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Uchida S, Hattori A, Fukui M, Matsunaga T, Takamochi K, Suzuki K. Long-term outcomes and risk factors for recurrence after lung segmentectomy. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae125. [PMID: 38950179 PMCID: PMC11245319 DOI: 10.1093/icvts/ivae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/24/2023] [Accepted: 06/29/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES The long-term oncological outcomes and risk factors for recurrence after lung segmentectomy are unclear. The aims of this study were to investigate the long-term prognosis and to evaluate risk factors for recurrence after segmentectomy. METHODS Between January 2008 and December 2012, a total of 177 patients underwent segmentectomy for clinical stage I non-small cell lung cancer. The median follow-up period was 120.1 months. The overall survival (OS) and recurrence-free survival curves were analysed using the Kaplan-Meier method with a log-rank test. Univariable and multivariable analyses were used to identify significant factors that predicted recurrence. RESULTS The study included 177 patients with a median age of 67 years. The median operative time was 155 min. No 30-day deaths were observed. Nine patients (5.1%) had recurrences: loco-regional in 3, distant in 3 and both in 3. The 5-year and 10-year recurrence-free survival rates were 89.7% and 79.8%, and the OS rates were 90.9% and 80.4%, respectively. On multivariable analysis, the risk factor associated with recurrence was a pure solid tumour [hazard ratio, 23.151; 95% confidence interval 2.575-208.178; P = 0.005]. The non-pure solid tumour group had a significantly better probability of survival (5-year OS: 95.4% vs 77.2%; 10-year OS: 86.5% vs 61.8%; P < 0.0001). A total of 113 patients received preoperative positron emission tomography/computed tomography. Patients with a higher maximum standardized uptake value had a significantly higher recurrence rate. CONCLUSIONS Segmentectomy for clinical stage I non-small cell lung cancer produced acceptable long-term outcomes. Pure solid radiographic appearance was associated with recurrence and decreased survival.
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Affiliation(s)
- Shinsuke Uchida
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Uchida S, Matsunaga T, Tomita H, Fukui M, Hattori A, Takamochi K, Suzuki K. Usefulness of final transection of the proximal pulmonary artery in robotic left upper lobectomy. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae054. [PMID: 38676663 PMCID: PMC11082465 DOI: 10.1093/icvts/ivae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/14/2024] [Accepted: 04/26/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES The pulmonary artery runs around the left upper bronchus, which poses the risk of blood vessel injury when cutting in the blind spot of the bronchus. During robotic surgery, the robotic arm holds the tissue under constant tension; therefore, even if the pulmonary artery is left for final transection, it is not injured by unexpected tension. In this study, we examined the usefulness of final transection of the proximal pulmonary artery in robotic left upper lobectomy. METHODS This retrospective single-institution study evaluated patients who had undergone robotic lung resection. Of the 453 robotic lung resections performed at our institution between 2017 and 2022, 49 patients who had undergone left upper lobectomy were evaluated. Patients who had undergone bronchial transection followed by pulmonary artery transection were assigned to the group, bronchus prior transection (BT group, n = 38), and those who had undergone pulmonary artery transection followed by bronchial transection were assigned to the group, pulmonary artery prior transection (AT group, n = 11). Patient characteristics and perioperative outcomes were compared between the groups. RESULTS The groups did not differ significantly in age, sex, smoking history, tumour size, complication rates or 30-day mortality. The BT group inclined to shorter operative times and lesser blood loss. No active intraoperative bleeding occurred in the BT group. However, the AT group had 2 cases of intraoperative pulmonary artery bleeding, one of which required urgent conversion to thoracotomy. CONCLUSIONS Final transection of the proximal pulmonary artery is a novel and effective surgical technique for robotic left upper lobectomy.
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Affiliation(s)
- Shinsuke Uchida
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hisashi Tomita
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Yi L, Xu Z, Ma T, Wang C, Wei P, Xiao B, Zhang H, Che N, Liu Z, Han Y. T-cell subsets and cytokines are indicative of neoadjuvant chemoimmunotherapy responses in NSCLC. Cancer Immunol Immunother 2024; 73:99. [PMID: 38619623 PMCID: PMC11018727 DOI: 10.1007/s00262-024-03687-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE Neoadjuvant PD-1 blockade combined with chemotherapy is a promising treatment for resectable non-small cell lung cancer (NSCLC), yet the immunological mechanisms contributing to tumor regression and biomarkers corresponding to different pathological responses remain unclear. METHODS Using dynamic and paired blood samples from NSCLC patients receiving neoadjuvant chemoimmunotherapy, we analyzed the frequencies of CD8 + T-cell and Treg subsets and their dynamic changes during neoadjuvant treatment through flow cytometry. Cytokine profiles and function-related gene expression of CD8 + T cells and Tregs were analyzed through flow cytometry and mRNA-seq. Infiltrating T-cell subsets in resected tissues from patients with different pathological responses were analyzed through multiplex immunofluorescence. RESULTS Forty-two NSCLC patients receiving neoadjuvant chemoimmunotherapy were enrolled and then underwent surgical resection and pathological evaluation. Nineteen patients had pCR (45%), 7 patients had MPR (17%), and 16 patients had non-MPR (38%). In patients with pCR, the frequencies of CD137 + CD8 + T cells (P = 0.0475), PD-1 + Ki-67 + CD8 + T cells (P = 0.0261) and Tregs (P = 0.0317) were significantly different from those of non-pCR patients before treatment. pCR patients usually had low frequencies of CD137 + CD8 + T cells, PD-1 + Ki-67 + CD8 + T cells and Tregs, and their AUCs were higher than that of tissue PD-L1 expression. Neoadjuvant chemoimmunotherapy markedly improved CD8 + T-cell proliferation and activation, especially in pCR patients, as the frequencies of CD137 + CD8 + (P = 0.0136) and Ki-67 + CD8 + (P = 0.0391) T cells were significantly increased. The blood levels of cytokines such as IL-2 (P = 0.0391) and CXCL10 (P = 0.0195) were also significantly increased in the pCR group, which is consistent with the high density of activated cytotoxic T cells at the tumor site (P < 0.0001). CONCLUSION Neoadjuvant chemoimmunotherapy drives CD8 + T cells toward a proliferative and active profile. The frequencies of CD137 + CD8 + T cells, PD-1 + Ki-67 + CD8 + T cells and Tregs at baseline might predict the response to neoadjuvant chemoimmunotherapy in NSCLC patients. The increase in IL-2 and CXCL10 might reflect the chemotaxis and enrichment of cytotoxic T cells at the tumor site and a better response to neoadjuvant chemoimmunotherapy.
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Affiliation(s)
- Ling Yi
- Department of Central Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Ziwei Xu
- Department of Minimally Invasive Surgery, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Tianyu Ma
- Department of Thoracic Surgery II, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Chong Wang
- Department of Minimally Invasive Surgery, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Panjian Wei
- Department of Central Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Bo Xiao
- Department of Minimally Invasive Surgery, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Hongtao Zhang
- Department of Central Laboratory, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China.
| | - Nanying Che
- Department of Pathology, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China.
| | - Zhidong Liu
- Department of Thoracic Surgery II, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China.
| | - Yi Han
- Department of Minimally Invasive Surgery, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China.
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Kristenson K, Hedman K. Percent predicted peak oxygen uptake is superior to weight-indexed peak oxygen uptake in risk stratification before lung cancer lobectomy. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00187-9. [PMID: 38452887 DOI: 10.1016/j.jtcvs.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To improve preoperative risk stratification in lung cancer lobectomy by identifying and comparing optimal thresholds for peak oxygen uptake (VO2peak) presented as weight-indexed and percent of predicted values, respectively. METHODS This was a longitudinal cohort study including national registry data on patients scheduled for cancer lobectomy that used available data from preoperative cardiopulmonary exercise testing. The measured VO2peak was indexed by body mass (mL/kg/min) and also compared with 2 established reference equations (Wasserman-Hansen and Study of Health in Pomerania, respectively). By receiver operating characteristic analysis, a lower 90% specificity and an upper 90% sensitivity threshold were determined for each measure, in relation to the outcome of any major complication or death. For each measure and based on these thresholds, patients were categorized as low risk, intermediate risk, or high risk. The frequency of complications was compared between groups using χ2. RESULTS The frequency of complications differed significantly between the proposed low-, intermediate-, and high-risk groups when using % predicted Study of Health in Pomerania (5%, 21%, 35%, P = .007) or % predicted Wasserman-Hansen (5%, 25%, 35%, P = .002) but not when using the weight-indexed VO2peak groups (7%, 23%, 15%, P = .08). Nonsignificant differences were found using the threshold <15 mL/kg/min (P = .34). CONCLUSIONS This study showed that weight-indexed VO2peak was of less use as a marker of risk at the lower range of exercise capacity, whereas % predicted VO2peak was associated with a continuously increasing risk of major complications, also at the lower end of exercise capacity. As identifying subjects at high risk of complications is important, % predicted VO2peak is therefore preferable.
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Affiliation(s)
- Karolina Kristenson
- Department of Cardiothoracic and Vascular Surgery, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Kristofer Hedman
- Department of Clinical Physiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Rushwan A, Stefanou D, Tariq J, Drosos P, Chaudhuri N, Milton R, Tcherveniakov P, Papagiannopoulos K, Brunelli A. Increased minute ventilation-to-carbon dioxide slope during cardiopulmonary exercise test is associated with poor postoperative outcome following lung cancer resection. Eur J Cardiothorac Surg 2024; 65:ezad337. [PMID: 37812232 DOI: 10.1093/ejcts/ezad337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/21/2023] [Accepted: 10/07/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Ventilatory efficiency [minute ventilation-to-carbon dioxide output slope (VE/VCO2 slope)] can be measured at sub-maximal workload during cardiopulmonary exercise test. The aim of this study is to assess the association between VE/VCO2 slope and outcome after lung cancer resections. METHODS Retrospective, single-centre analysis on all patients undergoing lung resection for cancer (April 2014-August 2022) and with a preoperative cardiopulmonary exercise test. VE/VCO2 slope >40 was chosen as high-risk threshold. Logistic regression analysis was used to test the association of VE/VCO2 slope and several patient- and surgery-related factors with 90-day mortality. RESULTS A total of 552 patients were included (374 lobectomies, 81 segmentectomies, 55 pneumonectomies and 42 wedge resections). Seventy-four percent were minimally invasive procedures. Cardiopulmonary morbidity was 32%, in-hospital/30-day mortality 6.9% and 90-day mortality 8.9%. A total of 137 patients (25%) had a slope of >40. These patients were older (72 vs 70 years, P = 0.012), had more frequently coronary artery disease (17% vs 10%, P = 0.028), lower carbon monoxide lung diffusion capacity (57% vs 68%, P < 0.001), lower body mass index (25.4 vs 27.0 kg/m2, P = 0.001) and lower peak VO2 (14.9 vs 17.0 ml/kg/min, P < 0.001) than those with a lower slope. The cardiopulmonary morbidity among patients with a slope of >40 was 40% vs 29% in those with lower slope (P = 0.019). Ninety-day mortality was 15% vs 6.7% (P = 0.002). The 90-day mortality of elderly patients with slope >40 was 21% vs 7.8% (P = 0.001). After adjusting for peak VO2 value, extent of operation and other patient-related variables in a logistic regression analysis, VE/VCO2 slope retained a significant association with 90-day mortality. CONCLUSIONS VE/VCO2 slope was strongly associated with morbidity and mortality following lung resection and should be included in the functional algorithm to assess fitness for surgery.
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Affiliation(s)
- Amr Rushwan
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Demetrios Stefanou
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Javeria Tariq
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Polivious Drosos
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Richard Milton
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
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Liu H, Qian SC, Li HY, Shao YF, Zhang HJ. Chinese Additive Anti-inflammatory Action for Aortopathy & Arteriopathy (5A) Registry protocol: rationale, design and methodology. BMC Cardiovasc Disord 2024; 24:120. [PMID: 38383323 PMCID: PMC10882838 DOI: 10.1186/s12872-024-03760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Acute aortic syndrome (AAS) is a life-threatening condition. Inflammation plays a key role in the pathogenesis, development and progression of AAS, and is associated with significant mortality and morbidity. Understanding the inflammatory responses and inflammation resolutions is essential for an appropriate management of AAS. METHOD Thirty Chinese cardiovascular centers have collaborated to create a multicenter observational registry (named Chinese Additive Anti-inflammatory Action for Aortopathy & Arteriopathy [5A] registry), with consecutive enrollment of adult patients who underwent surgery for AAS that was started on Jan 1, 2016 and will be ended on December 31, 2040. Specially, the impact of inflammation and anti-inflammatory strategies on the early and late adverse events are investigated. Primary outcomes are severe systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), Sequential Organ Failure Assessment (SOFA) scores at 7 days following this current surgery. Secondary outcomes are SISR, 30-day mortality, operative mortality, hospital mortality, new-onset stroke, acute kidney injury, surgical site infection, reoperation for bleeding, blood transfusion and length of stay in the intensive care unit. DISCUSSION The analysis of this multicenter registry will allow our better knowledge of the prognostic importance of preoperative inflammation and different anti-inflammatory strategies in adverse events after surgery for AAS. This registry is expected to provide insights into novel different inflammatory resolutions in management of AAS beyond conventional surgical repair. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04398992 (Initial Release: 05/19/2020).
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Affiliation(s)
- Hong Liu
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| | - Si-Chong Qian
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Hai-Yang Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yong-Feng Shao
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China
| | - Hong-Jia Zhang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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de Fréminville A, Saad M, Sage E, Pricopi C, Fischler M, Trillat B, Salze B, Pascreau T, Vasse M, Vallée A, Guen ML, Fessler J. Relationship Between Preoperative Inflammation Ratios Derived From Preoperative Blood Cell Count and Postoperative Pulmonary Complications in Patients Undergoing Lobectomy: A Single-Center Observational Study. J Cardiothorac Vasc Anesth 2024; 38:482-489. [PMID: 38016820 DOI: 10.1053/j.jvca.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/19/2023] [Accepted: 11/01/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Evaluation of the association of inflammatory cell ratios, especially neutrophil-to-lymphocyte ratio (NLR), based on preoperative complete blood counts, with postoperative complications in lobectomy surgery. DESIGN This was a retrospective monocentric cohort study. SETTING The study was conducted at Foch University Hospital in Suresnes, France. PARTICIPANTS Patients having undergone a scheduled lobectomy from January 2018 to September 2021. INTERVENTIONS There were no interventions. MEASUREMENTS AND MAIN RESULTS The authors studied 208 consecutive patients. Preoperative NLR, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammation index, systemic inflammation response index, and aggregate inflammation systemic index were calculated. Median and (IQR) of NLR was 2.67 (1.92-3.69). No statistically significant association was observed between any index and the occurrence of at least one major postoperative complication, which occurred in 37% of the patients. Median postoperative length of stay was 7 (5-10) days. None of the ratios was associated with prolonged length of stay (LOS), defined as a LOS above the 75th percentile. CONCLUSIONS The results suggested that simple available inflammatory ratios are not useful for the preoperative identification of patients at risk of postoperative major complications in elective lobectomy surgery.
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Affiliation(s)
- Amaury de Fréminville
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Mary Saad
- Department of Anesthesia, Institut Curie, PSL Research University, Saint Cloud, France, and PSL Research University, INSERM, Institut Curies, Saint Cloud, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Ciprian Pricopi
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Marc Fischler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France.
| | - Bernard Trillat
- Department of Information Systems, Hôpital Foch, Suresnes, France
| | - Benjamin Salze
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Tiffany Pascreau
- Department of Clinical Biology, Hôpital Foch, Suresnes, France, and Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation, Hôpital Foch, Suresnes, France
| | - Marc Vasse
- Department of Clinical Biology, Hôpital Foch, Suresnes, France, and Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation, Hôpital Foch, Suresnes, France
| | - Alexandre Vallée
- Department of Epidemiology and Public Health, Hôpital Foch, Suresnes, France
| | - Morgan Le Guen
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Julien Fessler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Forcada C, Gómez-Hernández MT, Rivas C, Fuentes M, Novoa N, Varela G, Jiménez M. Operative outcomes and middle-term survival of robotic-assisted lung resection for clinical stage IA lung cancer compared with video-assisted thoracoscopic surgery. Cir Esp 2024; 102:90-98. [PMID: 37967649 DOI: 10.1016/j.cireng.2023.10.003] [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: 07/11/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Despite limited published evidence, robotic-assisted thoracoscopic surgery (RATS) for anatomic lung resection in early-stage lung cancer continues growing. The aim of this study is to evaluate its safety and oncologic efficacy compared to video-assisted thoracoscopic surgery (VATS). METHODS Single-centre retrospective study of all patients with resected clinical stage IA NSCLC who underwent RATS or VATS anatomic lung resection from June 2018 to January 2022. RATS and VATS cases were matched by propensity scoring (PSM) according to age, sex, histology, and type of resection. Short-term outcomes were compared, and the Kaplan-Meier method and log-rank test were used to evaluate the overall survival (OS) and disease-free survival (DFS). RESULTS 321 patients (94 RATS and 227 VATS cases) were included. After PSM, 94 VATS and 94 RATS cases were compared. Demographics, pulmonary function, and comorbidity were similar in both groups. Overall postoperative morbidity was comparable for RATS and VATS cases (20.2% vs 25.5%, P = 0.385, respectively). Pathological nodal upstaging was similar in both groups (10.6% in RATS and 12.8% in VATS). During the 3.5-year follow-up period (median: 29 months; IQR: 18-39), recurrence rate was 6.4% in RATS group and 18.1% in the VATS group (P = 0.014). OS and DFS were similar in RATS and VATS groups (log rank P = 0.848 and P = 0.117, respectively). CONCLUSION RATS can be performed safely in patients with early-stage NSCLC. For clinical stage IA disease, robotic anatomic lung resection offers better oncologic outcomes in terms of recurrence, although there are no differences in OS and DFS compared with VATS.
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Affiliation(s)
- Clara Forcada
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain
| | | | - Cristina Rivas
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Marta Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Nuria Novoa
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research, Salamanca, Spain
| | - Marcelo Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
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Jain U, Jain B, Brown J, Sultan IB, Thoma F, Anetakis KM, Balzer JR, Subramaniam K, Yousef S, Wang Y, Nogueira R, Thirumala PD. Outcomes after Perioperative Transient Ischemic Attack Following Cardiac Surgery. J Cardiovasc Dev Dis 2024; 11:27. [PMID: 38248897 PMCID: PMC10816235 DOI: 10.3390/jcdd11010027] [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: 12/26/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
Perioperative transient ischemic attacks (PTIAs) are associated with significantly increased rates of postoperative complications such as low cardiac output, atrial fibrillation, and significantly higher mortality in cardiac procedures. The current literature on PTIAs is sparse and understudied. Therefore, we aim to understand the effects of PTIA on hospital utilization, readmission, and morbidity. Using data on all the cardiac procedures at the University of Pittsburgh Medical Center from 2011 to 2019, fine and gray analysis was performed to identify whether PTIAs and covariables correlate with increased hospital utilization, stroke, all-cause readmission, Major Adverse Cardiac and Cerebrovascular Events (MACCE), MI, and all-cause mortality. Logistic regression for longer hospitalization showed that PTIA (HR: 2.199 [95% CI: 1.416-3.416] increased utilization rates. Fine and gray modeling indicated that PTIA (HR: 1.444 [95% CI: 1.096-1.902], p < 0.01) increased the rates of follow-up all-cause readmission. However, PTIA (HR: 1.643 [95% CI: 0.913-2.956] was not statistically significant for stroke readmission modeling. Multivariate modeling for MACCE events within 30 days of surgery (HR: 0.524 [95% CI: 0.171-1.605], p > 0.25) and anytime during the follow-up period (HR: 1.116 [95% CI: 0.825-1.509], p > 0.45) showed no significant correlation with PTIA. As a result of PTIA's significant burden on the healthcare system due to increased utilization, it is critical to better define and recognize PTIA for timely management to improve perioperative outcomes.
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Affiliation(s)
- Urvish Jain
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Bhav Jain
- School of Medicine, Stanford University, Stanford, CA 94305, USA;
| | - James Brown
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (J.B.); (S.Y.); (Y.W.)
| | - Ibrahim B. Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (J.B.); (S.Y.); (Y.W.)
| | - Floyd Thoma
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (J.B.); (S.Y.); (Y.W.)
| | - Katherine M. Anetakis
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (K.M.A.); (J.R.B.); (P.D.T.)
| | - Jeffrey R. Balzer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (K.M.A.); (J.R.B.); (P.D.T.)
| | - Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Sarah Yousef
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (J.B.); (S.Y.); (Y.W.)
| | - Yisi Wang
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (J.B.); (S.Y.); (Y.W.)
| | - Raul Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Parthasarathy D. Thirumala
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (K.M.A.); (J.R.B.); (P.D.T.)
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
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10
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Kendall F, Silva G, Drummond M, Viana P, Eusébio E, Pinho P, Oliveira J, Bastos PT. Predictors of prolonged hospital stay in patients undergoing lung resection. Disabil Rehabil 2024:1-7. [PMID: 38166526 DOI: 10.1080/09638288.2023.2297936] [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: 02/28/2023] [Accepted: 12/16/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE To identify potential predictors of prolonged length of hospital stay in patients submitted to lung resection surgery. MATERIALS AND METHODS This is a cohort study, carried out in 105 patients with lung cancer, submitted to posterolateral thoracotomy pulmonary resection. Data collection included preoperative assessment of demographic, clinical, pulmonary function, respiratory muscle function, physical fitness, and behavioral habits. After surgery, length of hospital stay was documented, and the sample was divided into two groups according to the length of hospital stay (LOS): the normal hospital stay group (NLOS) until 8 days, and the prolonged hospital stay group (PLOS) with more than 8 days of hospital stay. Multiple linear regressions were performed between length of hospital stay and the studied variables, for the total sample and, specifically, for the PLOS group. RESULTS The multiple linear regression for the total sample, the most explanatory power variables were TLC, MIP, PEF, and BMI. When considering only the PLOS, the variables that mostly explained were the MIP%, MEP and TLC%. CONCLUSION Besides the classic outcomes used to calculate surgical risk, the body mass index, respiratory muscle strength, peak expiratory flow, and total lung capacity are predictors of the variation on length of hospital stay in patients submitted to lung resection.
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Affiliation(s)
- Filipa Kendall
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
- CESPU, Polytechnic Health Institute of the North, Gandra (PRD), Portugal
| | - Gustavo Silva
- Research Center in Sports Sciences, Health and Human Development (CIDESD), University of Maia (UMaia), Maia, Portugal
| | - Marta Drummond
- Pulmonology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Viana
- Pulmonology Department, Centro Hospitalar São João, Porto, Portugal
- Health School, Polytechnic Institute of Porto, Porto, Portugal
| | | | - Paulo Pinho
- Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - José Oliveira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
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11
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Tsubokawa N, Mimae T, Ito R, Sasai R, Hirano K, Kamigaichi A, Kawamoto N, Miyata Y, Okada M. Effectiveness of pleurodesis for postoperative air leaks after lung resection. J Cardiothorac Surg 2024; 19:2. [PMID: 38167171 PMCID: PMC10762858 DOI: 10.1186/s13019-023-02444-6] [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: 04/08/2023] [Accepted: 11/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Pleurodesis is often performed for air leaks; however, the ideal materials and timing of the procedure remain controversial. We investigated the efficacy of pleurodesis using different materials and timing. METHODS We retrospectively reviewed 913 consecutive patients who underwent segmentectomy or lobectomy for non-small cell lung cancer between 2014 and 2021. Pleurodesis efficacy was assessed on the day of chest tube removal. RESULTS Eighty-six patients (9%) underwent pleurodesis for postoperative air leaks. Pleurodesis was performed on a median of postoperative day (POD) 5. Talc was the most frequently used material (n = 52, 60%), followed by autologous blood patches (n = 20, 23%), OK-432 (n = 12, 14%), and others (n = 2, 2%). No difference existed in the number of days from initial pleurodesis to chest tube removal among the three groups (talc, 3 days; autologous blood patch, 3 days; OK-432, 2 days; P = 0.55). No difference in patient background, except for sex, was observed between patients who underwent pleurodesis within 4 PODs and those who underwent pleurodesis on POD 5 or later. Drainage time was significantly shorter in patients who underwent pleurodesis within 4 PODs (median, 7 vs. 9 days; P = 0.004). CONCLUSIONS The efficacies of autologous blood patch, talc, and OK-432 would be considered comparable and early postoperative pleurodesis could shorten drainage time. Prospective studies are required.
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Affiliation(s)
- Norifumi Tsubokawa
- Department of Surgical Oncology, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Risa Ito
- Department of Surgical Oncology, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ryuma Sasai
- Department of Surgical Oncology, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kouichi Hirano
- Department of Surgical Oncology, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Atsushi Kamigaichi
- Department of Surgical Oncology, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobutaka Kawamoto
- Department of Surgical Oncology, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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12
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Kristenson K, Gerring E, Björnsson B, Sandström P, Hedman K. Peak oxygen uptake in combination with ventilatory efficiency improve risk stratification in major abdominal surgery. Physiol Rep 2024; 12:e15904. [PMID: 38163673 PMCID: PMC10758333 DOI: 10.14814/phy2.15904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
This pilot study aimed to evaluate if peak VO2 and ventilatory efficiency in combination would improve preoperative risk stratification beyond only relying on peak VO2 . This was a single-center retrospective cohort study including all patients who underwent cardiopulmonary exercise testing (CPET) as part of preoperative risk evaluation before major upper abdominal surgery during years 2008-2021. The primary outcome was any major cardiopulmonary complication during hospitalization. Forty-nine patients had a preoperative CPET before decision to pursue to surgery (cancer in esophagus [n = 18], stomach [6], pancreas [16], or liver [9]). Twenty-five were selected for operation. Patients who suffered any major cardiopulmonary complication had lower ventilatory efficiency (i.e., higher VE/VCO2 slope, 37.3 vs. 29.7, p = 0.031) compared to those without complications. In patients with a low aerobic capacity (i.e., peak VO2 < 20 mL/kg/min) and a VE/VCO2 slope ≥ 39, 80% developed a major cardiopulmonary complication. In this pilot study of patients with preoperative CPET before major upper abdominal surgery, patients who experienced a major cardiopulmonary complication had significantly lower ventilatory efficiency compared to those who did not. A low aerobic capacity in combination with low ventilatory efficiency was associated with a very high risk (80%) of having a major cardiopulmonary complication.
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Affiliation(s)
- Karolina Kristenson
- Department of Thoracic and Vascular Surgery in Östergötland, and Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Edvard Gerring
- Department of Clinical Physiology, and Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Bergthor Björnsson
- Department of Surgery, Department of Biomedicine and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Per Sandström
- Department of Surgery, Department of Biomedicine and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Kristofer Hedman
- Department of Clinical Physiology, and Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
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13
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Du C, Chen Y, Zhou Y, Zheng D, Zhao J, Tang J, Wu Y, Tu Z. Neo-adjuvant chemotherapy plus immunotherapy in resectable N1/N2 NSCLC. BMC Cancer 2023; 23:1260. [PMID: 38129808 PMCID: PMC10734172 DOI: 10.1186/s12885-023-11745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Locally advanced non-small cell lung cancer (NSCLC) with N1/N2 lymph node metastasis is challenging with poor survival. Neo-adjuvant chemo-immunotherapy has gained benefits in a proportion of these patients. However no specific biomarker has been proved to predict the effect before therapy. In addition, the relationship of nodal status and survival after neo-adjuvant chemo-immunotherapy is still not well stated. METHODS A total of 75 resectable NSCLC patients with N1/N2 stage who received neo-adjuvant chemo-immunotherapy plus surgery were retrospectively studied. The clinical characteristics, surgical information and safety parameters were collected. The correlations of major pathological response (MPR) and pathological complete response (pCR) with clinical data were analyzed. The progression free disease(PFS) and overall survival(OS) were evaluated with pathological response and nodal status. RESULTS Of the 75 patients, 69 (92%) patients experienced treatment related adverse effects, while grade 3-4 adverse effects occurred in 8 (10%) patients. All the patients received surgical R0 resection with a MPR rate of 60% and a pCR rate of 36%. 67% of N1 patients and 77% of N2 patients had nodal clearance after neo-adjuvant treatment. A significant difference was observed between pathological response with age, histology and multiple lymph node metastasis. The PFS was better in the MPR cohort. The PFS was 90.1% and 83.6% at the nodal clearance group at the time of 12 and 18 months, compared with 70.1% and 63.7% at the nodal residual group. CONCLUSIONS The neo-adjuvant chemo-immunotherapy for locally advanced NSCLC with nodal positive was safe and feasible. The patients with elder age and squamous-cell carcinoma (SCC) were more likely to have better pathological response, while multiple nodal metastasis was a negative predictor. The clearance of lymph node resulted in significantly longer PFS and OS.
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Affiliation(s)
- Chengli Du
- Department of Thoracic Surgery, the first affiliated hospital, Zhejiang University School, 1367 West Wenyi Rd., Hangzhou, 311121, China
| | - Yunhao Chen
- Department of Thoracic Surgery, the first affiliated hospital, Zhejiang University School, 1367 West Wenyi Rd., Hangzhou, 311121, China
| | - Yuwei Zhou
- Department of Thoracic Surgery, the first affiliated hospital, Zhejiang University School, 1367 West Wenyi Rd., Hangzhou, 311121, China
| | - Difang Zheng
- Department of Thoracic Surgery, the first affiliated hospital, Zhejiang University School, 1367 West Wenyi Rd., Hangzhou, 311121, China
| | - Jiangang Zhao
- Department of Thoracic Surgery, the first affiliated hospital, Zhejiang University School, 1367 West Wenyi Rd., Hangzhou, 311121, China
| | - Jie Tang
- Department of Thoracic Surgery, the first affiliated hospital, Zhejiang University School, 1367 West Wenyi Rd., Hangzhou, 311121, China
| | - Yihe Wu
- Department of Thoracic Surgery, the first affiliated hospital, Zhejiang University School, 1367 West Wenyi Rd., Hangzhou, 311121, China
| | - Zhengliang Tu
- Department of Thoracic Surgery, the first affiliated hospital, Zhejiang University School, 1367 West Wenyi Rd., Hangzhou, 311121, China.
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14
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Brunelli A, Rushwan A, Stefanou D, Drosos P, Chaudhuri N, Milton R, Tcherveniakov P, Papagiannopoulos K, Valuckiene L. Minimally invasive segmentectomy and lobectomy for peripheral stage IA1-2 non-small-cell lung cancer: a case-matched cohort study from a UK Centre. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad204. [PMID: 38092061 PMCID: PMC10746861 DOI: 10.1093/icvts/ivad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/22/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES The objective of this study is to compare in a real-world series the short- and long-term results of segmentectomy and lobectomy for peripheral clinical stage IA non-small-cell lung cancer (NSCLC). METHODS Single-centre cohort study including a series of consecutive patients undergoing minimally invasive segmentectomy or lobectomy for peripheral (outer third of the lung) clinical stage IA NSCLC (January 2017-August 2022). Propensity score case matching analysis generated 2 matched groups of patients undergoing segmentectomy or lobectomy. Short-term (morbidity and mortality) and long-term [overall survival and event-free survival (EFS)] outcomes were compared between the 2 matched groups. EFS was calculated by including death resulting from any cause and any recurrence as events. RESULTS Propensity score generated 118 pairs of patients undergoing minimally invasive segmentectomy or lobectomy. The median follow-up was 30 months (95% confidence limits (CL) 4-64). The median postoperative length of stay was 4 days in both groups. Ninety-day mortality was similar (segmentectomy 2.5% versus lobectomy 1.7%, P = 1). Three-year overall survival [segmentectomy 87% (76-93) versus lobectomy 81% (72-88), P = 0.73] and EFS [segmentectomy 82% (72-90) versus lobectomy 78% (68-84), P = 0.52] did not differ between the groups. Loco-regional recurrence rate [segmentectomy 4.2% (5/118) versus lobectomy 9.3% (11/118), P = 0.19] was similar despite a lower nodal upstaging [segmentectomy 3.4% (4/118) versus lobectomy 14% (17/118), P = 0.005]. The occurrence of compromised resection margins (pR1 or pR uncertain) was similar between the groups [segmentectomy 7.6% (9/118) versus lobectomy 9.3% (11/118), P = 0.81]. CONCLUSIONS This observational series confirms the non-inferiority of segmentectomy compared to lobectomy in treating peripherally located stage IA NSCLC.
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Affiliation(s)
- Alessandro Brunelli
- University of Leeds, School of Medicine, Leeds, UK
- Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK
| | - Amr Rushwan
- Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK
| | - Demetrios Stefanou
- Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK
| | - Polivious Drosos
- Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK
| | - Nilanjan Chaudhuri
- Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK
| | - Richard Milton
- Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK
| | | | | | - Laura Valuckiene
- Department of Thoracic Surgery, St James’s University Hospital, Leeds, UK
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15
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Zhang Y, Wang Y, Chen J, Li J, Sun Y, Lai H, Wang C, Ji Q. No Sex-Based Differences Exist in Clinical Outcomes of Extended Aortic Arch Repair for Acute Type A Aortic Dissection. Can J Cardiol 2023; 39:1675-1685. [PMID: 37480989 DOI: 10.1016/j.cjca.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Reports regarding the association between sex and clinical outcomes after surgical repair of acute type A aortic dissection (ATAAD) are not exhaustive and in part even conflicting. METHODS A total of 786 eligible adult patients with ATAAD undergoing extended arch repair from January 2015 to December 2021 were included. They were divided into a female group (n = 161) and a male group (n = 625). In-hospital outcomes (surgical mortality and major postoperative morbidity) and midterm outcomes (survival and aortic reintervention) between the 2 groups were compared before and after propensity score matching (1:1). RESULTS Compared with male patients, female patients were more likely to be older (median [interquartile range]: 57 [46-67] vs 50 [42-59] years; P < 0.001) and to have a lower body mass index, but were less likely to be current smokers. Operative death occurred in 66 patients (6.8% female vs 8.8% male), without significant differences between groups before and after matching (P = 0.422 and P > 0.999, respectively). Major postoperative morbidity was observed in 313 patients (39.8%), including 57 (35.4%) female and 256 (41.0%) male patients (P = 0.199). Sex-based grouping was not significantly associated with operative mortality or major postoperative morbidity. The 5-year cumulative survival and incidence of aortic reintervention among female patients were 90.6% and 6.0%, respectively, which were not statistically different from those observed in male patients before and after matching. CONCLUSIONS No sex-based differences were found in terms of in-hospital and midterm outcomes of extended arch repair for ATAAD.
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Affiliation(s)
- Yixiao Zhang
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Yulin Wang
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Jinmiao Chen
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Jun Li
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Yongxin Sun
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Hao Lai
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China; Shanghai Municipal Institute for Cardiovascular Diseases, Shanghai, China.
| | - Qiang Ji
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, China.
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16
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Forcada C, Gómez-Hernández MT, Fuentes MG, Rivas CE, Novoa NM, Aranda JL, Varela G, Jiménez MF. Robotic-Assisted Thoracoscopic Anatomical Lung Resection Improves Cardiopulmonary Outcomes in Patients With Body Mass Index≥25kg/m 2: A Propensity Score Matching Analysis. Arch Bronconeumol 2023; 59:779-781. [PMID: 37709586 DOI: 10.1016/j.arbres.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/01/2023] [Accepted: 08/19/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Clara Forcada
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - María Teresa Gómez-Hernández
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain.
| | - Marta G Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Cristina E Rivas
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain
| | - Nuria M Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - José Luis Aranda
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research, Salamanca, Spain
| | - Marcelo F Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
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17
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Fra-Fernández S, Muñoz-Molina GM, Cabañero-Sánchez A, Del Campo-Albendea L, Bolufer-Nadal S, Embún-Flor R, Martínez-Hernández NJ, Moreno-Mata N. Postoperative morbidity after anatomical lung resections by VATS vs thoracotomy: Treatment and intention-to-treat analysis of the Spanish Video-Assisted Thoracic Surgery Group. Cir Esp 2023; 101:778-786. [PMID: 37422151 DOI: 10.1016/j.cireng.2023.05.012] [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: 10/25/2022] [Accepted: 05/04/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES In recent years, video-assisted thoracoscopic lung resections (VATS) have been associated with lower morbidity than open surgery. The aim of our study is to compare postoperative morbidity among patients from the national database of the Spanish Group of Video-Assisted Thoracic Surgery (GE-VATS) after open and video-assisted anatomic lung resections using a propensity score analysis. METHODS From December 2016 to March 2018, a total of 3533 patients underwent anatomical lung resection at 33 centers. Pneumonectomies and extended resections were excluded. A propensity score analysis was performed to compare the morbidity of the thoracotomy group (TG) vs the VATS group (VATSG). Treatment and intention-to-treat (ITT) analyses were conducted. RESULTS In total, 2981 patients were finally included in the study: 1092 (37%) in the TG and 1889 (63%) in the VATSG for the treatment analysis; and 816 (27.4%) in the TG and 2165 patients (72.6%) in the VATSG for the ITT analysis. After propensity score matching, in the treatment analysis, the VATSG was significantly associated with fewer overall complications than the TG OR 0.680 [95%CI 0.616, 0.750]), fewer respiratory (OR 0.571 [0.529, 0.616]) cardiovascular (OR 0.529 [0.478, 0.609]) and surgical (OR 0.875 [0.802, 0.955]) complications, lower readmission rate (OR 0.669 [0.578, 0.775]) and a reduction of hospital length of stay (-1.741 ([-2.073, -1.410]). Intention-to-treat analysis showed only statistically significant differences in overall complications (OR 0.76 [0.54-0.99]) in favor of the VATSG. CONCLUSION In this multicenter population, VATS anatomical lung resections have been associated with lower morbidity than those performed by thoracotomy. However, when an intention-to-treat analysis was performed, the benefits of the VATS approach were less prominent.
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Affiliation(s)
- Sara Fra-Fernández
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | | | | | | | - Sergio Bolufer-Nadal
- Department of Thoracic Surgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Raúl Embún-Flor
- Department of Thoracic Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Nicolás Moreno-Mata
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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18
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Soro-García J, Cilleruelo Ramos Á, Fuentes-Martín Á, Loucel Bellino MA, Mora Puentes DA, Victoriano Soriano GI, Matilla González JM. Outcomes of Surgery for Metachronous Second Primary Non-small Cell Lung Cancer. Arch Bronconeumol 2023; 59:743-749. [PMID: 37612175 DOI: 10.1016/j.arbres.2023.07.027] [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: 06/08/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE The optimal surgical approach for second primary metachronous lung cancer (MPLC) remains unclear. Our aim is to evaluate the morbidity and prognostic value based on the extent of surgical resection in MPLC. METHODS Retrospective study of 84 patients with a history of anatomical resection for lung cancer and MPLC surgically treated between January 2010 and December 2020. RESULTS The interval between the initial primary tumor and the second was 50.38±32.89 months. The second resection was contralateral in 43 patients (51.2%) and ipsilateral in 41 (48.8%). Thirty-six patients (42.9%) underwent a second anatomical resection, and in 48 patients (57.1%), it was non-anatomical. Postoperative complications were observed in 29 patients (34.5%) after the second lung resection. According to the Clavien-Dindo classification, 95.2% were mild (Clavien-Dindo I-II), and a single patient died (1.2%) in the postoperative period (Grade V). Prolonged air leak (p=0.037), postoperative arrhythmias (p=0.019) and hospital stay showed significant differences depending on the extent of surgery in ipsilateral resections. The main histological type was adenocarcinoma (47.6%) and the median tumor size was 17.74±11.74mm. The overall survival was 58.07 months (95% CI 49.29-66.85) for patients undergoing anatomical resection and 50.97 months (95% CI 43.31-58.63) for non-anatomical without significant differences (p=0.144). The disease-free survival after the second surgery was 53.75 months (95% CI 45.28-62.23) for anatomical resection and 41.34 months (95% CI 33.04-49.65) for non-anatomical group. CONCLUSION Second anatomical resections provide good long-term outcomes and have been shown to provide better disease-free survival compared to non-anatomical resections in properly selected patients.
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Affiliation(s)
- José Soro-García
- Thoracic Surgery Department, Hospital Clínico Universitario de Valladolid, Spain.
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19
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Ismahel H, Hughes C, Lafferty B, Shelley B. Prediction of postoperative cardiopulmonary complications via assessment of heart rate recovery after submaximal exercise testing. Anaesthesia 2023; 78:1295-1297. [PMID: 37211873 DOI: 10.1111/anae.16043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Affiliation(s)
- H Ismahel
- Peri-operative Medicine and Critical Care Research Group, Glasgow Royal Infirmary, Glasgow, UK
| | - C Hughes
- Peri-operative Medicine and Critical Care Research Group, Glasgow Royal Infirmary, Glasgow, UK
| | - B Lafferty
- Peri-operative Medicine and Critical Care Research Group, Glasgow Royal Infirmary, Glasgow, UK
| | - B Shelley
- Peri-operative Medicine and Critical Care Research Group, Glasgow Royal Infirmary, Glasgow, UK
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20
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Jones D, Kumar S, Anstee C, Gingrich M, Simone A, Ahmadzai Z, Thavorn K, Seely A. Index hospital cost of adverse events following thoracic surgery: a systematic review of economic literature. BMJ Open 2023; 13:e069382. [PMID: 37770272 PMCID: PMC10546169 DOI: 10.1136/bmjopen-2022-069382] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 07/26/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES Adverse events (AEs) following thoracic surgery place considerable strain on healthcare systems. A rigorous evaluation of the economic impact of thoracic surgical AEs remains lacking and is required to understand the value of money of formal quality improvement initiatives. Our objective was to conduct a systematic review of all available literature focused on specific cost of postoperative AEs following thoracic surgery. DESIGN Systematic review of the economic literature was performed, following recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES An economic search filter developed by the Canadian Agency for Drugs and Technologies in Health was applied, and MEDLINE, Embase and The Cochrane Library were searched from inception to January 2022. ELIGIBILITY CRITERIA We included English articles involving adult patients who underwent a thoracic surgical procedure with estimated costs of postoperative complications. Eligible study designs included comparative observational studies, randomised control trials, decision analytic or cost-prediction models, cost analyses, cost or burden of illness studies, economic evaluation studies and systematic reviews and/or meta-analyses of cost analyses and cost of illness studies. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened titles and abstracts in the first stage and full-text articles of included studies in the second stage. Disagreements during abstract and full-text screening stages were resolved via discussion until a consensus was reached. Studies were appraised for methodological quality using the Critical Appraisal Skills Program checklist. RESULTS 3349 studies were identified: 20 met inclusion criteria. Most were conducted in the USA (12/20), evaluating AE impact on hospital expenditures (18/20). 68 procedure-specific AE mean costs were characterised (USD$). The most commonly described were anastomotic leak (mean:range) (USD$49 278:$6 176-$133 002) and pneumonia ($12 258:$2608-$34 591) following esophagectomy, and prolonged air leak ($2556:$571-$3573), respiratory failure ($19 062:$11 841-$37 812), empyema ($30 189:$23 784-$36 595), pneumonia ($15 362:$2542-$28 183), recurrent laryngeal nerve injury ($16 420:$4224-$28 616) and arrhythmia ($6835:$5833-$8659) following lobectomy. CONCLUSIONS Hospital costs associated with AEs following thoracic surgery are substantial and varied. Quantifying costs of AEs enable future economic evaluation studies, which could help prioritising value-directed quality improvement to optimally improve outcomes and reduce costs.
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Affiliation(s)
- Daniel Jones
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
- Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Srishti Kumar
- Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Caitlin Anstee
- Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Molly Gingrich
- Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexander Simone
- Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrew Seely
- Department of Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
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Gabryel P, Skrzypczak P, Campisi A, Kasprzyk M, Roszak M, Piwkowski C. Predictors of Long-Term Survival of Thoracoscopic Lobectomy for Stage IA Non-Small Cell Lung Cancer: A Large Retrospective Cohort Study. Cancers (Basel) 2023; 15:3877. [PMID: 37568693 PMCID: PMC10416904 DOI: 10.3390/cancers15153877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The standard of care for patients with early-stage non-small cell lung cancer (NSCLC) is anatomical lung resection with lymphadenectomy. This multicenter, retrospective, cohort study aimed to identify predictors of 5-year survival in patients after thoracoscopic lobectomy for stage IA NSCLC. The study included 1249 patients who underwent thoracoscopic lobectomy for stage IA NSCLC between 17 April 2007, and December 28, 2016. The 5-year survival rate equaled 77.7%. In the multivariate analysis, higher age (OR, 1.025, 95% CI: 1.002 to 1.048; p = 0.032), male sex (OR, 1.410, 95% CI: 1.109 to 1.793; p = 0.005), chronic obstructive pulmonary disease (OR, 1.346, 95% CI: 1.005 to 1.803; p = 0.046), prolonged postoperative air leak (OR, 2.060, 95% CI: 1.424 to 2.980; p < 0.001) and higher pathological stage (OR, 1.271, 95% CI: 1.048 to 1.541; p = 0.015) were related to the increased risk of death within 5 years after surgery. Lobe-specific mediastinal lymph node dissection (OR, 0.725, 95% CI: 0.548 to 0.959; p = 0.024) was related to the decreased risk of death within 5 years after surgery. These findings provide valuable insights for clinical practice and may contribute to improving the quality of treatment of early-stage NSCLC.
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Affiliation(s)
- Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland; (P.S.); (M.K.); (C.P.)
| | - Piotr Skrzypczak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland; (P.S.); (M.K.); (C.P.)
| | - Alessio Campisi
- Department of Thoracic Surgery, University and Hospital Trust—Ospedale Borgo Trento, Piazzale Aristide Stefani 1, 37126 Verona, Italy;
| | - Mariusz Kasprzyk
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland; (P.S.); (M.K.); (C.P.)
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Rokietnicka 7 Street, 60-806 Poznan, Poland;
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland; (P.S.); (M.K.); (C.P.)
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22
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Gabryel P, Roszak M, Skrzypczak P, Gabryel A, Zielińska D, Sielewicz M, Campisi A, Kasprzyk M, Piwkowski C. Identification of Factors Related to the Quality of Lymphadenectomy for Lung Cancer: Secondary Analysis of Prospective Randomized Trial Data. J Clin Med 2023; 12:jcm12113780. [PMID: 37297976 DOI: 10.3390/jcm12113780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The outcomes of non-small cell lung cancer surgery are influenced by the quality of lymphadenectomy. This study aimed to evaluate the impact of different energy devices on lymphadenectomy quality and identify additional influencing factors. This secondary analysis of the prospective randomized trial data (clinicaltrials.gov: NCT03125798) compared patients who underwent thoracoscopic lobectomy with the LigaSure device (study group, n = 96) and monopolar device (control group, n = 94). The primary endpoint was the lobe-specific mediastinal lymphadenectomy. Lobe-specific mediastinal lymphadenectomy criteria were met in 60.4% and 38.3% of patients in the study and control groups, respectively (p = 0.002). In addition, in the study group, the median number of mediastinal lymph node stations removed was higher (4 vs. 3, p = 0.017), and complete resection was more often achieved (91.7% vs. 80.9%, p = 0.030). Logistic regression analysis indicated that lymphadenectomy quality was positively associated with the use of the LigaSure device (OR, 2.729; 95% CI, 1.446 to 5.152; p = 0.002) and female sex (OR, 2.012; 95% CI, 1.058 to 3.829; p = 0.033), but negatively associated with a higher Charlson Comorbidity Index (OR, 0.781; 95% CI, 0.620 to 0.986; p = 0.037), left lower lobectomy (OR, 0.263; 95% CI, 0.096 to 0.726; p = 0.010) and middle lobectomy (OR, 0.136; 95% CI, 0.031 to 0.606, p = 0.009). This study found that using the LigaSure device can improve the quality of lymphadenectomy in lung cancer patients and also identified other factors that affect the quality of lymphadenectomy. These findings contribute to improving lung cancer surgical treatment outcomes and provide valuable insights for clinical practice.
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Affiliation(s)
- Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Rokietnicka 7 Street, 60-806 Poznan, Poland
| | - Piotr Skrzypczak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Anna Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Dominika Zielińska
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Magdalena Sielewicz
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Alessio Campisi
- Department of Thoracic Surgery, University and Hospital Trust-Ospedale Borgo Trento, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Mariusz Kasprzyk
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland
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Messina G, Natale G, Bove M, Opromolla G, Di Filippo V, Martone M, Noro A, Leonardi B, Mirra R, Capasso F, Pica DG, Grande M, Panini D'alba F, Vicario G, Liguori G, Fiorito R, Ciaravola M, Massimilla E, Messina G, Fiorelli A, Vicidomini G, Ciardiello F, Fasano M. Intraoperative ventilatory leak: Real-time guidance for management of air leak in lung cancer patients undergoing VATS lobectomy. Thorac Cancer 2023. [PMID: 37144333 DOI: 10.1111/1759-7714.14925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Persistent air leak (PAL) is a common complication after video-assisted thoracoscopic surgery (VATS) lobectomy. We aimed to evaluate whether the intraoperative quantitative measurement of air leaks using a mechanical ventilation test could predict PAL and identify those patients needing additional treatment for the prevention of PAL. METHODS This was an observational, retrospective, single-center study that included 82 patients who underwent VATS lobectomy with a mechanical ventilation test for VL. Only 2% of patients who underwent lobectomy surgery had persistent air leaks. RESULTS At the end of lobectomy performed in patients with non-small cell lung cancer, the lung was reinflated at a 25-30 mmH2O pressure and ventilatory leaks (VL) were calculated and in relation to the entity of the air leaks, we evaluated the most suitable intraoperative treatment to prevent persistent air leaks. CONCLUSION VL is an independent predictor of PAL after VATS lobectomy; it provides a real-time intraoperative guidance to identify those patients who can benefit from additional intraoperative preventive interventions to reduce PAL.
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Affiliation(s)
- Gaetana Messina
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Mary Bove
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Giorgia Opromolla
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Vincenzo Di Filippo
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Mario Martone
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Antonio Noro
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Beatrice Leonardi
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Rosa Mirra
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Francesca Capasso
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Davide Gerardo Pica
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Mario Grande
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Francesco Panini D'alba
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Giuseppe Vicario
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Giovanni Liguori
- Anesthesiology and Intensive Care Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Roberta Fiorito
- Anesthesiology and Intensive Care Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Massimo Ciaravola
- Anesthesiology and Intensive Care Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Eva Massimilla
- Otorhinolaryngology Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | | | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Giovanni Vicidomini
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Fortunato Ciardiello
- Oncology, Department of Precision Medicine, Università della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Morena Fasano
- Oncology, Department of Precision Medicine, Università della Campania "Luigi Vanvitelli", Naples, Campania, Italy
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24
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A Clinical Prediction Model for Postoperative Pneumonia After Lung Cancer Surgery. J Surg Res 2023; 284:62-69. [PMID: 36549037 DOI: 10.1016/j.jss.2022.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/24/2022] [Accepted: 11/06/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Postoperative pneumonia (POP) is a common complication following lung cancer surgery and is associated with increased hospitalization costs and mortalities. We aimed to identify risk factors associated with POP and to develop a reliable predictive model. METHODS Patients who underwent lung cancer surgery between January 2015 and December 2021 in our hospital were enrolled. Least absolute shrinkage and selection operator regression analysis was used to select predictors of POP. Multivariable logistic regression was performed to construct the nomogram. Bootstrap resampling was conducted for internal validation. The performance of the model was evaluated by discrimination and calibration. RESULTS A total of 5269 consecutive patients were enrolled. POP occurred in 1.7% of patients (92/5269). Five independent predictors were identified: age, predicted forced expiratory volume in 1 s, predicted diffusing capacity of the lungs for carbon monoxide, tuberculosis history, and surgery duration. The multivariable regression model showed good discrimination (C-index: 0.821, 95% confidence interval, 0.783-0.859), which was well validated by internal validation. The calibration curve illustrated good agreement between the predicted probability and observed probability of POP. CONCLUSIONS Based on the easily available risk factors, our nomogram could predict the risk of POP with good discrimination and calibration. The model has good clinical practicability, enabling precise and targeted interventions to reduce the incidence of POP in high-risk patients.
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25
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Orlandi R, Rinaldo RF, Mazzucco A, Baccelli A, Mondoni M, Marchetti F, Zagaria M, Cefalo J, Leporati A, Montoli M, Ghilardi G, Baisi A, Centanni S. Early outcomes of “low-risk” patients undergoing lung resection assessed by cardiopulmonary exercise testing: Single-institution experience. Front Surg 2023; 10:1130919. [PMID: 37009610 PMCID: PMC10062454 DOI: 10.3389/fsurg.2023.1130919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveCardiopulmonary exercise testing (CPET) is currently recommended for all patients undergoing lung resection with either respiratory comorbidities or functional limitations. The main parameter evaluated is oxygen consumption at peak (VO2peak). Patients with VO2peak above 20 ml/kg/min are classified as low risk surgical candidates. The aims of this study were to evaluate postoperative outcomes of low-risk patients, and to compare their outcomes with those of patients without pulmonary impairment at respiratory function testing.MethodsRetrospective monocentric observational study was designed, evaluating outcomes of patients undergoing lung resection at San Paolo University Hospital, Milan, Italy, between January 2016 and November 2021, preoperatively assessed by CPET, according to 2009 ERS/ESTS guidelines. All low-risk patients undergoing any extent surgical lung resection for pulmonary nodules were enrolled. Postoperative major cardiopulmonary complications or death, occurring within 30 days from surgery, were assessed. A case-control study was nested, matching 1:1 for type of surgery the cohort population with control patients without functional respiratory impairment consecutively undergoing surgery at the same centre in the study period.ResultsA total of 80 patients were enrolled: 40 subjects were preoperatively assessed by CPET and deemed at low risk, whereas 40 subjects represented the control group. Among the first, 4 patients (10%) developed major cardiopulmonary complications, and 1 patient (2.5%) died within 30 days from surgery. In the control group, 2 patients (5%) developed complications and none of the patients (0%) died. The differences in morbidity and mortality rates did not reach statistically significance. Instead, age, weight, BMI, smoking history, COPD incidence, surgical approach, FEV1, Tiffenau, DLCO and length of hospital stay resulted significantly different between the two groups. At a case-by-case analysis, CPET revealed a pathological pattern in each complicated patient, in spite of VO2peak above target for safe surgery.ConclusionsPostoperative outcomes of low-risk patients undergoing lung resections are comparable to those of patients without any pulmonary functional impairment; nonetheless the formers represent a dramatically different category of individuals from the latter and may harbour few patients with worse outcomes. CPET variables overall interpretation may add to the VO2peak in identifying higher risk patients, even in this subgroup.
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Affiliation(s)
- Riccardo Orlandi
- Department of Thoracic Surgery, University of Milan, Milan, Italy
- Correspondence: Riccardo Orlandi
| | - Rocco Francesco Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alessandra Mazzucco
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Andrea Baccelli
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Francesca Marchetti
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Mariapia Zagaria
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Jacopo Cefalo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Andrea Leporati
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Matteo Montoli
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giorgio Ghilardi
- General Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alessandro Baisi
- Thoracic Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
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Ninety-Day Mortality of Thoracoscopic vs Open Lobectomy: A Large Multicenter Cohort Study. Ann Thorac Surg 2023; 115:693-699. [PMID: 35988738 DOI: 10.1016/j.athoracsur.2022.07.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/19/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies have demonstrated a lower incidence of complications after video-assisted thoracoscopic surgery (VATS) lobectomy compared with thoracotomy, but the data on in-hospital and 90-day mortality are inconclusive. This study analyzed whether surgical approach, VATS or thoracotomy, was related to early mortality of lobectomy in lung cancer and determined the differences between in-hospital and 90-day mortality. METHODS Data of all patients with non-small cell lung cancer who underwent lobectomy between January 1, 2007, and July 30, 2018, were retrieved from Polish National Lung Cancer Registry. Included were 31 433 patients who met all study criteria. After propensity score matching, 4946 patients in the VATS group were compared with 4946 patients in the thoracotomy group. RESULTS Compared with thoracotomy, VATS lobectomy was related to lower in-hospital (1.5% vs 0.9%, P = .004) and 90-day mortality (3.4% vs 1.8%, P < .001). Mortality at 90 days was twice as high as in-hospital mortality in both the VATS (1.8% vs 0.9%, P < .001) and thoracotomy groups (3.4% vs 1.5%, P < .001). Postoperative complications were less common after VATS compared with thoracotomy (23.6% vs 31.8%, P < .001). CONCLUSIONS VATS lobectomy is associated with lower in-hospital and 90-day mortality compared with thoracotomy and should be recommended for lung cancer treatment, if feasible. Patients should also be closely monitored after discharge from the hospital, because 90-day mortality is significant higher than in-hospital mortality.
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Comparison of the LigaSure™ bipolar vessel sealer to monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy: a prospective randomized controlled trial. Surg Endosc 2023:10.1007/s00464-023-09892-0. [PMID: 36792782 DOI: 10.1007/s00464-023-09892-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/15/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND High-energy devices allow better vessel sealing compared with monopolar electrocautery and could improve the outcomes of surgical operations. The objective of the study was to compare tissue dissection by the LigaSure™ device with that by monopolar electrocoagulation for thoracoscopic lobectomy and lymphadenectomy. METHODS This pragmatic, parallel group, prospective randomized controlled trial was funded by the Medtronic External Research Program (ISR-2016-10,756) and registered at www. CLINICALTRIALS gov (NCT03125798). The study included patients aged 18 years or older, who had undergone thoracoscopic lobectomy with lymphadenectomy at the Department of Thoracic Surgery of Poznan University of Medical Sciences between May 3, 2018, and November 4, 2021. Using simple randomization, the patients were assigned to undergo tissue dissection with either the LigaSure device (study group) or monopolar electrocautery (control group). Participants and care givers, except operating surgeons, were blinded to group assignment. The primary outcome was postoperative chest drainage volume. Secondary outcomes were change of the esophageal temperature during subcarinal lymphadenectomy and C-reactive protein level 72 h after surgery. RESULTS Study outcomes were analyzed in 107 patients in each group. We found no differences between the study and control groups in terms of chest drainage volume (550 vs. 600 mL, respectively; p = 0.315), changes in esophageal temperature (- 0.1 °C vs. - 0.1 °C, respectively; p = 0.784), and C-reactive protein levels (72.8 vs. 70.8 mg/L, respectively; p = 0.503). The mean numbers of lymph nodes removed were 12.9 (SD: 3.1; 95% CI, 12.4 to 13.5) in the study group and 11.6 (SD: 3.2; 95% CI, 11.0 to 12.2) in the control group (p < 0.001). CONCLUSIONS The use of the LigaSure device did not allow to decrease the chest drainage volume, local thermal spread, and systemic inflammatory response. The number of lymph nodes removed was higher in patients operated with the LigaSure device, which indicated better quality of lymphadenectomy.
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Gao H, Wang L, Liu Y, Liang S, Zhang B, Ren J, Yu C, Sun X. Impact of frozen elephant trunk on the outcomes of thoracoabdominal aortic repair with normothermic iliac perfusion. Front Surg 2023; 9:1044089. [PMID: 36684352 PMCID: PMC9852519 DOI: 10.3389/fsurg.2022.1044089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/02/2022] [Indexed: 01/08/2023] Open
Abstract
Background Frozen elephant trunk technique (FET) has been proven to provide an excellent landing zone for second-stage thoracoabdominal (TA) aortic repair. The aim of this study was to evaluate the impact of FET in TA aortic repair with normothermic iliac perfusion. Methods From January 2008 to December 2019, 144 patients undergoing TA repair with normothermic iliac perfusion were enrolled in this study. Early and mid-term outcomes of patients with previous FET implantation (group A, n = 62) were compared with patients without previous FET implantation (group B, n = 82). The logistic regression analysis was performed to investigate the risk factors for adverse events, which were defined as early death, permanent stroke, permanent paraplegia, or permanent renal failure necessitating dialysis. Results The proximal aortic clamp time and operating time was 14.26 ± 5.57 min and 357.40 ± 94.51 respectively in group A, which were both significantly shorter than that in group B (18.67 ± 5.24 min and 18.67 ± 5.24 min). The incidence of adverse event was significantly lower in group A than that in group B (9.7% vs. 25.6%, P = 0.027). There was no significant difference between two groups with regard to other complications or late outcomes. In addition, age >50 years, a Ccr < 90 ml/min/1.73 m2 and the operating time were identified as significant risk factors through logistic regression analysis for adverse events of TA repair. Conclusions The FET technique simplifies the operative technique of proximal anastomosis, decreases the operating time and improves the early outcomes in TA repair, whereas does not provide a significant benefit with regard to late outcomes. Long-term follow-up and studies with larger sample sizes are necessary for further confirmation.
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Gómez-Hernández MT, Rivas C, Novoa N, Jiménez MF. Failure to rescue following anatomical lung resection. Analysis of a prospective nationwide database. Front Surg 2023; 10:1077046. [PMID: 36896264 PMCID: PMC9989191 DOI: 10.3389/fsurg.2023.1077046] [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: 10/22/2022] [Accepted: 01/19/2023] [Indexed: 02/25/2023] Open
Abstract
Background Rescue failure has been described as an important factor that conditions postoperative mortality after surgical interventions. The objective of this study is to determine the incidence and main determinants of failure to rescue after anatomical lung resections. Methods Prospective multicenter study that included all patients undergoing anatomical pulmonary resection between December 2016 and March 2018 and registered in the Spanish nationwide database GEVATS. Postoperative complications were classified as minor (grades I and II) and major (grades IIIa to V) according to the Clavien-Dindo standardized classification. Patients that died after a major complication were considered rescue failure. A stepwise logistic regression model was created to identify predictors of failure to rescue. Results 3,533 patients were analyzed. In total, 361 cases (10.2%) had major complications, of which 59 (16.3%) could not be rescued. The variables associated with rescue failure were: ppoDLCO% (OR, 0.98; 95% CI, 0.96-1; p = 0.067), cardiac comorbidity (OR, 2.1; 95% CI, 1.1-4; p = 0.024), extended resection (OR, 2.26; 95% CI, 0.94-5.41; p = 0.067), pneumonectomy (OR, 2.53; 95 CI, 1.07-6.03; p = 0.036) and hospital volume <120 cases per year (OR, 2.53; CI 95%, 1.26-5.07; p = 0.009). The area under the curve of the ROC curve was 0.72 (95% CI: 0.64-0.79). Conclusion A significant percentage of patients who presented major complications after anatomical lung resection did not survive to discharge. Pneumonectomy and annual surgical volume are the risk factors most closely related to rescue failure. Complex thoracic surgical pathology should be concentrated in high-volume centers to obtain the best results in potentially high-risk patients.
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Affiliation(s)
- María Teresa Gómez-Hernández
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.,Salamanca Institute of Biomedical Research, Salamanca, Spain.,University of Salamanca, Salamanca, Spain
| | - Cristina Rivas
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.,Salamanca Institute of Biomedical Research, Salamanca, Spain.,University of Salamanca, Salamanca, Spain
| | - Marcelo F Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.,Salamanca Institute of Biomedical Research, Salamanca, Spain.,University of Salamanca, Salamanca, Spain
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Seely AJE, Ahmadzai Z, French DG, Gingrich M, Jones D, Anstee C, Safieddine N, Waddell TK, Malthaner R, Ferri L, Finley C, Darling G. Multicentre positive deviance to reduce adverse events and length of stay after pulmonary resection. BMJ Open Qual 2023; 12:e001997. [PMID: 36669834 PMCID: PMC9872471 DOI: 10.1136/bmjoq-2022-001997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Postoperative adverse events (AEs) following pulmonary resection enormously impact patient well-being, length of stay (LOS) and healthcare costs. Standardised AE data collection can be used to identify positive outliers demonstrating positive deviance (PD) who may be helpful to inform the best practice. Here, we describe our initial experience of a novel quality improvement process using PD to reduce LOS and AEs. METHODS AE rates and LOS were collected from four centres (2014-2020) using a common dictionary. Surgeons repeatedly participated in 60 to 90 min seminars consisting of the following process: identify outcome and procedure targeted, review relevant best evidence literature, view all data anonymised by surgeon or centre (if multicentre), choose and reveal identity of best performance PD outliers, who discuss their management principles while all receive self-evaluation reports, followed by collegial discussion to generate consensus recommendations, voted by all. We assessed overall impact on AEs and LOS using aggregate data in a before/after analysis. RESULTS A total of 131 surgeons (average 12/seminar) participated in 11 PD seminars (8 local and 3 multicentre), yielding 85 consensus recommendation (average 8/seminar). Median LOS following lobectomy decreased from 4.0 to 3.0 days (p=0.04) following local PD seminars and from 4.0 to 3.5 days (p=0.11) following multicentre seminars. Trends for reductions in multiple AE rates were also observed. CONCLUSION While limited by the longitudinal design, these findings provide preliminary support for this data-driven, collegial and actionable quality improvement process to help standardise and improve patient care, and merits further more rigorous investigation.
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Affiliation(s)
- Andrew J E Seely
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Daniel G French
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Molly Gingrich
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Daniel Jones
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Caitlin Anstee
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Najib Safieddine
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Christian Finley
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Gail Darling
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Yu F, Zhang Y, Xu H, Li K, Gheng J, Lin C, Li L, Wang N, Wang L. Comparison of McKeown Minimally Invasive Esophagectomy vs sweet esophagectomy for esophageal squamous cell carcinoma: A retrospective study. Front Oncol 2022; 12:1009315. [PMID: 36601481 PMCID: PMC9806205 DOI: 10.3389/fonc.2022.1009315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
There are two most widely used transthoracic esophagectomy methods: the McKeown Minimally Invasive esophagectomy (McKeown MIE) and the Sweet Esophagectomy. We evaluated and compared the therapeutic effects of these two methods to determine the appropriate method for the treatment of middle and lower third esophageal cancer patients who received neoadjuvant chemotherapy combined with immunotherapy (NACI). We retrospectively analyzed 43 sweet esophagectomy cases received NACI and 167 cases with McKeown MIE in the fourth hospital of Hebei Medical University from December 2019 to May 2022. This retrospective observational study showed that Sweet esophagectomy and McKeown MIE after NACI therapy for resectable ESCC patients appeared to be safe with low operative mortality and morbidity rate in the current population. In addition, sweet esophagectomy was associated with a lower incidence of severe complications and shorter hospital stay for patients over 70 years of age compared with McKeown MIE. There were no differences were found in length of stay, mortality and complication incidence rate between the two groups. The Sweet approach has advantage in hospital stay for the treatment of the elderly NACI patients with middle or lower third esophageal squamous cell carcinoma. In conclusion, Sweet esophagectomy and McKeown MIE are both safe, effective, and worthwhile approaches for ESCC patients in immunotherapy age.
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Affiliation(s)
- Fan Yu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yaozhong Zhang
- Department of infectious disease, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haidi Xu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kuankuan Li
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingge Gheng
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenxi Lin
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Li
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Na Wang
- Department of Molecular Biology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China,*Correspondence: Lei Wang, ; Na Wang,
| | - Lei Wang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China,*Correspondence: Lei Wang, ; Na Wang,
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Ponholzer F, Chorazy K, Ng C, Kocher F, Maier H, Lucciarini P, Öfner D, Augustin F. External validation of risk prediction scores in patients undergoing anatomic video-assisted thoracoscopic resection. Surg Endosc 2022; 37:2789-2799. [PMID: 36477642 PMCID: PMC10081977 DOI: 10.1007/s00464-022-09786-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
Abstract
Background
EuroLung Risk scores were established to predict postoperative morbidity and mortality in patients undergoing anatomic lung resections. We aimed to perform an external validation of the EuroLung scores, which were calculated from data of the European Society of Thoracic Surgeons database, in our video-assisted thoracoscopic surgery cohort.
Methods
All available EuroLung scores were calculated for 718 patients scheduled for anatomic video-assisted thoracoscopic surgery resections between 2009 and 2019. Morbidity and mortality according to the definitions of the EuroLung scores were analyzed in a prospectively maintained database.
Results
Overall observed complication rate was 10.45%. Scores showed weak individual correlation (η = 0.155–0.174). The EuroLung1 app score showed the biggest area under the receiver operative characteristic (ROC) curve with 0.660. Binary logistic regression analysis showed that predicted postoperative forced expiratory volume in 1 s was associated with increased complications in both EuroLung1 and parsimonious EuroLung1 scores. Thirty-day mortality was 0.7% (predicted 1.10–1.40%) and was associated with predicted postoperative forced expiratory volume in 1 s for both EuroLung2 and parsimonious EuroLung2 scores. The EuroLung2 (2016) showed the biggest area under the ROC curve with 0.673. Only a very weak eta correlation between predicted and observed mortality was found for both aggregate EuroLung2, EuroLung2 (2016), EuroLung2 (2019), and parsimonious EuroLung2 (2016) (η = 0.025/0.015/0.011/0.009).
Conclusion
EuroLung scores help to estimate postoperative morbidity. However, even with the highest aggregate EuroLung scores possible only 50% suffer from postoperative morbidity. Although calibration of the scores was acceptable, discrimination between predicted and observed events was poor. Therefore, individual correlation between predicted and observed events is weak. Therefore, EuroLung scores may be best used to compare institutional quality of care to the European Society of Thoracic Surgeons database but should not be used to preclude patients from surgical treatment.
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Affiliation(s)
- Florian Ponholzer
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Karol Chorazy
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Caecilia Ng
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Florian Kocher
- Department of Internal Medicine V: Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Herbert Maier
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Paolo Lucciarini
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Chouinard G, Roy P, Blais MC, Lippens A, Pelletier É, Roy E, Marcoux M, Ugalde PA, Rheault J, Pigeon MA, Nicodème F, Lacasse Y, Maltais F. Exercise testing and postoperative complications after minimally invasive lung resection: A cohort study. Front Physiol 2022; 13:951460. [PMID: 36213231 PMCID: PMC9540366 DOI: 10.3389/fphys.2022.951460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Peak oxygen uptake (V˙O2) during cardiospulmonary exercise testing (CPET) is used to stratify postoperative risk following lung cancer resection but peak V˙O2 thresholds to predict post-operative mortality and morbidity were derived mostly from patients who underwent thoracotomy. Objectives: We evaluated whether peak V˙O2 or other CPET-derived variables predict post-operative mortality and cardiopulmonary morbidity after minimally invasive video-assisted thoracoscopic surgery (VATS) for lung cancer resection. Methods: A retrospective analysis of patients who underwent VATS lung resection between 2002 and 2019 and in whom CPET was performed. Logistic regression models were used to determine predictors of postoperative outcomes until 30 days after surgery. The ability of peak V˙O2 to discriminate between patients with and without post-operative complications was evaluated using Receiver operating characteristic (ROC) analysis. Results: Among the 593 patients, postoperative cardiopulmonary complications occurred in 92 (15.5%) individuals, including three deaths. Mean peak V˙O2 was 18.8 ml⋅kg−1⋅min−1, ranging from 7.0 to 36.4 ml⋅kg−1⋅min−1. Best predictors of postoperative morbidity and mortality were peripheral arterial disease, bilobectomy or pneumonectomy (versus sublobar resection), preoperative FEV1, peak V˙O2 , and peak V˙E/V˙CO2. The proportion of patients with peak V˙O2 of < 15 ml⋅kg−1⋅min−1, 15 to < 20 ml⋅kg−1⋅min−1 and ≥ 20 ml⋅kg−1⋅min−1 experiencing at least one postoperative complication was 23.8, 16.3 and 10.4%, respectively. The area under the ROC curve for peak V˙O2 was 0.63 (95% CI: 0.57–0.69). Conclusion: Although lower peak V˙O2 was a predictor of postoperative complications following VATS lung cancer resection, its ability to discriminate patients with or without complications was limited.
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Affiliation(s)
- Gabriel Chouinard
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Pascalin Roy
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Marie-Christine Blais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Alexandre Lippens
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Éliane Pelletier
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Emma Roy
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Mathieu Marcoux
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
- Centre hospitalier universitaire de Québec, Université Laval, Québec, QC, Canada
| | - Paula A. Ugalde
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Justine Rheault
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Marc-Antoine Pigeon
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Frédéric Nicodème
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Yves Lacasse
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
- *Correspondence: François Maltais,
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Huang G, Liu L, Wang L, Li S. Prediction of postoperative cardiopulmonary complications after lung resection in a Chinese population: A machine learning-based study. Front Oncol 2022; 12:1003722. [PMID: 36212485 PMCID: PMC9539671 DOI: 10.3389/fonc.2022.1003722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Approximately 20% of patients with lung cancer would experience postoperative cardiopulmonary complications after anatomic lung resection. Current prediction models for postoperative complications were not suitable for Chinese patients. This study aimed to develop and validate novel prediction models based on machine learning algorithms in a Chinese population. Methods Patients with lung cancer receiving anatomic lung resection and no neoadjuvant therapies from September 1, 2018 to August 31, 2019 were enrolled. The dataset was split into two cohorts at a 7:3 ratio. The logistic regression, random forest, and extreme gradient boosting were applied to construct models in the derivation cohort with 5-fold cross validation. The validation cohort accessed the model performance. The area under the curves measured the model discrimination, while the Spiegelhalter z test evaluated the model calibration. Results A total of 1085 patients were included, and 760 were assigned to the derivation cohort. 8.4% and 8.0% of patients experienced postoperative cardiopulmonary complications in the two cohorts. All baseline characteristics were balanced. The values of the area under the curve were 0.728, 0.721, and 0.767 for the logistic, random forest and extreme gradient boosting models, respectively. No significant differences existed among them. They all showed good calibration (p > 0.05). The logistic model consisted of male, arrhythmia, cerebrovascular disease, the percentage of predicted postoperative forced expiratory volume in one second, and the ratio of forced expiratory volume in one second to forced vital capacity. The last two variables, the percentage of forced vital capacity and age ranked in the top five important variables for novel machine learning models. A nomogram was plotted for the logistic model. Conclusion Three models were developed and validated for predicting postoperative cardiopulmonary complications among Chinese patients with lung cancer. They all exerted good discrimination and calibration. The percentage of predicted postoperative forced expiratory volume in one second and the ratio of forced expiratory volume in one second to forced vital capacity might be the most important variables. Further validation in different scenarios is still warranted.
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Kristenson K, Hylander J, Boros M, Fyrenius A, Hedman K. Ventilatory efficiency in combination with peak oxygen uptake improves risk stratification in patients undergoing lobectomy. JTCVS OPEN 2022; 11:317-326. [PMID: 36172418 PMCID: PMC9510865 DOI: 10.1016/j.xjon.2022.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
Objective We aimed to evaluate whether or not using the slope of the increase in minute ventilation in relation to carbon dioxide (VE/VCo2-slope), with a cutoff value of 35, could improve risk stratification for major pulmonary complications or death following lobectomy in lung cancer patients at moderate risk (Vo2peak = 10-20 mL/kg/min). Methods Single center, retrospective analysis of 146 patients with lung cancer who underwent lobectomy and preoperative cardiopulmonary exercise testing in 2008-2020. The main outcome was any major pulmonary complication or death within 30 days of surgery. Patients were categorized based on their preoperative cardiopulmonary exercise testing as: low-risk group, peak oxygen uptake >20 mL/kg/min; low-moderate risk, peak oxygen uptake 10 to 20 mL/kg/min and VE/VCo2-slope <35; and moderate-high risk, peak oxygen uptake 10 to 20 mL/kg/min and VE/VCo2-slope ≥35. The frequency of complications between groups was compared using χ2 test. Logistic regression was used to calculate the odds ratio with 95% CI for the main outcome based on the cardiopulmonary exercise testing group. Results Overall, 25 patients (17%) experienced a major pulmonary complication or died (2 deaths). The frequency of complications differed between the cardiopulmonary exercise testing groups: 29%, 13%, and 8% in the moderate-high, low-moderate, and low-risk group, respectively (P = .023). Using the low-risk group as reference, the adjusted odds ratio for the low-moderate risk group was 3.44 (95% CI, 0.66-17.90), whereas the odds ratio for the moderate-high risk group was 8.87 (95% CI, 1.86-42.39). Conclusions Using the VE/VCo2-slope with a cutoff value of 35 improved risk stratification for major pulmonary complications following lobectomy in lung cancer patients with moderate risk based on a peak oxygen uptake of 10 to 20 mL/kg/min. This suggests that the VE/VCo2-slope can be used for preoperative risk evaluation in lung cancer lobectomy.
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Gómez-Hernández MT, Fuentes MG, Novoa NM, Rodríguez I, Varela G, Jiménez MF. Similar outcomes after newly implemented rats approach compared to standard vats for anatomical lung resection. A propensity-score matched analysis. Cir Esp 2022; 100:504-510. [PMID: 35842254 DOI: 10.1016/j.cireng.2022.06.032] [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: 08/29/2020] [Accepted: 04/06/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Outcomes after the introduction of surgical innovations can be impaired by learning periods. The aim of this study is to compare the short-term outcomes of a recently implemented RATS approach to a standard VATS program for anatomical lung resections. METHODS Retrospective review of consecutive patients undergoing pulmonary anatomical resection through a minimally invasive approach since RATS approach was applied in our department (June 01, 2018, to November 30, 2019). Propensity score matching was performed according to patients' age, gender, ppoFEV1, cardiac comorbidity, type of malignancy, and type of resection. Outcome evaluation includes: overall morbidity, significant complications (cardiac arrhythmia, pneumonia, prolonged air leak, and reoperation), 30-day mortality, and length of hospital stay. Data were compared by two-sided chi-square or Fisher's exact test for categorical and Mann-Whitney U test for continuous variables. RESULTS A total of 273 patients (206 VATS, 67 RATS) were included in the study. After propensity score matching, data of 132 patients were analyzed. The thirty-days mortality was nil. Overall morbidity (RATS: 22.4%, VATS: 29.2%; p=0.369), major complications (RATS: 9% vs VATS: 9.2%; p=0.956) and the rates of specific major complications (cardiac arrhythmia RATS: 4.5%, VATS: 4.6%, p=1; pneumonia RATS:0%, VATS:4.6%, p=0.117; prolonged air leak RATS: 7.5%; VATS: 4.6%, p=0.718) and reoperation (RATS: 3%, VATS: 1.5%, p=1) were comparable between both groups. The median length of stay was 3 days in both groups (p=0.101). CONCLUSIONS A RATS program for anatomical lung resection can be implemented safely by experienced VATS surgeons without increasing morbidity rates.
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Affiliation(s)
| | - Marta G Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria M Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Israel Rodríguez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | | | - Marcelo F Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research, Spain
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Yun JK, Lee GD, Kim HR, Kim YH, Kim DK, Park SI, Choi S. Parsimonious risk model for predicting mortality after surgical lung biopsy for interstitial lung disease. Eur J Cardiothorac Surg 2022; 62:6586796. [PMID: 35579359 DOI: 10.1093/ejcts/ezac291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/20/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To develop a risk model for predicting postoperative mortality and morbidity in patients with interstitial lung disease undergoing surgical lung biopsy. METHODS From 2004 to 2019, patients who underwent surgical lung biopsy for interstitial lung disease were included in this study. Based on the findings of the multivariable analysis using preoperative clinical variables, a risk model for predicting postoperative mortality and morbidity was developed. RESULTS During the study period, 1177 patients were enrolled. Among them, morbidity and mortality occurred in 45 (3.8%) and 29 (2.5%) patients, respectively, which gradually declined over time from 8.9% in 2004-2005 to 0% in 2018-2019. In the final multivariable analysis, the dyspnoea grade, a forced vital capacity of ≤ 60%, preoperative oxygen therapy, and preoperative intensive care unit stay were found to be the independent factors associated with both morbidity and mortality; smoking> 40 pack-years was additionally identified as a factor related to mortality. Diffusing capacity of carbon monoxide ≤ 50%, which was a significant factor in the univariable analysis, became insignificant after adjustment for the forced vital capacity in the multivariable analysis. The risk scoring system based on this model showed a good discriminant ability for both morbidity (area under the receiver operating characteristic curve [95% confidence interval]: 0.830 [0.726-0.932]) and mortality (0.887 [0.804-0.975]). CONCLUSIONS We developed a scoring system for predicting the risk of morbidity and mortality, which could help determine surgical candidates for lung biopsy among patients with interstitial lung disease.
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Affiliation(s)
- Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
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Gómez de Antonio D, Crowley Carrasco S, Romero Román A, Royuela A, Calle ÁS, Obiols Fornell C, Call Caja S, Embún R, Royo Í, Recuero JL, Cabañero A, Moreno N, Bolufer S, Congregado M, Jimenez MF, Aguinagalde B, Amor-Alonso S, Arrarás MJ, Blanco Orozco AI, Boada M, Cal I, Cilleruelo Ramos Á, Fernández-Martín E, García-Barajas S, García-Jiménez MD, García-Prim JM, Garcia-Salcedo JA, Gelbenzu-Zazpe JJ, Giraldo-Ospina CF, Gómez Hernández MT, Hernández J, Wolf JDI, Jáuregui Abularach A, Jiménez U, López Sanz I, Martínez-Hernández NJ, Martínez-Téllez E, Milla Collado L, Mongil Poce R, Moradiellos-Díez FJ, Moreno-Basalobre R, Moreno Merino SB, Quero-Valenzuela F, Ramírez-Gil ME, Ramos-Izquierdo R, Rivo E, Rodríguez-Fuster A, Rojo-Marcos R, Sanchez-Lorente D, Sánchez Moreno L, Simón C, Trujillo-Reyes JC, López García C, Fibla Alfara JJ, Sesma Romero J, Hernando Trancho F. [Translated article] Surgical Risk Following Anatomic Lung Resection in Thoracic Surgery: A Prediction Model Derived From a Spanish Multicenter Database. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Pulmonary sclerosing pneumocytoma: clinical features and prognosis. World J Surg Oncol 2022; 20:140. [PMID: 35490241 PMCID: PMC9055737 DOI: 10.1186/s12957-022-02603-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/14/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pulmonary sclerosing pneumocytoma is a kind of rare benign pulmonary tumor with potential malignancy. The clinical features, risk factors for prognosis, and optimal treatment have not been identified yet. This study aimed to investigate the clinical features and prognosis of pulmonary sclerosing pneumocytoma. METHODS We retrospectively performed a review of pulmonary sclerosing pneumocytoma patients in West China Hospital from 2009 to 2019. The basic characteristics, treatment regimens, operation detail, postoperative variables, and follow-up time were recorded for each case. Differences in features between patients undergoing lobectomy and segmentectomy were compared. We also performed a case review and summarized reported clinical features in former studies. RESULTS Altogether 61 pulmonary sclerosing pneumocytoma patients were retrospectively reviewed. Fifty-six patients were female and 5 were male. The patients' median age was 51 (23-73). Seven (11.48%) patients had smoking history. Twenty tumors were located in the right lung [upper lobe (n = 7), middle (n = 2), and lower (n = 11)] and 41 in the left [upper (n = 12) and lower (n = 29)]. The median tumor size was 2 (0.9-7) cm. Thirty-six (59.02%) patients underwent sublobectomy (segmentectomy or wedge resection) whereas 25 (40.98%) underwent lobectomy. All patients recovered uneventfully, and no perioperative mortality was identified. Sublobectomy showed a trend towards reduced chest tube duration and shorter postoperative hospital stays compared with lobectomy. CONCLUSIONS The findings showed good prognosis of pulmonary sclerosing pneumocytoma and proved its benign characteristics. Sublobectomy showed advanced efficacy regarding chest tube duration and postoperative hospital stay compared with lobectomy.
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Decaluwé H, Van Raemdonck D. The bubble in predicting bubbles? Eur J Cardiothorac Surg 2022; 62:6564473. [PMID: 35388885 DOI: 10.1093/ejcts/ezac202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven and Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, University Hospitals Leuven and Katholieke Universiteit Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven and Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, University Hospitals Leuven and Katholieke Universiteit Leuven, Leuven, Belgium
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Bronchoscopic Intra-Pleural Instillation of Fibrin Glue and Autologous Blood to Manage Persistent Air Leaks after Lung Resection. J Clin Med 2022; 11:jcm11071934. [PMID: 35407542 PMCID: PMC8999597 DOI: 10.3390/jcm11071934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Persistent air leak is a common complication after lung resection causing prolonged length of stay and increased healthcare costs. Surgical intervention can be an option, but other more conservative approaches should be considered first. Here, we describe the use of flexible bronchoscopy to apply fibrin glue and autologous blood sequentially to the damaged lung. We named the technique “flexible thoracoscopy”. Methods: Medical records from patients with persistent air leaks after lung resection were collected retrospectively. Depending on the type of aerostasis that was performed, two groups were created: flexible thoracoscopy and surgery (thoracotomy). Flexible thoracoscopy was introduced at our institution in 2013. We entered the pleural space with a bronchoscope following the same surgical pathway that was used for tube thoracostomy. Perioperative characteristics and outcomes were analyzed using R software (ver. 3.4.4). Results: From 1997 to 2021, a total of 23 patients required an intervention for persistent air leaks. Aerostasis was performed via flexible thoracoscopy in seventeen patients (69%) and via thoracotomy in six patients (31%). The median age was 70 years (22–82). Twenty patients were males (87%). There was no difference in age, sex distribution, BMI, comorbidities and FEV1%. An ASA score of 3 was more represented in the flexible thoracoscopy group; however, no evidence of a difference was found when compared to the thoracotomy group (p = 0.124). Length of in-hospital stay and chest tube duration was also similar between groups (p = 1 and p = 0.68, respectively). Conclusions: Aerostasis achieved either by flexible thoracoscopy or by thoracotomy showed similar results. We believe that flexible thoracoscopy could be a valid alternative to facilitate minimally invasive treatments for persistent air leaks. Further studies are needed to confirm these results.
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Linden PA, Block MI, Perry Y, Gaissert HA, Worrell SJ, Grau-Sepulveda MV, Kosinski AS, Jawitz OK, Hartwig MG, Towe CW. Risk of Each of the Five Lung Lobectomies: A Society of Thoracic Surgery Database Analysis. Ann Thorac Surg 2022; 114:1871-1877. [PMID: 35339439 DOI: 10.1016/j.athoracsur.2022.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The perioperative risk of pulmonary lobectomy as a solitary procedure has been extensively studied, yet the differences in outcomes between each lobe, which have unique anatomy and a different amount of lung parenchyma, are entirely unknown. The purpose of this study is to define the risk of each of the five lobectomies. METHODS The Society of Thoracic Surgery Database was queried for patients undergoing lobectomy between 2008 and 2018. Patient and disease characteristics, operative variables, major morbidity and 30-day mortality were examined. A multivariable logistic regression model (using the same variables in the current STS lobectomy risk model) was developed to assess for the contribution to lobectomy site to adverse outcomes. RESULTS 65,006 patients were analyzed. Adjusted perioperative mortality rate is lowest for RML (0.63%) intermediate for RUL, LUL and LLL (1.08-1.24%), and highest for RLL (1.63%). The adjusted major morbidity rate is lowest for RML (5.36%) intermediate for LLL and LUL (7.82-8.33%), and highest for RUL and RLL (8.94-9.32%). Adjusted intraoperative transfusion rate is lowest for RML (1.37%) intermediate for RLL and LLL (1.81-1.94%) and highest for RUL and LUL (2.47-2.72%). CONCLUSIONS There are clear differences in postoperative outcomes by lobectomy location. Mortality, major morbidity, and transfusion rate are lowest for RML, but vary across other lobectomies. These differences should be appreciated when evaluating risk of operation, deciding upon best therapy, counseling patients, and comparing outcomes.
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Affiliation(s)
- Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH
| | - Mark I Block
- Division of Thoracic Surgery, Memorial Healthcare System, Hollywood, FL
| | - Yaron Perry
- Division of Thoracic Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York
| | - Henning A Gaissert
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Stephanie J Worrell
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH
| | - Maria V Grau-Sepulveda
- Duke Clinical Research Institute, Durham, NC Classifications: Database, Lung Cancer Surgery, Statistics - risk analysis/modeling, Surgery - complications
| | - Andrzej S Kosinski
- Duke Clinical Research Institute, Durham, NC Classifications: Database, Lung Cancer Surgery, Statistics - risk analysis/modeling, Surgery - complications
| | - Oliver K Jawitz
- Duke Clinical Research Institute, Durham, NC Classifications: Database, Lung Cancer Surgery, Statistics - risk analysis/modeling, Surgery - complications
| | - Matthew G Hartwig
- Duke Clinical Research Institute, Durham, NC Classifications: Database, Lung Cancer Surgery, Statistics - risk analysis/modeling, Surgery - complications
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, OH
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Patella M, Brunelli A, Adams L, Cafarotti S, Costardi L, De Leyn P, Decaluwé H, Franks KN, Fuentes M, Jimenez MF, Karri S, Moons J, Novellis P, Ruffini E, Veronesi G, Voulaz E, Shargall Y. A risk model to predict the delivery of adjuvant chemotherapy following lung resection in patients with pathologically positive lymph nodes. Semin Thorac Cardiovasc Surg 2022; 35:387-398. [PMID: 35272025 DOI: 10.1053/j.semtcvs.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 01/20/2023]
Abstract
To investigate factors associated with the ability to receive adjuvant chemotherapy in patients with pathological N1 and N2 stage after anatomic lung resections for non-small cell lung cancer (NSCLC). Multicenter retrospective analysis on 707 consecutive patients found pathologic N1 (pN1) or N2 (pN2) disease following anatomic lung resections for NSCLC (2014-2019). Multiple imputation logistic regression was used to identify factors associated with adjuvant chemotherapy and to develop a model to predict the probability of starting this treatment. The model was externally validated in a population of 253 patients. In the derivation set, 442 patients were pN1 and 265 pN2. 58% received at least one cycle of adjuvant chemotherapy. The variables significantly associated with the probability of starting chemotherapy after multivariable regression analysis were: younger age (p<0.0001), Body Mass Index (BMI) (p=0.031), Forced Expiratory Volume in 1 second (FEV1) (p=0.037), better performance status (PS) (p<0.0001), absence of chronic kidney disease (CKD) (p=0.016), resection lesser than pneumonectomy (p=0.010). The logit of the prediction model was: 6.58 -0.112 x age +0.039 x BMI +0.009 x FEV1 -0.650 x PS -1.388 x CKD -0.550 x pneumonectomy. The predicted rate of adjuvant chemotherapy in the validation set was 59.2 and similar to the observed one (59%, p=0.87) confirming the model performance in external setting. This study identified several factors associated with the probability of initiating adjuvant chemotherapy after lung resection in node-positive patients. This information can be used during preoperative multidisciplinary meetings and patients counseling to support decision-making process regarding the timing of systemic treatment.
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Affiliation(s)
- Miriam Patella
- Department of Thoracic Surgery, San Giovanni Hospital, Via Ospedale, 6500, Bellinzona, Switzerland
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St James's University Hospital, Leeds Teaching Hospital NHS Trust, Beckett St, Harehills, Leeds LS9 7TF, Leeds, United Kingdom
| | - Laura Adams
- Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Beckett St, Harehills, Leeds LS9 7TF, Leeds, UK
| | - Stefano Cafarotti
- Department of Thoracic Surgery, San Giovanni Hospital, Via Ospedale, 6500, Bellinzona, Switzerland
| | - Lorena Costardi
- Department of Thoracic Surgery, University Hospital of Torino, Città della Salute e della Scienza, Corso Bramante, 88, 10126, Torino, Italy
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Kevin N Franks
- Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Beckett St, Harehills, Leeds LS9 7TF, Leeds, UK
| | - Marta Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, IBSAL, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | - Marcelo F Jimenez
- Service of Thoracic Surgery, Salamanca University Hospital, IBSAL, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | - Sunanda Karri
- Division of Thoracic Surgery, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E., Hamilton, ON L8N 4A6, Canada
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Pierluigi Novellis
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano (MI), Italy; Present address: Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy Via Olgettina 58, 20132 Milano
| | - Enrico Ruffini
- Department of Thoracic Surgery, University Hospital of Torino, Città della Salute e della Scienza, Corso Bramante, 88, 10126, Torino, Italy
| | - Giulia Veronesi
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano (MI), Italy; Present address: Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy Via Olgettina 58, 20132 Milano
| | - Emanuele Voulaz
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano (MI), Italy
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E., Hamilton, ON L8N 4A6, Canada
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Sesma J, Bolufer S, García-Valentín A, Embún R, López ÍJ, Moreno-Mata N, Jiménez U, Trancho FH, Martín-Ucar AE, Gallar J. Thoracoscopic segmentectomy versus lobectomy: A propensity score–matched analysis. JTCVS OPEN 2022; 9:268-278. [PMID: 36003470 PMCID: PMC9390783 DOI: 10.1016/j.xjon.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy. Methods From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score–matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan–Meier and competing risks method were used to compare survival. Results In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score–matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan–Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression–related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups. Conclusions Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.
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Affiliation(s)
- Julio Sesma
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
- Address for reprints: Julio Sesma, MD, Pintor Baeza 12. 03013, Alicante, Spain.
| | - Sergio Bolufer
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Antonio García-Valentín
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Raúl Embún
- Cardiac Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Íker Javier López
- Thoracic Surgery Department, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Nicolás Moreno-Mata
- Thoracic Surgery Department, Hospital Universitario de Donostia, San Sebastián-Donostia, Spain
| | - Unai Jiménez
- Thoracic Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Antonio Eduardo Martín-Ucar
- Thoracic Surgery Department, Hospital Clínico San Carlos, Madrid, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Juana Gallar
- Miguel Hernandez de Elche University, Alicante, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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Huang G, Liu L, Wang L, Wang Z, Wang Z, Li S. External validation of five predictive models for postoperative cardiopulmonary morbidity in a Chinese population receiving lung resection. PeerJ 2022; 10:e12936. [PMID: 35186502 PMCID: PMC8840067 DOI: 10.7717/peerj.12936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND No postoperative cardiopulmonary morbidity models have been developed or validated in Chinese patients with lung resection. This study aims to externally validate five predictive models, including Eurolung models, the Brunelli model and the Age-adjusted Charlson Comorbidity Index, in a Chinese population. METHODS Patients with lung cancer who underwent anatomic lung resection between 2018/09/01 and 2019/08/31 in our center were involved. Model discrimination was assessed by the area under the receiver operating characteristic curve. Model calibration was evaluated by the Hosmer-Lemeshow test. Calibration curves were plotted. Specificity, sensitivity, negative predictive value, positive predictive value and accuracy were calculated. Model updating was achieved by re-estimating the intercept and/or the slope of the linear predictor and re-estimating all coefficients. RESULTS Among 1085 patients, 91 patients had postoperative cardiopulmonary complications defined by the European Society of Thoracic Surgeons. For original models, only parsimonious Eurolung1 had acceptable discrimination (area under the receiver operating characteristic curve = 0.688, 95% confidence interval 0.630-0.745) and calibration (p = 0.23 > 0.05) abilities simultaneously. Its sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 0.700, 0.649, 0.153, 0.960 and 0.653, respectively. In the secondary analysis, increased pleural effusion (n = 94), which was nonchylous and nonpurulent, was labeled as a kind of postoperative complication. The area under the receiver operating characteristic curve of the models increased slightly, but all models were miscalibrated. The original Eurolung1 model had the highest discrimination ability but poor calibration, and thus it was updated by three methods. After model updating, new models showed good calibration and small improvements in discrimination. The discrimination ability was still merely acceptable. CONCLUSIONS Overall, none of the models performed well on postoperative cardiopulmonary morbidity prediction in this Chinese population. The original parsimonious Eurolung1 and the updated Eurolung1 were the best-performing models on morbidity prediction, but their discrimination ability only achieved an acceptable level. A multicenter study with more relevant variables and sophisticated statistical methods is warranted to develop new models among Chinese patients in the future.
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Affiliation(s)
- Guanghua Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Luyi Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhile Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaojian Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yun JK, Jeong JH, Lee GD, Kim HR, Kim YH, Kim DK, Park SI, Choi S. Predicting Postoperative Complications and Long-Term Survival After Lung Cancer Surgery Using Eurolung Risk Score. J Korean Med Sci 2022; 37:e36. [PMID: 35132842 PMCID: PMC8822110 DOI: 10.3346/jkms.2022.37.e36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/15/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND This study aimed to assess the clinical relevance of the parsimonious Eurolung risk scoring system for predicting postoperative morbidity, mortality, and long-term survival in Korean patients with surgically resected non-small cell lung cancer. METHODS This retrospective analysis used the data of patients who underwent anatomical resection for non-small cell lung cancer between 2004 and 2018 at a single institution. The parsimonious aggregate Eurolung score was calculated for each patient. The Cox regression model was used to determine the ability of the Eurolung scoring system for predicting long-term outcomes. RESULTS Of the 7,278 patients in the study, cardiopulmonary complications and mortality occurred in 687 (9.4%) and 53 (0.7%) patients, respectively. The rate of cardiopulmonary complications and mortality gradually increased with the increase in the Eurolung risk scores (all P < 0.001). When risk scores were grouped into four categories, the Eurolung scoring system showed a stepwise deterioration of overall survival with the increase in risk scores, and this association was statistically significant (P < 0.001). Multivariate Cox analysis showed that the Eurolung scoring system, classified into four categories, was a significant prognostic factor of overall survival even after adjusting for covariates such as tumor histology and pathological stage (P < 0.001). CONCLUSION Stratification based on the parsimonious Eurolung scoring system showed good discriminatory ability for predicting postoperative morbidity, mortality, and long-term survival in South Korean patients with surgically resected non-small cell lung cancer. This might help clinicians to provide a detailed prognosis and decide the appropriate treatment option for high-risk patients with non-small cell lung cancer.
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Affiliation(s)
| | | | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
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Agrafiotis AC, Bourlon L, Etienne H, Le Roux M, Mazzoni L, Giol M, Debrosse D, Assouad J. Is surgical rib fixation in patients aged more than 65 years old associated with worse outcomes compared to younger patients? A retrospective single-center study. Acta Chir Belg 2022; 122:35-40. [PMID: 33146583 DOI: 10.1080/00015458.2020.1846939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is no robust data regarding rib fixation in elderly patients. The aim of this study is to compare the postoperative outcomes of patients aged less and more than 65 years old. METHODS Patients operated from January 2012 to December 2018 were retrospectively analyzed. The following data were collected: age, sex, comorbidities, smoking habit, Injury Severity Score (ISS), number of fractured ribs, indication for surgery, associated injuries, time from trauma to surgery, number of fixed ribs, intrathoracic injuries, duration of intubation, ICU stay, postoperative cardiopulmonary complications, blood transfusion, overall and 30-day mortality, length of stay. RESULTS There was no difference regarding the ISS (p = 0.09), the number of rib fractures (p = 0.291), the indication for surgery, the number of fixed ribs (p = 0.819), the ICU stay (p = 0.096), the postoperative intubation duration (p = 0.059), the cardiopulmonary complications (p = 0.273) and perioperative blood transfusions (p = 0.34). Elderly patients presented more postoperative cognitive complications (p < 0.001). There was no difference in terms of overall mortality (p = 0.06) and 30-day mortality (p = 0.69). Elderly patients stayed longer in the hospital (p < 0.001). CONCLUSIONS The outcomes of rib fixation in the elderly patients are comparable to younger patients. However, elderly patients experience more frequently postoperative cognitive complications and their hospitalizations are longer.
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Affiliation(s)
| | - Lucie Bourlon
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Marielle Le Roux
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Lucia Mazzoni
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Mihaela Giol
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Denis Debrosse
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Paris, France
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Zheng Q, Ge L, Zhou J, Zhang Y, Lyu M, Chen C, Wang T, Liu L. Risk factors for prolonged air leak after pulmonary surgery: A systematic review and meta-analysis. Asian J Surg 2022; 45:2159-2167. [PMID: 35120835 DOI: 10.1016/j.asjsur.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/09/2021] [Accepted: 01/14/2022] [Indexed: 02/08/2023] Open
Abstract
This study aimed to comprehensively identify risk factors for the occurrence of prolonged air leak (PAL) in patients undergoing pulmonary surgery. Studies were retrieved from 3 databases, including PubMed, Web of Science, and EmBase up to 13 May 2020. We performed meta-analysis using Bayesian random effect models through divergence restricting conditional tessellation (DIRECT) algorithm. The effect size was expressed as odds ratio (OR) or mean difference (MD), each with 95% credible interval (CrI). The evidence quality was evaluated. Subgroup analyses and sensitivity analyses were conducted. Thirty-nine studies with 89006 patients were finally included. Pooled PAL incidence was 15%. Of 30 risk factors, 22 were significantly associated with increased PAL incidence. Five risk factors were ultimately selected with high evidence quality: smoking history (OR 1.84, 95%CrI 1.45 to 2.31, P<0.001), preoperative steroid use (OR 1.51, 95%CrI 0.87 to 2.65, P = 0.031), lower ratio of forced expiratory volume in 1 s and forced vital capacity (OR 1.99, 95%CrI 1.22 to 3.33, P = 0.005), non-fissureless technique (OR 2.14, 95%CrI 1.31 to 3.66, P = 0.003), and pathological TNM stage III/IV (OR 1.50, 95%CrI 1.07 to 2.12, P = 0.003). Regarding the negative impact of PAL on the personal cost and postoperative recovery, the verification of previous proposed factors and investigation of recently discovered ones both implied directions for risk stratification and the establishment of an applicable prediction model.
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Affiliation(s)
- Quan Zheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Lingling Ge
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuanjin Zhang
- West China School of Medicine, Sichuan University, Chengdu, China; Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mengyuan Lyu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Chen
- West China School of Medicine, Sichuan University, Chengdu, China; Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Tengyong Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China.
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Xu K, Yang H, Ma W, Fan L, Sun B, Wang Z, Al-Hurani MF, Schmid RA, Yao F. Neoadjuvant immunotherapy facilitates resection of surgically-challenging lung squamous cell cancer. J Thorac Dis 2022; 13:6816-6826. [PMID: 35070366 PMCID: PMC8743415 DOI: 10.21037/jtd-21-1195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/23/2021] [Indexed: 12/25/2022]
Abstract
Background Locally-advanced lung squamous cell carcinoma represents a special subset that is challenging to resect completely with surgery alone. Immunotherapy has achieved great success in treating late-stage lung cancer. However, whether neoadjuvant immunotherapy can facilitate resection of initially locally-advanced and surgically-difficult locally-advanced lung squamous cell carcinoma remains to be investigated. Methods We retrospectively collected clinical records of locally-advanced lung squamous cell carcinoma patients who received neoadjuvant immunotherapy followed by surgery between 2018 and 2020 at a large academic thoracic cancer center. Results A total of 23 patients (22 males, 1 female) with locally-advanced locally-advanced lung squamous cell carcinoma were included, initially clinically staged at IIIA (16, 69.6%), IIIB (n=4, 17.4%), IIB (n=2, 8.7%) and IIIC (n=1, 4.3%). The median interval between final treatment to surgery was 36 days (range, 25-93 days), without treatment-related delay in surgery. The neoadjuvant treatment resulted in a high rate of radical resection (n=20, 87.0%). The final histopathological examination demonstrated 6 (26.1%) cases with pathological complete response and 8 (34.8%) with pathological major response. Comparing with the computed tomography scan-based response, we observed a very low consistency (weighted kappa =0.122, P=0.315) between the computed tomography scan-based and final pathological evaluation. The median follow-up time was 510 days (range, 217-920 days). At the end of the follow-up, 1 patient died. Conclusions Our findings showed the clinical promise of neoadjuvant immunotherapy plus surgery for locally-advanced lung squamous cell carcinoma. Computed tomography scan displays a poor role in assessing the resectability after neoadjuvant immunotherapy.
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Affiliation(s)
- Ke Xu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haitang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenyan Ma
- Clinical Statistical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Liwen Fan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Beibei Sun
- Institute for Thoracic Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhexin Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mohammad Faisal Al-Hurani
- Department of General and Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Ralph A Schmid
- Division of General Thoracic Surgery, Department of BioMedical Research (DBMR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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50
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6550397. [DOI: 10.1093/ejcts/ezac170] [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: 08/27/2021] [Revised: 02/11/2022] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
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