODS Retrospective analysis of on-line databases, collected readings, and other scholarly experiences of the experienced authors were used to construct this review. All available reports that contained long-term survival comparisons for open versus MIL were tabulated. RESULTS The preponderance of limited randomized and numerous large propensity-matched database analyses indicate equivalent or improved long-term MIL survival for early-stage disease. MIL lymph node dissection quality has been challenged; however, this was attributed to MIL avoidance of central tumors in early reports. Although technical inadequacies for MIL should be amplified for advanced cancer resections, early reports show no such concern. In fact, for special populations such as older, frail patients, evidence is much stronger that MIL confers a survival advantage. CONCLUSIONS MIL is an oncologically equivalent operation with substantially less morbidity, especially in frail populations. It is reasonable to suggest that MIL should be the technique of choice, even a quality indicator, for lobectomy.
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20
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Gonfiotti A, Bongiolatti S, Bertolaccini L, Viggiano D, Solli P, Droghetti A, Bertani A, Crisci R, Voltolini L. Thoracoscopic lobectomy for locally advanced-stage non-small cell lung cancer is a feasible and safe approach: analysis from multi-institutional national database. J Vis Surg 2017; 3:160. [PMID: 29302436 DOI: 10.21037/jovs.2017.09.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 11/06/2022]
Abstract
Background Video-assisted thoracoscopic lobectomy (VATS-L) is a well-established approach for early-stage non-small cell lung cancer (NSCLC) with functional and oncological outcomes similar to thoracotomy. The role of VATS-L in locally advanced stage of NSCLC has not been well standardized. The objective of this study was to evaluate the state of the art in Italy of VATS-L for NSCLC advanced stages using the data from the Italian VATS Group Database. Methods Between 1st January 2014 and 31th May 2017, 3,720 patients underwent VATS-L at VATS Group participating centres and included in the VATS Group database. Patients were divided into two groups: (A) early stages and (B) locally-advanced stages (tumours with dimension >5 cm (cT2b), cT3, cT4 and/or tumours that received neo-adjuvant chemotherapy). A retrospective study was performed, to evaluate the safety and the oncological adequacy of VATS-L comparing peri-operative outcomes and pathological data. Results A total of 3,266 (87.7%) patients were included into the group A, while 454 (13.3%) patients formed the group B. VATS-L for locally advanced-stage NSCLC is associated with a longer procedure, a higher estimated blood loss, an increased incidence of conversion (9.3% vs. 13.0%, P=0.018) and a significant higher number of total, hilar and mediastinal dissected lymph nodes. The mortality rate (1.6% vs. 1.5%), the proportion of patients who suffered any complication (24.8% vs. 29.1%) and the hospitalization were not statistically different between the two groups (P=0.880, 0.057 and 0.660, respectively); the overall complication rate was statistically higher in group B (30.4% vs. 37.0%; P=0.04). Patients of group B who required conversion had a statistically significantly higher operative time (P<0.01), blood loss (P<0.01) and hospital stay (P<0.01), but not significantly higher overall morbidity rate (35.5% vs. 28.0%) compared with patients completely operated by VATS. Conclusions VATS-L for locally advanced-stage NSCLC in Italy is a safe and effective procedure when performed in appropriately selected patients, ensuring peri-operative results similar to those obtained in early-stage tumours.
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Affiliation(s)
| | | | - Luca Bertolaccini
- Thoracic Surgery Unit, AUSL Romagna Teaching Hospital, Ravenna, Italy
| | | | - Piergiorgio Solli
- Thoracic Surgery Unit, AUSL Romagna Teaching Hospital, Ravenna, Italy
| | | | - Alessandro Bertani
- Department of Thoracic Surgery, IRCCS ISMETT-UPMC, University of Pittsburgh, Palermo, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
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21
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Veronesi G, Novellis P, Difrancesco O, Dylewski M. Robotic assisted lobectomy for locally advanced lung cancer. J Vis Surg 2017; 3:78. [PMID: 29078641 DOI: 10.21037/jovs.2017.04.03] [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] [Received: 03/26/2017] [Accepted: 04/11/2017] [Indexed: 11/06/2022]
Abstract
Some series report the use of video-assisted thoracic surgery (VATS) in patients with locally advanced non-small cell lung cancer (NSCLC) but, few studies describe the use of the robotic approach specifically for locally advanced disease. One potential advantage of the robotic approach over traditional VATS is the increased radicality. While the benefit of the robotic approach over open thoracotomy is directly related to reduced surgical trauma and the improved tolerability in fragile patients that have received induction treatment. In case of occult N2 disease, robotic assisted surgery can translate into a quicker recovery with improved compliance with adjuvant treatments following surgery. Technical details are reported and described. The robotic instrument technology allows sharp and controlled dissection compared to the typical blunt sweeping methods used in most VATS lobectomy techniques. The authors believe that robotic technology favors a more radical resection in the case of complex locally advanced tumors. Robotic technology has some limitations that have affected adoption such as significant capital and maintenance costs, reduced operating room efficiencies, and a steep learning curve.
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Affiliation(s)
- Giulia Veronesi
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Orazio Difrancesco
- Department of Anesthesia and Intensive Care Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Mark Dylewski
- Thoracic and Robotic Surgery, Baptist Health of South Florida, Miami, Florida, USA
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Thoracoscopic lobectomy for clinical N2 and N1 lung cancer: Innovation outpacing standard of care. J Thorac Cardiovasc Surg 2017; 153:977-978. [PMID: 28168981 DOI: 10.1016/j.jtcvs.2016.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/27/2016] [Indexed: 11/21/2022]
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23
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Fan J, Yao J, Wang Q, Chang Z. Safety and feasibility of uniportal video-assisted thoracoscopic surgery for locally advanced non-small cell lung cancer. J Thorac Dis 2016; 8:3543-3550. [PMID: 28149548 DOI: 10.21037/jtd.2016.12.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Conventional video-assisted thoracoscopic surgery (VATS) lobectomy for locally advanced non-small cell lung cancer (NSCLC) is a feasible and safe surgery in high-volume centers with significant VATS experience. Uniportal VATS lobectomy has been recently been reported to be a promising, less invasive approach. The purpose of this study is to explore the safety and feasibility of uniportal video-assisted thoracoscopic surgery (U-VATS) for the treatment of patients with locally advanced NSCLC. METHODS From January 2013 to September 2015, a total of 132 patients with locally advanced NSCLC underwent U-VATS or open thoracotomy major pulmonary resections and standard mediastinal lymph node dissection. Patients were divided into two groups: (I) locally advanced NSCLC underwent U-VATS (U-VATS); (II) locally advanced NSCLC underwent open thoracotomy (open). A descriptive and retrospective study was performed, including the operative time, operative blood loss, postoperative chest tube duration, postoperative hospital stay, lymph node dissection, postoperative complications and postoperative recovery. RESULTS A total of 132 patients with locally advanced NSCLC were included in this study: 64 (U-VATS) vs. 68 (open) patients. The patient demographic data was similar in both groups. Median operative time (157.0 vs. 160.6) and median number of lymph nodes (35.5 vs. 32.5) were similar in both groups. Chest tube duration and hospital of stay were statistically shorter in U-VATS group while rate of complications were higher in open thoracotomy group. One patient died on the 55th postoperative day because of tumor metastasis and bronchopleural fistula. A higher percentage of patients who underwent UVATS resections were able to receive adjuvant therapy timely compared to the open group. CONCLUSIONS Uniportal VATS major pulmonary resections and mediastinal lymph node dissection is a safe and feasible procedure for the treatment of locally advanced NSCLC. Particularly it is suitable for the frail patients with locally advanced NSCLC who require comprehensive treatment.
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Affiliation(s)
- Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Jie Yao
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Qi Wang
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Zhibo Chang
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
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Park BJ, Yang HX, Woo KM, Sima CS. Minimally invasive (robotic assisted thoracic surgery and video-assisted thoracic surgery) lobectomy for the treatment of locally advanced non-small cell lung cancer. J Thorac Dis 2016; 8:S406-13. [PMID: 27195138 DOI: 10.21037/jtd.2016.04.56] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Insufficient data exist on the results of minimally invasive surgery (MIS) for locally advanced non-small cell lung cancer (NSCLC) traditionally approached by thoracotomy. The use of telerobotic surgical systems may allow for greater utilization of MIS approaches to locally advanced disease. We will review the existing literature on MIS for locally advanced disease and briefly report on the results of a recent study conducted at our institution. METHODS We performed a retrospective review of a prospective single institution database to identify patients with clinical stage II and IIIA NSCLC who underwent lobectomy following induction chemotherapy. The patients were classified into two groups (MIS and thoracotomy) and were compared for differences in outcomes and survival. RESULTS From January 2002 to December 2013, 428 patients {397 thoracotomy, 31 MIS [17 robotic and 14 video-assisted thoracic surgery (VATS)]} underwent induction chemotherapy followed by lobectomy. The conversion rate in the MIS group was 26% (8/31) The R0 resection rate was similar between the groups (97% for MIS vs. 94% for thoracotomy; P=0.71), as was postoperative morbidity (32% for MIS vs. 33% for thoracotomy; P=0.99). The median length of hospital stay was shorter in the MIS group (4 vs. 5 days; P<0.001). The 3-year overall survival (OS) was 48.3% in the MIS group and 56.6% in the thoracotomy group (P=0.84); the corresponding 3-year DFS were 49.0% and 42.1% (P=0.19). CONCLUSIONS In appropriately selected patients with NSCLC, MIS approaches to lobectomy following induction therapy are feasible and associated with similar disease-free and OS to those following thoracotomy.
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Affiliation(s)
- Bernard J Park
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China ; 4 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hao-Xian Yang
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China ; 4 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaitlin M Woo
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China ; 4 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Camelia S Sima
- 1 Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA ; 2 Weill Cornell Medical College, New York, NY, USA ; 3 Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China ; 4 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Gonzalez-Rivas D, Yang Y, Sekhniaidze D, Stupnik T, Fernandez R, Lei J, Zhu Y, Jiang G. Uniportal video-assisted thoracoscopic bronchoplastic and carinal sleeve procedures. J Thorac Dis 2016; 8:S210-22. [PMID: 26981273 DOI: 10.3978/j.issn.2072-1439.2016.01.76] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Despite of the recent advanced with the video-assisted thoracoscopic surgery (VATS), the most common approach for bronchial and carinal resection is still the open surgery. The technical difficulties, the steep learning curve and the concerns about performing an oncologic and safe reconstruction in advanced cases, are the main reasons for the low adoption of VATS for sleeve resections. Most of the authors use 3-4 incisions for thoracoscopic sleeve procedures. However these surgical techniques can be performed by a single incision approach by skilled uniportal VATS surgeons. The improvements of the surgical instruments, high definition cameras and recent 3D systems have greatly contributed to facilitate the adoption of uniportal VATS techniques for sleeve procedures. In this article we describe the technique of thoracoscopic bronchial sleeve, bronchovascular and carinal resections through a single incision approach.
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Affiliation(s)
- Diego Gonzalez-Rivas
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Yang Yang
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Dmitrii Sekhniaidze
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Tomaz Stupnik
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Ricardo Fernandez
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Jiang Lei
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Yuming Zhu
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
| | - Gening Jiang
- 1 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, 15006 Coruña, Spain ; 2 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 3 Department of Thoracic Surgery, Regional Oncological Center, Tyumen, Russian Federation ; 4 Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia
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26
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Gonzalez-Rivas D, Yang Y, Stupnik T, Sekhniaidze D, Fernandez R, Velasco C, Zhu Y, Jiang G. Uniportal video-assisted thoracoscopic bronchovascular, tracheal and carinal sleeve resections. Eur J Cardiothorac Surg 2015; 49 Suppl 1:i6-16. [DOI: 10.1093/ejcts/ezv410] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/25/2015] [Indexed: 12/17/2022] Open
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27
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Abstract
Concerns regarding the sequelae of neoadjuvant chemotherapy or chemoradiotherapy on the pleural space and tissue planes had previously deterred the application of video-assisted thoracoscopic (VATS) lobectomy for patients who underwent neoadjuvant therapy. As experience with VATS has increased, however, its application toward more technically demanding operations has also expanded. The diminished impact on pulmonary function associated with the VATS approach may make pulmonary resection more tolerable in compromised patients. This article describes an approach designed for maximal safety on carefully selected patients who have undergone induction therapy.
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Affiliation(s)
- Nathan M Mollberg
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA 98195, USA
| | - Michael S Mulligan
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA 98195, USA.
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28
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Nakanishi R, Shinohara S, Yamashita T, Oyama T, Hanaka T, Kuboi S. Advances in the use of video-assisted thoracoscopic lobectomy in lung cancer: sleeve bronchoplasty and arterioplasty. Lung Cancer Manag 2014. [DOI: 10.2217/lmt.14.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY This article focuses on the technical strategies for performing sleeve bronchoplasty and pulmonary arterioplasty as advances in the application of video-assisted thoracoscopic surgery (VATS) as lobectomy with bronchovascular reconstruction is a favorable alternative to pneumonectomy in terms of the pulmonary function. When performing VATS sleeve bronchoplasty or arterioplasty, several technical issues should be discussed, including how to reduce the anastomotic tension of the airway, perform bronchial anastomosis, and clamp the pulmonary artery and select the type of vascular clamp. The traction device technique and continuous suture technique are thought to help surgeons perform VATS sleeve bronchoplasty, while cross-clamping of the pulmonary artery using thoracoscopic instruments aids in carrying out VATS arterioplasty.
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Affiliation(s)
- Ryoichi Nakanishi
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
| | - Shinji Shinohara
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
| | - Toshihiro Yamashita
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
| | - Tsunehiro Oyama
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
| | - Tetsuya Hanaka
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
| | - Satoshi Kuboi
- Department of Thoracic Disease, Shin-Kokura Hospital, Federation of National Public Service Personnel Mutual Aid Associations, 1–3–1 Kanada, Kokurakita-ku, Kitakyushu 803-8505, Japan
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29
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Yendamuri S. Invited commentary. Ann Thorac Surg 2014; 97:986. [PMID: 24580912 DOI: 10.1016/j.athoracsur.2013.11.047] [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: 11/22/2013] [Revised: 11/22/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Sai Yendamuri
- Thoracic Surgery, Roswell Park Cancer Institute, Elm and Carlton Sts, Buffalo, NY14263.
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