1
|
Hurley PD, Fabbri G, Berjaoui N, Patel AJ, Lampridis S, Routledge T, Bille A. Lymph node dissection in lung cancer surgery: a comparison between robot-assisted vs. video-assisted thoracoscopic approach. Front Surg 2024; 11:1395884. [PMID: 38952439 PMCID: PMC11215068 DOI: 10.3389/fsurg.2024.1395884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024] Open
Abstract
Background TNM staging is the most important prognosticator for non-small cell lung cancer (NSCLC) patients. Staging has significant implications for the treatment modality for these patients. Lymph node dissection in robot-assisted thoracoscopic (RATS) surgery remains an area of ongoing evaluation. In this study, we aim to compare lymph node dissection in RATS and VATS approach for lung resection in NSCLC patients. Methods We retrospectively compiled a database of 717 patients from July 31, 2015-July 7, 2022, who underwent either a wedge resection, segmentectomy or lobectomy. We analysed the database according to lymph node dissection. The database was divided into RATS (n = 375) and VATS (n = 342) procedures. Results The mean number of lymph nodes harvested overall with RATS was 6.1 ± 1.5 nodes; with VATS approach, it was 5.53 ± 1.8 nodes. The mean number of N1 stations harvested was 2.66 ± 0.8 with RATS, 2.36 ± 0.9 with VATS. RATS approach showed statistically higher lymph node dissection rates compared to VATS (p = 0.002). Out of the 375 RATS procedures, 26 (6.4%) patients undergoing a RATS procedure were upstaged from N0/N1 staging to N2. N0/N1-N2 upstaging was reported in 28 of 342 (8.2%) patients undergoing a VATS procedure. The majority of upstaging was seen in N0-N2 disease: 19 of 375 (5%) for RATS and 23 of 342 (6.7%) for VATS. Conclusions We conclude that in RATS procedures, there is a higher rate of lymph node dissection compared to VATS procedures. Upstaging was mostly seen in N0-N2 disease, this was observed at a higher rate with VATS procedures.
Collapse
Affiliation(s)
- Patrick Deniz Hurley
- Department of Thoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Giulia Fabbri
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Nabih Berjaoui
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Akshay Jatin Patel
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Savvas Lampridis
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Tom Routledge
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Andrea Bille
- Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
2
|
Kidane B, Bott M, Spicer J, Backhus L, Chaft J, Chudgar N, Colson Y, D'Amico TA, David E, Lee J, Najmeh S, Sepesi B, Shu C, Yang J, Swanson S, Stiles B. The American Association for Thoracic Surgery (AATS) 2023 Expert Consensus Document: Staging and multidisciplinary management of patients with early-stage non-small cell lung cancer. J Thorac Cardiovasc Surg 2023; 166:637-654. [PMID: 37306641 DOI: 10.1016/j.jtcvs.2023.04.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/27/2023] [Indexed: 06/13/2023]
Abstract
Novel targeted therapy and immunotherapy drugs have recently been approved for use in patients with surgically resectable lung cancer. Accurate staging, early molecular testing, and knowledge of recent trials are critical to optimize oncologic outcomes in these patients.
Collapse
Affiliation(s)
| | - Matthew Bott
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Jamie Chaft
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | | | - Jay Lee
- University of California, Los Angeles, Los Angeles, Calif
| | | | | | | | | | | | | |
Collapse
|
3
|
Ureña A, Moreno C, Macia I, Rivas F, Déniz C, Muñoz A, Serratosa I, García M, Masuet-Aumatell C, Escobar I, Ramos R. A Comparison of Total Thoracoscopic and Robotic Surgery for Lung Cancer Lymphadenectomy. Cancers (Basel) 2023; 15:3442. [PMID: 37444555 DOI: 10.3390/cancers15133442] [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: 05/17/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Robotic-assisted thoracic surgery (RATS) is used increasingly frequently in major lung resection for early stage non-small-cell lung cancer (NSCLC) but has not yet been fully evaluated. The aim of this study was to compare the surgical outcomes of lymph node dissection (LND) performed via RATS with those from totally thoracoscopic (TT) four-port videothoracoscopy. METHODS Clinical and pathological data were collected retrospectively from patients with clinical stage N0 NSCLC who underwent pulmonary resection in the form of lobectomy or segmental resection between June 2010 and November 2022. The assessment criteria were number of mediastinal lymph nodes and number of mediastinal stations dissected via the RATS approach compared with the four-port TT approach. RESULTS A total of 246 pulmonary resections with LND for clinical stages I-II NSCLC were performed: 85 via TT and 161 via RATS. The clinical characteristics of the patients were similar in both groups. The number of mediastinal nodes dissected and mediastinal stations dissected was significantly higher in the RATS group (TT: mean ± SD, 10.72 ± 3.7; RATS, 14.74 ± 6.3 [p < 0.001]), except in the inferior mediastinal stations. There was no difference in terms of postoperative complications. CONCLUSIONS In patients with early stage NSCLC undergoing major lung resection, the quality of hilomediastinal LND performed using RATS was superior to that performed using TT.
Collapse
Affiliation(s)
- Anna Ureña
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Department of Thoracic Surgery, Hospital Clinic, 08036 Barcelona, Spain
| | - Camilo Moreno
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Doctoral Programme of Medicine and Translational Research, University of Barcelona, 08036 Barcelona, Spain
| | - Ivan Macia
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Francisco Rivas
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carlos Déniz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Anna Muñoz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ines Serratosa
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Marta García
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Cristina Masuet-Aumatell
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Department of Thoracic Surgery, Hospital Clinic, 08036 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| |
Collapse
|
4
|
Zhang F, Xu L, Lu H, Ma A, Wang G. Short-Term Surgical Outcomes for Lobectomy Between Robot-Assisted Thoracic Surgery and Uniportal Video-Assisted Thoracoscopic Surgery. Front Oncol 2022; 12:914059. [PMID: 35912191 PMCID: PMC9326123 DOI: 10.3389/fonc.2022.914059] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/06/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives To evaluate the short-term outcomes of uniportal video–assisted thoracoscopic surgery (UVATS) and Da Vinci robot–assisted thoracoscopic surgery (RATS) in lobectomy and lymph node (LN) dissection. Methods The two groups of patients with primary non-small cell lung cancer (NSCLC; RATS group, UVATS group) were matched by the propensity score to compare LN dissection and recent clinical outcomes. The results were analyzed by univariate analysis. From November 2020 to November 2021, 412 NSCLC patients (54 RATS and 358 UVATS) from a single institution of the Provincial Hospital affiliated with Shandong First Medical University were included in the analysis. Age, sex, lung lobe, surgical resection scope, solid nodules, and core tumor ratios were matched according to different surgical methods. Results From November 2020 to November 2021, 412 patients with NSCLC (54 RATS, 358 UVATS) from the Provincial Hospital affiliated with Shandong First Medical University were included in the analysis. According to our matching results, LN dissection was more thorough in the RATS group. Conclusion RATS has potential advantages over UVATS in radical lung cancer surgery.
Collapse
Affiliation(s)
- Fan Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lin Xu
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hongda Lu
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Anqun Ma
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Gongchao Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
- *Correspondence: Gongchao Wang,
| |
Collapse
|
5
|
Nawalaniec JT, Elson M, Reznik SI, Wait MA, Peltz M, Jessen ME, Madrigales A, Lysikowski J, Kernstine KH. Training Cardiothoracic Residents in Robotic Lobectomy Is Cost-Effective With No Change in Clinical Outcomes. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:127-135. [PMID: 35341368 DOI: 10.1177/15569845221086278] [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] [Indexed: 11/17/2022]
Abstract
Objective: Our objective was to evaluate for any changes in quality or cost when robotic lung resection is used with significant trainee participation. Methods: All anatomic lung resections between January 2006 and June 2016 were identified from a prospectively maintained database. Clinical data were recorded by double entry. Cost and cancer-related data were gathered from the business analytics department and tumor registry. Robotic outcomes were compared to an ongoing thoracotomy and video-assisted thoracic surgery (VATS) experience. Propensity scores using age, sex, and comorbidities were assigned for statistical analysis. Survival was evaluated using the Kaplan-Meier method. Results: Of 523 consecutive cases, 483 were included (211 robotic, 210 thoracotomy, 62 VATS). There were 74 robotic cases (35%) performed by trainees as the console surgeon. Length of stay was shortest for robotics (3 days) compared to thoracotomy (7 days, P < 0.001) and VATS (5 days, P = 0.010). Complications occurred in 33% of robotic cases, 42% of VATS cases (P = 0.854), and 52% of thoracotomy cases (P < 0.001). Stage I non-small cell lung cancer 3-year overall survival for robotics, thoracotomy, and VATS was 79.5%, 74.3%, and 74.0%, respectively (P > 0.25). There was no significant difference in negative margin rates. Total cost related to the hospitalization for surgery was $5,721 less for robotics compared to thoracotomy (P = 0.003) but comparable to VATS. Trainees served as console surgeon in 0% of cases in the first 2 years of robotics but increased to 79% in the last year of the study. Conclusions: Robotic lung resection can be safely performed and taught in an academic medical center without sacrificing quality or cost.
Collapse
Affiliation(s)
- James T Nawalaniec
- Department of Surgery, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Matthew Elson
- Department of Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott I Reznik
- Department of Cardiovascular and Thoracic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Wait
- Department of Cardiovascular and Thoracic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alejandra Madrigales
- Tumor Registry, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jerzy Lysikowski
- Biostatistics, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kemp H Kernstine
- Department of Cardiovascular and Thoracic Surgery, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
6
|
Nachira D, Congedo MT, Tabacco D, Sassorossi C, Calabrese G, Ismail M, Vita ML, Petracca-Ciavarella L, Margaritora S, Meacci E. Surgical Effectiveness of Uniportal-VATS Lobectomy Compared to Open Surgery in Early-Stage Lung Cancer. Front Surg 2022; 9:840070. [PMID: 35310438 PMCID: PMC8931028 DOI: 10.3389/fsurg.2022.840070] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/31/2022] [Indexed: 12/25/2022] Open
Abstract
BackgroundAlthough the feasibility and safety of Uniportal-Video-Assisted thoracic surgery (U-VATS) has been proven, its surgical effectiveness is still debated. The aim of this study is to assess the equivalence of the U-VATS approach compared with an open technique in terms of surgical (nodal-upstaging, complications, and post-operative results) and short-term survival outcomes.MethodsThe clinical data of patients undergoing lobectomy for NSCLC at our center, from January 2014 to December 2019, were analyzed retrospectively. All patients undergoing open or U-VATS lobectomy with lymphadenectomy for early-stage lung cancer (cT1-T3N0, stages IA-IIB) were included in the study. Only 230 patients satisfied the inclusion criteria. Group bias was reduced through 1:1 propensity score matching, which resulted in 46 patients in each group (open surgery and U-VATS).ResultsThe intra- and post-operative mortality were null in both groups. There was no difference in the post-operative complications (p: 1.00) between U-VATS and open lobectomy. There was also no recorded difference in the pathological nodal up-staging [11 (23.9%) after thoracotomy vs. 8 (17.4%) after U-VATS, p: 0.440). The chest tube duration was longer in the open group (p: 0.025), with a higher post-operative pain (p: 0.001). Additionally, the 3-year overall survival (OS) was 78% after U-VATS lobectomy vs. 74% after open lobectomy (p: 0.204), while 3-year disease-specific survival (DSS) was 97 vs. 89% (p: 0.371), respectively. The 3-year disease-free survival (DFS) was 62% in the U-VATS group and 66% in the thoracotomy group, respectively (p: 0.917).ConclusionsUniportal-VATS lobectomy for the treatment of early-stage lung cancer seems to be a safe and effective technique with similar surgical and short-term survival outcomes as open surgery, but with lower post-operative pain and shorter in-hospital stay.
Collapse
Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Dania Nachira
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diomira Tabacco
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carolina Sassorossi
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Calabrese
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann Potsdam, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Leonardo Petracca-Ciavarella
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
- Elisa Meacci
| |
Collapse
|
7
|
Obiols C, Call S, Rami-Porta R, Jaén Á, Gómez de Antonio D, Crowley Carrasco S, Royo-Crespo Í, Embún R. Radicality of lymphadenectomy in lung cancer resections by thoracotomy and video-assisted thoracoscopic approach: A prospective, multicentre and propensity-score adjusted study. Lung Cancer 2022; 165:63-70. [PMID: 35091211 DOI: 10.1016/j.lungcan.2022.01.004] [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: 10/16/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyse differences in intraoperative nodal assessment in patients undergoing lung cancer resection by thoracotomy and video-assisted thoracoscopy (VATS) in the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). METHODS Prospective multicentre cohort study of anatomic pulmonary resections (n = 3533) performed from December 2016 to March 2018. Main surgical, clinical and oncological variables related with lymphadenectomy were compared according to surgical approach. Corresponding tests for homogeneity were performed. Multiple logistic regression analyses were used to determine the odds ratio (OR) and 95% confidence interval (95%CI). Covariate adjustment using the propensity score (PS) was performed to reduce confounding effects. RESULTS After exclusions, 2532 patients were analysed. Systematic nodal dissection (SND) was performed in 65%, with a median of resected/sampled lymph nodes (LN) of 7 (IQR 4-12) and pathologic (p) N2 and uncertain (u) pNu rates of 9.4% and 28.9%, respectively. At multivariate analysis, the following were associated with thoracotomy (OR; 95%CI): SND (1.4; 1.08-1.96; p = 0.014), staging mediastinoscopy (2.6; 1.59-4.25; p < 0.001), tumor > 3 cm (2.1; 1.66-2.78; p < 0.001), central tumor (2.5; 1.90-3.24; p < 0.001); pN1 (1.8; 1.25-2.67; p < 0.002), pN2 (1.8; 1.18-2.76; p = 0.006), lower FEV1 (0.9; 0.98-0.99; p < 0.001), squamous cell carcinoma (1.5; 1.16-1.98; p = 0.002) and inexperienced surgeons in VATS (compared with > 100 VATS experience) (37.6; 13.55-104.6; p < 0.001). After PS adjustment, SND maintained the OR, but in the limit of signification (1.4; 1-1.98; p = 0.05). Nodal upstaging was significantly higher in the thoracotomy group. Complication rates of SND and no SND were similar. CONCLUSIONS Thoracotomy was associated with a more thorough lymphadenectomy in GEVATS. Therefore, intraoperative lymph node evaluation performed at VATS should be improved to have better prognostic information and more solid grounds to indicate adjuvant therapy.
Collapse
Affiliation(s)
- Carme Obiols
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain.
| | - Sergi Call
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain; Department of Morphological Sciences, Medical School, Autonomous University of Barcelona, Bellaterra, Spain
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain; Network of Centres of Biomedical Research in Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Spain
| | - Ángeles Jaén
- Unit of Research. Fundació Docència i Recerca Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - David Gómez de Antonio
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Silvana Crowley Carrasco
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Íñigo Royo-Crespo
- Department of Thoracic Surgery, IIS Aragón, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Raúl Embún
- Department of Thoracic Surgery, IIS Aragón, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| |
Collapse
|
8
|
Nakagawa K, Yoshida Y, Yotsukura M, Watanabe SI. Minimally invasive open surgery (MIOS) for clinical stage I lung cancer: diversity in minimally invasive procedures. Jpn J Clin Oncol 2021; 51:1649-1655. [PMID: 34373902 DOI: 10.1093/jjco/hyab128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many thoracic surgeons have tried to make lung cancer surgery less invasive. Among the minimally invasive approaches that are currently available, it is controversial which is optimal. Minimally invasive open surgery, i.e. hybrid video-assisted thoracic surgery, has been adopted for lung cancer surgery at our institute. The objective of this study was to evaluate minimally invasive open surgery in terms of perioperative outcomes over the most recent 5 years. METHODS Between 2015 and 2019, 2738 patients underwent pulmonary resection for lung cancer at National Cancer Center Hospital, Japan. Among them, 2174 patients with clinical stage I lung cancer who underwent minimally invasive open surgery were included. Several perioperative parameters were evaluated. RESULTS The patients consisted of 1092 men (50.2%) and 1082 women (49.8%). Lobectomy was performed in 1255 patients (57.7%), segmentectomy in 603 (27.7%) and wide wedge resection in 316 (14.5%). Median blood loss was 30 ml (interquartile range: 15-57 ml) for lobectomy, 17 ml (interquartile range: 10-31 ml) for segmentectomy and 5 ml (interquartile range: 2-10 ml) for wide wedge resection. Median operative time was 120 min (interquartile range: 104-139 min) for lobectomy, 109 min (interquartile range: 98-123 min) for segmentectomy and 59 min (interquartile range: 48-76 min) for wide wedge resection. Median length of postoperative hospital stay was 4 days (interquartile range: 3-5 days). The 30-day mortality rate was 0.08% for lobectomy, 0.17% for segmentectomy and 0.00% for wide wedge resection. CONCLUSIONS Minimally invasive open surgery for clinical stage I lung cancer is a feasible approach with a low mortality and a short hospital stay. Oncological outcomes need to be investigated.
Collapse
Affiliation(s)
- Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
9
|
Haruki T, Takagi Y, Kubouchi Y, Kidokoro Y, Nakanishi A, Nozaka Y, Oshima Y, Matsui S, Nakamura H. Comparison between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery for mediastinal and hilar lymph node dissection in lung cancer surgery. Interact Cardiovasc Thorac Surg 2021; 33:409-417. [PMID: 34297835 DOI: 10.1093/icvts/ivab112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/01/2021] [Accepted: 03/26/2021] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Lymph node dissection (LND) with robot-assisted thoracoscopic surgery (RATS) in lung cancer surgery has not been fully evaluated. The aim of this study was to compare LND surgical results between video-assisted thoracoscopic surgery (VATS) and RATS. METHODS We retrospectively compared perioperative parameters, including the incidence of LND-associated complications (chylothorax, recurrent and/or phrenic nerve paralysis and bronchopleural fistula), lymph node (LN) counts and postoperative locoregional recurrence, among 390 patients with primary lung cancer who underwent lobectomy and mediastinal LND by RATS (n = 104) or VATS (n = 286) at our institution. RESULTS The median total dissected LN numbers significantly differed between the RATS and the VATS groups (RATS: 18, VATS: 15; P < 0.001). They also significantly differed in right upper zone and hilar (#2R + #4R + #10L) (RATS: 12, VATS: 10; P = 0.002), left lower paratracheal and hilar (#4L + #10L) (RATS: 4, VATS: 3; P = 0.019), aortopulmonary zone (#5 + #6) (RATS: 3, VATS: 2; P = 0.001) and interlobar and lobar (#11 + #12) LNs (RATS: 7, VATS: 6; P = 0.041). The groups did not significantly differ in overall nodal upstaging (P = 0.64), total blood loss (P = 0.69) or incidence of LND-associated complications (P = 0.77). CONCLUSIONS In this comparison, it was suggested that more LNs could be dissected using RATS than VATS, especially in bilateral superior mediastinum and hilar regions. Accumulation of more cases and longer observation periods are needed to verify whether RATS can provide the acceptable quality of LND and local control of lung cancer.
Collapse
Affiliation(s)
- Tomohiro Haruki
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yuzo Takagi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yasuaki Kubouchi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yoshiteru Kidokoro
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Atsuyuki Nakanishi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yuji Nozaka
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yuki Oshima
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Shinji Matsui
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hiroshige Nakamura
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| |
Collapse
|
10
|
Khanh HQ, Vinh VH, Khoi NV, Vuong NL. Videothoracoscopic versus open resection in the treatment of mediastinal tumors: a prospective study. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
11
|
Khanh HQ, Van Khoi N, Vuong NL. Long-term outcome in mediastinal malignancies: video-assisted thoracoscopic versus open surgery. Indian J Thorac Cardiovasc Surg 2020; 37:44-52. [PMID: 33442207 DOI: 10.1007/s12055-020-01023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose There are not many studies comparing long-term oncological outcomes between video-assisted thoracoscopic surgery (VATS) and open surgery for mediastinal malignancies. This study aimed to compare perioperative and long-term outcomes of these two techniques in the treatment of mediastinal malignancies. Methods This is a retrospective study: patients with mediastinal malignancies underwent VATS or open surgery from 2010 to 2013 and were followed until 2019. The primary endpoints were long-term oncological outcomes, including tumor recurrence and mortality. Secondary endpoints were perioperative outcomes (operative duration, blood loss, pain, chest drainage duration, hospital length of stay, and complications). Results There were 36 patients in the VATS group and 49 patients in the open group. The median follow-up duration was 90 months. VATS significantly reduced operation time (84.6 versus 124.8 min), blood loss (59.8 versus 235.2 ml), postoperative pain score (4.9 versus 6.7), the duration of chest tube drainage (2.1 versus 3.1 days), and postoperative hospital stay (5.2 versus 8.0 days). The two groups were comparable regarding the recurrence rate (2.4 versus 2.1/100 person-years) and mortality rate (0.8 versus 0.9/100 person-years). Conclusion Compared with open surgery, VATS is less traumatic, reduces postoperative chest drainage, and shortens hospital stay with comparable long-term oncological outcomes. We advocate the VATS approach as a favored option for the resection of mediastinal malignancies.
Collapse
Affiliation(s)
- Huynh Quang Khanh
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Van Khoi
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Lam Vuong
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
| |
Collapse
|
12
|
Results of video-assisted thoracic surgery versus thoracotomy in surgical resection of pN2 non-small cell lung cancer in a Chinese high-volume Center. Surg Endosc 2020; 35:2186-2197. [PMID: 32394172 DOI: 10.1007/s00464-020-07624-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/02/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the short-term outcomes and long-term oncological efficacy of video-assisted thoracic surgery (VATS) for surgical treatment of pN2 non-small cell lung cancer (NSCLC) compared with open thoracotomy (OT). PATIENTS AND METHODS We retrospectively collected data from 1034 patients who underwent pulmonary resection and systemic lymph node dissection for pathological N2 NSCLC from September 2005 to December 2017 (536 patients in VATS group and 498 patients in OT group). Propensity score matching was applied to reduce the confounding effects. Factors affecting survival were assessed by Kaplan-Meier estimates and Cox regression analysis. RESULTS The VATS procedure was associated with shorter operative time compared with the OT procedure (147.96 ± 58.91 min vs. 165.34 ± 58.91 min, P < 0.001). No significant difference was identified between the two groups in the number of dissected mediastinal lymph nodes (MLNs) and number of dissected MLNs stations. More patients after VATS procedure received postoperative adjuvant therapy (83.4% vs. 75.5%, P = 0.002). At a median follow-up of 36 (range 4-150) months, comparing VATS procedure and OT procedure, no significant differences were noted in 5-year DFS (20.7% vs. 22.5%, P = 0.89) and 5-year OS (30.7% vs. 34.5%, P = 0.821). The VATS procedure was not found to be an independent predictor of DFS (hazard ratio, 0.986; 95% CI, 0.809 to 1.202) or OS (hazard ratio, 0.977; 95% CI 0.802 to 1.191). CONCLUSION In this large propensity-matched comparison, the VATS procedure offered comparable short-term outcomes and long-term oncological efficacy for patients with pN2 NSCLC when compared with OT procedure.
Collapse
|
13
|
Marulli G, Faccioli E, Mammana M, Nicotra S, Comacchio G, Verderi E, De Palma A, Rea F. Predictors of nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC): results from the Italian VATS Group Registry. Surg Today 2019; 50:711-718. [PMID: 31873770 DOI: 10.1007/s00595-019-01939-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/29/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Accurate staging of early non-small cell lung cancer is fundamental for selecting the best treatment. The aim of this study was to identify risk factors for nodal upstaging after video-assisted thoracoscopic lobectomy for clinical T1-3N0 tumors. METHODS From 2014 to 2017, 3276 thoracoscopic lobectomies were recorded in the prospective database "Italian VATS Group". Linear and multiple logistic regression models were adapted to identify independent predictors of nodal upstaging and factors associated with progression in postoperative N status. RESULTS Nodal upstaging was found in 417 cases (12.7%), including 206 cases (6.2%) of N1-positive nodes, 81 cases of N2 nodes (2.4%), and 130 cases (4%) of involvement of both N1 + N2 nodes. A total of 241 (7.3%) patients had single-station nodal involvement, whereas 176 (5.3%) had multiple-station involvement. In the final regression model, the tumor grade, histology, pathologic T status, and > 12 resected nodes were independent predictors of nodal upstaging. CONCLUSIONS The number of resected lymph nodes seems to predict nodal upstaging better than the type of intraoperative lymph node management. Other preoperative risk factors correspond to those for which the current guidelines of the European Society of Thoracic Surgery recommend more extensive preoperative mediastinal staging.
Collapse
Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation (DETO), University Hospital of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Samuele Nicotra
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Giovanni Comacchio
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Enrico Verderi
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Angela De Palma
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation (DETO), University Hospital of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| |
Collapse
|
14
|
Pregernig A, Beck-Schimmer B. Which Anesthesia Regimen Should Be Used for Lung
Surgery? CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
Development of a predictive radiomics model for lymph node metastases in pre-surgical CT-based stage IA non-small cell lung cancer. Lung Cancer 2019; 139:73-79. [PMID: 31743889 DOI: 10.1016/j.lungcan.2019.11.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/03/2019] [Accepted: 11/08/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To develop and validate predictive models using clinical parameters, radiomic features and a combination of both for lymph node metastasis (LNM) in pre-surgical CT-based stage IA non-small cell lung cancer (NSCLC) patients. METHODS This retrospective study included 649 pre-surgical CT-based stage IA NSCLC patients from our hospital. One hundred and thirty-eight (21 %) of the 649 patients had LNM after surgery. A total of 396 radiomic features were extracted from the venous phase contrast enhanced computed tomography (CECT). The training group included 455 patients (97 with and 358 without LNM) and the testing group included 194 patients (41 with and 153 without LNM). The least absolute shrinkage and selection operator (LASSO) algorithm was used for radiomic feature selection. The random forest (RF) was used for model development. Three models (a clinical model, a radiomics model, and a combined model) were developed to predict LNM in early stage NSCLC patients. The area under the receiver operating characteristic (ROC) curve (AUC) value and decision curve analysis were used to evaluate the performance in LNM status (with or without LNM) using the three models. RESULTS The ROC analysis (also decision curve analysis) showed predictive performance for LNM of the radiomics model (AUC values for training and testing, respectively 0.898 and 0.851) and of the combined model (0.911 and 0.860, respectively). Both performed better than the clinical model (0.739 and 0.614, respectively; delong test p-values both<0.001). CONCLUSION A radiomics model using the venous phase of CE-CT has potential for predicting LNM in pre-surgical CT-based stage IA NSCLC patients.
Collapse
|
16
|
Venkitaraman B, Lei J, Liang W, Jianqiao C. Uniportal video-assisted thoracoscopy surgery in lung cancer: largest experience. Asian Cardiovasc Thorac Ann 2019; 27:559-564. [PMID: 31407931 DOI: 10.1177/0218492319868651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Uniportal video-assisted thoracoscopic surgery is one of the latest development in minimal invasive thoracic surgery. It is being increasing applied in various parts of the world for the treatment of lung cancer. Although the technique has become popular, there is a lack of largescale literature addressing the safety and oncological outcomes. We aimed to describe our experience, highlighting the short-term outcomes and oncological efficacy. Methods From July 2013 to December 2017, 441 uniportal video-assisted thoracoscopic procedures were carried out in patients with primary lung cancer and no metastatic disease. The male-to-female ratio was 240:201. The median age of the patients was 63 years (range10 to 85 years). Results The median number of mediastinal lymph node stations dissected and median number of mediastinal nodes were 5 and 14, respectively. Ten or more nodes were dissected in 93.1% of patients. All surgeries were complete R0 resection. Minor postoperative morbidity according to the Clavien-Dindo classification was 4%. Seven patients experienced major morbidity requiring intensive care management. There was no 30-day mortality. Conclusion Uniportal video-assisted thoracoscopic anatomical resection for lung cancer appears to have similar postoperative outcomes to multiport surgery in terms of short-term morbidity and oncological efficacy. Uniportal video-assisted thoracoscopic surgery can be offered as a standard of care for lung cancer surgery in centers with adequate surgical expertise. Long-term follow-up will be needed to establish the long-term oncological outcomes.
Collapse
Affiliation(s)
- Balasubramanian Venkitaraman
- 1 Department of Thoracic Surgery Shanghai Pulmonary Hospital, Shanghai, China.,2 Department of Surgical Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Jiang Lei
- 1 Department of Thoracic Surgery Shanghai Pulmonary Hospital, Shanghai, China
| | - Wu Liang
- 1 Department of Thoracic Surgery Shanghai Pulmonary Hospital, Shanghai, China
| | - Cai Jianqiao
- 1 Department of Thoracic Surgery Shanghai Pulmonary Hospital, Shanghai, China
| |
Collapse
|
17
|
Wu HR, Liu CQ, Xu MQ, Xu GW, Xiong R, Li CW, Xie MR. Systematic mediastinal lymph node dissection outcomes and conversion rates of uniportal video-assisted thoracoscopic lobectomy for lung cancer. ANZ J Surg 2019; 89:1056-1060. [PMID: 31334598 DOI: 10.1111/ans.15338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND To evaluate the systematic mediastinal lymph node (LN) dissection outcomes and conversion rates of uniportal video-assisted thoracoscopic surgery (UVATS). METHODS Patients with non-small-cell lung cancer who underwent video-assisted thoracoscopic surgery (VATS) and systematic mediastinal LN dissection between January 2015 and January 2017 were retrospectively reviewed. We categorized the patients into two groups according to the different surgical approaches. Patients' clinical data were collected and compared. The index of estimated benefit from LN dissection was used to evaluate the therapeutic value of LN dissection for each station. RESULTS A total of 453 patients underwent VATS, including 197 patients in the UVATS group and 256 patients in the triportal VATS (TVATS) group. There were no significant differences in the 1-, 2- and 3-year survival rates of these two groups (P > 0.05). There were no statistically significant differences in the operative time, numbers and stations of LNs, numbers and stations of N2 LNs, conversion rate or postoperative complications. The UVATS group had less intraoperative blood loss, a shorter duration of hospital stay, less chest tube drainage and a shorter duration of chest tube drainage than the TVATS group (P < 0.05). The conversion rates in the UVATS and TVATS groups were 5.1% and 4.3%, respectively, and the difference was not significant. The same degree of LN sampling was achieved in both groups. CONCLUSION UVATS permits the same degree of LN sampling as TVATS without a difference in the conversion rate.
Collapse
Affiliation(s)
- Han-Ran Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Chang-Qing Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Mei-Qing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Guang-Wen Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Ran Xiong
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Cai-Wei Li
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Ming-Ran Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| |
Collapse
|
18
|
Lavaud P, Besse B, de Baere T, Deschamps F, Mussot S, Le Pechoux C, Caramella C, Mercier O, Mezquitta L, Botticella A, Pradere P, Adam J, Planchard D, Tselikas L. Focus on Recommendations for the Management of Non-small Cell Lung Cancer. Cardiovasc Intervent Radiol 2019; 42:1230-1239. [PMID: 31062067 DOI: 10.1007/s00270-019-02222-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 04/10/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Pernelle Lavaud
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
- Faculté de médecine, Paris Sud, Paris Saclay, Orsay, France
| | - Thierry de Baere
- Faculté de médecine, Paris Sud, Paris Saclay, Orsay, France
- Interventional Radiology, Gustave Roussy, Villejuif, France
| | | | - Sacha Mussot
- Thoracic Surgery, Hopital Marie Lannelongue, Le Plessis Robinson, France
| | | | | | - Olaf Mercier
- Thoracic Surgery, Hopital Marie Lannelongue, Le Plessis Robinson, France
| | - Laura Mezquitta
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | | | - Pauline Pradere
- Pneumology, Hopital Marie Lannelongue, Le Plessis Robinson, France
| | - Julien Adam
- Pathology Department, Gustave Roussy, Villejuif, France
| | - David Planchard
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | - Lambros Tselikas
- Interventional Radiology, Gustave Roussy, Villejuif, France.
- Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif, France.
| |
Collapse
|
19
|
Guo C, Xia L, Mei J, Liu C, Lin F, Ma L, Pu Q, Liu L. A propensity score matching study of non-grasping en bloc mediastinal lymph node dissection versus traditional grasping mediastinal lymph node dissection for non-small cell lung cancer by video-assisted thoracic surgery. Transl Lung Cancer Res 2019; 8:176-186. [PMID: 31106128 DOI: 10.21037/tlcr.2018.12.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The aim of our study was to compare the efficacy of lymph node (LN) dissection, short-term surgical outcomes, and long-term outcomes between non-grasping en bloc mediastinal lymph node dissection (NE-MLND) and traditional grasping mediastinal lymph node dissection (G-MLND) under video-assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed 872 patients with pathological stage I-III NSCLC who underwent VATS. The patient's demographic characteristics, short-term surgical outcomes, overall survival (OS) and disease-free survival (DFS) were assessed. A propensity score-matched (PSM) analysis was performed between NE-MLND and G-MLND to reduce bias, and 349 pairs of patients were matched. Results Before propensity-score matching, for short-term surgical outcomes, the NE-MLND group had shorter operation time (P<0.001), more LNs removed (N1: P=0.002; N2: P<0.001; N1+N2: P<0.001), more pleural drainage during the first 3 days after surgery (P<0.001), and longer postoperative hospital stay (P<0.001). For long-term survival outcomes, the NE-MLND group had a longer OS (5-year OS: 71.8% vs. 64.8%, P=0.013), and there was no difference in DFS between the 2 groups (P=0.138). After propensity-score matching, the short-term surgical outcomes were consistent with the results before PSM. The OS and DFS in NE-MLND group were significantly longer than those in the G-MLND group (5-year OS: 76.4% vs. 63.5%, P=0.001 and 5-year DFS: 63.0% vs. 54.6%, P=0.033, respectively). Multivariate analysis showed that NE-MLND was an independent protective factor against OS [G-MLND: hazard ratio (HR) 1.461; 95% confidence interval (CI), 1.130-1.890; P=0.004]. Conclusions NE-MLND is a safe, acceptable and superior approach to remove mediastinal LNs with shorter operation time. Patients with NSCLC may benefit from NE-MLND, which could lead to better OS and DFS as compared with G-MLND.
Collapse
Affiliation(s)
- Chenglin Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Liang Xia
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Feng Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Lin Ma
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China
| |
Collapse
|
20
|
Heineman DJ, van Berge Henegouwen MI. Extensive thoracoscopic mediastinal lymph node dissection on the left side: how it should be done. J Thorac Dis 2019; 11:62-64. [PMID: 30863573 DOI: 10.21037/jtd.2019.01.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- David J Heineman
- Department of Surgery, Amsterdam UMC, VU University Medical Center, 1081 HV, Amsterdam, The Netherlands.,Cardiothoracic Surgery, Amsterdam UMC, VU University Medical Center, 1081 HV, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
21
|
Liao H, Mei J, Lin F, Liu C, Pu Q, Liu L. Single-direction thoracoscopic lobectomy: left side. J Thorac Dis 2018; 10:5932-5934. [PMID: 30505502 DOI: 10.21037/jtd.2018.09.34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Hu Liao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Feng Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
22
|
Liao H, Liu C, Mei J, Lin F, Pu Q, Liu L. Single-direction thoracoscopic lobectomy: right side. J Thorac Dis 2018; 10:5935-5938. [PMID: 30505503 DOI: 10.21037/jtd.2018.09.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Hu Liao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Feng Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
23
|
Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, Escriu C, Peters S. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28:iv1-iv21. [PMID: 28881918 DOI: 10.1093/annonc/mdx222] [Citation(s) in RCA: 1181] [Impact Index Per Article: 168.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P E Postmus
- The Clatterbridge Cancer Centre and Liverpool Heart and Chest Hospital, Liverpool
| | - K M Kerr
- University of Aberdeen, Aberdeen, UK
| | - M Oudkerk
- Center for Medical Imaging, University of Groningen, Groningen
| | - S Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - D A Waller
- Department of Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - C Escriu
- The Clatterbridge Cancer Centre and Liverpool Heart and Chest Hospital, Liverpool
| | - S Peters
- Oncology Department, Service d'Oncologie Médicale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| |
Collapse
|