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Rodriguez GR, Kucera J, Antevil JL, Mullenix PS, Trachiotis GD. Contemporary Video-Assisted Thoracoscopic Lobectomy for Early-Stage Lung Cancer. J Laparoendosc Adv Surg Tech A 2024; 34:798-807. [PMID: 39288366 DOI: 10.1089/lap.2024.0281] [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] [Indexed: 09/19/2024] Open
Abstract
The treatment of non-small cell lung cancer (NSCLC) has evolved tremendously in recent decades as innovations in medical therapies advanced concomitantly with minimally invasive surgical techniques. Despite early skepticism regarding its benefits, video-assisted thoracoscopic surgery (VATS) techniques for the surgical resection of early-stage NSCLC have now become the standard of care. After being the subject of many studies since its inception, VATS has been shown to cause less postoperative pain, have shorter recovery time, and have fewer overall complications when compared to conventional open approaches. Furthermore, some studies have shown it to have comparable oncological outcomes, though more higher evidence studies are needed. Newer technologies and improved surgical instruments, advancements in nodule localization techniques, and improved preoperative staging procedures have allowed for the development of newer, less invasive techniques such as uniportal VATS and parenchymal-sparing sublobar resections, which might further improve postoperative rates of complications in specific cases. These minimally invasive approaches have allowed surgeons to offer surgery to high-risk patients and those who would otherwise not tolerate conventional thoracotomy, though some relative contraindications still exist. This review aims to describe the evolution of VATS lobectomy, current techniques, its indications, contraindications, preoperative testing, benefits, and outcomes in patients with stage I and II NSCLC.
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Affiliation(s)
- Gustavo R Rodriguez
- Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA
| | - John Kucera
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jared L Antevil
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Philip S Mullenix
- Division of Cardiothoracic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Gregory D Trachiotis
- Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
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Lee JD, Zheng R, Okusanya OT, Evans NR, Grenda TR. Association between surgical quality and long-term survival in lung cancer. Lung Cancer 2024; 190:107511. [PMID: 38417278 DOI: 10.1016/j.lungcan.2024.107511] [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: 07/27/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES There are significant variations in both perioperative and long-term outcomes after lung cancer resection. While perioperative outcomes are often used as comparative measures of quality, they are unreliable, and their association with long-term outcomes remain unclear. In this context, we evaluated whether historical perioperative mortality after lung cancer resection is associated with 5-year survival. PATIENTS AND METHODS The National Cancer Database (NCDB) was queried to identify patients diagnosed with non-small cell lung cancer (NSCLC) in 2010-2016 who underwent surgical resection (n = 234200). Hospital-level reliability-adjusted 90-day mortality rate quartiles for 2010-2013 was used as the independent variable to analyze 5-year survival for patients diagnosed in 2014-2016 (n = 85396). RESULTS There were 85,396 patients in the 2014-2016 cohort across 1,086 hospitals. Overall observed 90-day mortality rate was 3.2% (SD 17.6%) with 2.6% (SD 16.0%) for the historically best performing quartile vs. 3.9% (SD 19.4%) for the worst performing quartile (p < 0.0001). Patients who underwent resection at hospitals with the best historical mortality rate had significantly better 5-year survival across all stages compared to those treated at hospitals in the worst performing quartile in multivariate Cox regression analysis (all stages - HR 1.21 [95% CI 1.15-1.26]; stage I - HR 1.19 [95% CI 1.12-1.25]; stage II - HR 1.20 [95% CI 1.09-1.32]; stage III - HR 1.36 [95% CI 1.20-1.54]) and Kaplan-Meier survival estimates (all stages - p < 0.0001, stage I - p < 0.0001; stage II - p = 0.0004; stage III - p < 0.0001). CONCLUSION With expanded lung cancer screening criteria and likely increase in early-stage detection, profiling performance is paramount to ensuring mortality benefits. We found that episodes surrounding surgical resection may be used to profile long-term outcomes that likely reflect quality across a broader context of care. Evaluating lung cancer care quality using perioperative outcomes may be useful in profiling provider performance and guiding value-based payment policies.
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Affiliation(s)
- James D Lee
- Division of Pulmonary, Allergy, and Critical Care, Penn Presbyterian Medical Center, Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Richard Zheng
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Olugbenga T Okusanya
- Division of Thoracic Surgery, Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nathaniel R Evans
- Division of Thoracic Surgery, Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Tyler R Grenda
- Division of Thoracic Surgery, Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
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Kaltenhauser S, Niessen C, Zeman F, Stroszczynski C, Zorger N, Grosse J, Großer C, Hofmann HS, Robold T. Diagnosis of sarcopenia on thoracic computed tomography and its association with postoperative survival after anatomic lung cancer resection. Sci Rep 2023; 13:18450. [PMID: 37891259 PMCID: PMC10611729 DOI: 10.1038/s41598-023-45583-5] [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: 03/27/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023] Open
Abstract
Computer tomography-derived skeletal muscle index normalized for height in conjunction with muscle density enables single modality-based sarcopenia assessment that accounts for all diagnostic criteria and cutoff recommendations as per the widely accepted European consensus. Yet, the standard approach to quantify skeletal musculature at the third lumbar vertebra is limited for certain patient groups, such as lung cancer patients who receive chest CT for tumor staging that does not encompass this lumbar level. As an alternative, this retrospective study assessed sarcopenia in lung cancer patients treated with curative intent at the tenth thoracic vertebral level using appropriate cutoffs. We showed that skeletal muscle index and radiation attenuation at level T10 correlate well with those at level L3 (Pearson's R = 0.82 and 0.66, p < 0.001). During a median follow-up period of 55.7 months, sarcopenia was independently associated with worse overall (hazard ratio (HR) = 2.11, 95%-confidence interval (95%-CI) = 1.38-3.23, p < 0.001) and cancer-specific survival (HR = 2.00, 95%-CI = 1.19-3.36, p = 0.009) of lung cancer patients following anatomic resection. This study highlights feasibility to diagnose sarcopenia solely by thoracic CT in accordance with the European consensus recommendations. The straightforward methodology offers easy translation into routine clinical care and potential to improve preoperative risk stratification of lung cancer patients scheduled for surgery.
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Affiliation(s)
- Simone Kaltenhauser
- Department of Thoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Christoph Niessen
- Department of Radiology, Caritas-Krankenhaus St Josef, Regensburg, Germany
| | - Florian Zeman
- Center of Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | | | - Niels Zorger
- Department of Radiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Jirka Grosse
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Christian Großer
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Tobias Robold
- Department of Thoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Kim BG, Choi YS, Shin SH, Lee K, Um SW, Kim H, Jeon YJ, Lee J, Cho JH, Kim HK, Kim J, Shim YM, Jeong BH. Mortality and lung function decline in patients who develop chronic pulmonary aspergillosis after lung cancer surgery. BMC Pulm Med 2022; 22:436. [PMID: 36418999 PMCID: PMC9682797 DOI: 10.1186/s12890-022-02253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Lung cancer surgery is reported as a risk factor for chronic pulmonary aspergillosis (CPA). However, limited data are available on its clinical impact. We aimed to determine the effect of developed CPA after lung cancer surgery on mortality and lung function decline. METHODS We retrospectively identified the development of CPA after lung cancer surgery between 2010 and 2016. The effect of CPA on mortality was evaluated using multivariable Cox proportional hazard analyses. The effect of CPA on lung function decline was evaluated using multiple linear regression analyses. RESULTS During a median follow-up duration of 5.01 (IQR, 3.41-6.70) years in 6777 patients, 93 developed CPA at a median of 3.01 (IQR, 1.60-4.64) years. The development of CPA did not affect mortality in multivariable analysis. However, the decline in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were greater in patients with CPA than in those without (FVC, - 71.0 [- 272.9 to - 19.4] vs. - 10.9 [- 82.6 to 57.9] mL/year, p < 0.001; FEV1, - 52.9 [- 192.2 to 3.9] vs. - 20.0 [- 72.6 to 28.6] mL/year, p = 0.010). After adjusting for confounding factors, patients with CPA had greater FVC decline (β coefficient, - 103.6; 95% CI - 179.2 to - 27.9; p = 0.007) than those without CPA. However, the FEV1 decline (β coefficient, - 14.4; 95% CI - 72.1 to 43.4; p = 0.626) was not significantly different. CONCLUSION Although the development of CPA after lung cancer surgery did not increase mortality, the impact on restrictive lung function deterioration was profound.
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Affiliation(s)
- Bo-Guen Kim
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Yong Soo Choi
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Hye Shin
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Kyungjong Lee
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Sang-Won Um
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Hojoong Kim
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Yeong Jeong Jeon
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junghee Lee
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Ho Cho
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jhingook Kim
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
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An S, Han GY, Eo W, Kim DH, Lee S. Comparison of the geriatric nutritional risk index and the prognostic nutritional index in determining survival outcome in patients with non-small cell lung cancer undergoing surgical resection: A cohort study. Medicine (Baltimore) 2022; 101:e31591. [PMID: 36397370 PMCID: PMC9666186 DOI: 10.1097/md.0000000000031591] [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] [Indexed: 11/18/2022] Open
Abstract
To assess the clinical feasibility of the geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) as determinants of survival in patients with stage I to III non-small cell lung cancer (NSCLC). This retrospective study included patients with stage I to III NSCLC from all age groups. Hazard ratios (HRs) for overall survival (OS), cancer-specific survival (CSS), and relapse-free survival (RFS) were calculated using the Cox regression analysis. The concordance index (C-index) of the models was evaluated following the establishment of the prognostic models for survival. The median patient age was 69 years, and 64.6% of the patients were male. In total, 172 (65.4%) patients were classified as having stage I disease, 52 (19.8%) as stage II disease, and 39 (14.8%) as stage III disease. Using multivariate Cox regression analysis, the HRs of GNRI for OS, CSS, and RFS were 0.37 (P = .003), 0.47 (P = .041), and 0.38 (P < .001), respectively. However, the HRs of the PNI for survival outcomes were not statistically significant. Overall, age, sex, tumor-node-metastasis (TNM) stage, pleural invasion (PI), and GNRI were significant determinants of OS and constituted the OS model (concordance index [C-index], 0.824). In addition, age, TNM stage, PI, and GNRI were significant determinants of CSS and constituted the CSS model (C-index, 0.828). Finally, TNM stage, PI, lymphatic invasion, and GNRI were significant determinants of RFS and constituted the RFS model (C-index, 0.783). Our study showed that GNRI, but not PNI, was a predictor of OS, CSS, and RFS in patients with stage I-III NSCLC across all age groups. Excellent discriminant power was observed for OS, CSS, and RFS models.
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Affiliation(s)
- Soomin An
- Department of Nursing, Dongyang University, Gyeongbuk, Republic of Korea
| | - Ga Young Han
- Department of Music, Chang Shin University, Changwon, Republic of Korea
| | - Wankyu Eo
- College of Medicine, Kyung Hee University, Seoul, Republic of Korea
- *Correspondence: Wankyu Eo, Department of Internal Medicine, College of Medicine, Kyung Hee University, #892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea (e-mail: )
| | - Dae Hyun Kim
- Department of Thoracic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sookyung Lee
- Department of Clinical Oncology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Syed YA, Stokes W, Rupji M, Liu Y, Khullar O, Sebastian N, Higgins K, Bradley JD, Curran WJ, Ramalingam S, Taylor J, Sancheti M, Fernandez F, Moghanaki D. Surgical Outcomes for Early Stage Non-small Cell Lung Cancer at Facilities With Stereotactic Body Radiation Therapy Programs. Chest 2022; 161:833-844. [PMID: 34785235 PMCID: PMC8941602 DOI: 10.1016/j.chest.2021.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/26/2021] [Accepted: 11/07/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Patients undergoing surgery for early stage non-small cell lung cancer (NSCLC) may be at high risk for postoperative mortality. Access to stereotactic body radiation therapy (SBRT) may facilitate more appropriate patient selection for surgery. RESEARCH QUESTION Is postoperative mortality associated with early stage NSCLC lower at facilities with higher use of SBRT? STUDY DESIGN AND METHODS Patients with early stage NSCLC reported to the National Cancer Database between 2004 and 2015 were included. Use of SBRT was defined by each facility's SBRT experience (in years) and SBRT to surgery volume ratios. Multivariate logistic regression was used to test for the associations between SBRT use and postoperative mortality. RESULTS The study cohort consisted of 202,542 patients who underwent surgical resection of cT1-T2N0M0 NSCLC tumors. The 90-day postoperative mortality rate declined during the study period from 4.6% to 2.6% (P < .001), the proportion of facilities that used SBRT increased from 4.6% to 77.5% (P < .001), and the proportion of patients treated with SBRT increased from 0.7% to 15.4% (P < .001). On multivariate analysis, lower 90-day postoperative mortality rates were observed at facilities with > 6 years of SBRT experience (OR, 0.84; 95% CI, 0.76-0.94; P = .003) and SBRT to surgery volume ratios of more than 17% (OR, 0.85; 95% CI, 0.79-0.92; P < .001). Ninety-day mortality also was associated with surgical volume, region, year, age, sex, and race, among other covariates. Interaction testing between these covariates showed negative results. INTERPRETATION Patients who underwent resection for early stage NSCLC at facilities with higher SBRT use showed lower rates of postoperative mortality. These findings suggest that the availability and use of SBRT may improve the selection of patients for surgery who are predicted to be at high risk of postoperative mortality.
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Affiliation(s)
- Yusef A. Syed
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - William Stokes
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - Manali Rupji
- Biostatistics Shared Resource, Emory University Winship Cancer Institute, Atlanta, GA
| | - Yuan Liu
- Biostatistics Shared Resource, Emory University Winship Cancer Institute, Atlanta, GA
| | - Onkar Khullar
- Department of Surgery, Emory University, Atlanta, GA
| | - Nikhil Sebastian
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - Jeffrey D. Bradley
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - Walter J. Curran
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - Suresh Ramalingam
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - James Taylor
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Manu Sancheti
- Department of Surgery, Emory University, Atlanta, GA
| | | | - Drew Moghanaki
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
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Twenty-Year Survival of Patients Operated on for Non-Small-Cell Lung Cancer: The Impact of Tumor Stage and Patient-Related Parameters. Cancers (Basel) 2022; 14:cancers14040874. [PMID: 35205621 PMCID: PMC8870355 DOI: 10.3390/cancers14040874] [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: 01/18/2022] [Revised: 02/01/2022] [Accepted: 02/05/2022] [Indexed: 02/04/2023] Open
Abstract
Surgery is the mainstay treatment of non-small-cell lung cancer (NSCLC), but its impact on very-long-term survival (beyond 15 years) has never been evaluated. METHODS All patients operated on for major lung resection (Jun. 2001-Dec. 2002) for NSCL in the Thoracic Surgery Department at Paris-Hôtel-Dieu-University-Hospital were included. Patients' characteristics were prospectively collected. Vital status was obtained by checking INSEE database and verifying if reported as "non-death" by the hospital administrative database and direct phone interviews with patients of families. RESULTS 345 patients were included. The 15- and 20-year survival rates were 12.2% and 5.7%, respectively. At univariate analysis, predictors of worse survivals were: increasing age at surgery (p = 0.0042), lower BMI (p = 0.009), weight loss (p = 0.0034), higher CRP (p = 0.049), pathological stage (p = 0.00000042), and, among patients with adenocarcinoma, higher grade (p = 0.028). Increasing age (p = 0.004), cumulative smoking (p = 0.045), lower BMI (0.046) and pathological stage (p = 0.0026), were independent predictors of long-term survival at Cox multivariate analysis. In another model, increasing age (p = 0.013), lower BMI (p = 0.02), chronic bronchitis (p = 0.03), lower FEV1% (p = 0.00019), higher GOLD class of COPD (p = 0.0079), and pathological stage (p = 0.000024), were identified as independent risk factors. CONCLUSIONS Very-long-term survivals could be achieved after surgery of NSCLC, and factors classically predicting 5- and 10-years survival also determined longer outcomes suggesting that both initial tumor aggressiveness and host's characteristics act beyond the period usually taken into account in oncology.
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Wang P, Wang S, Liu Z, Sui X, Wang X, Li X, Qiu M, Yang F. Segmentectomy and Wedge Resection for Elderly Patients with Stage I Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11020294. [PMID: 35053989 PMCID: PMC8782039 DOI: 10.3390/jcm11020294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Considerable controversies exist regarding the efficacies of segmentectomy and wedge resection for elderly patients with early-stage non-small cell lung cancer (NSCLC). This systematic review and meta-analysis aimed to solve these issues. Methods: We searched the online databases PubMed, Web of Science, EMBASE, and Cochrane Library to identify eligible studies. Elderly patients were defined as ≥65 years. Early-stage NSCLC was defined as stage I based on TNM systems. The primary endpoints were survival outcomes (overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS)) and recurrence patterns. The second endpoints were perioperative morbidities. The hazard rate (HR) and odds ratio (OR) were effect sizes. Results: Sixteen cohort studies (3140 participants) and four database studies were finally included. Segmentectomy and lobectomy showed no significant difference in OS (cohort studies HR 1.00, p = 0.98; database studies HR 1.07, p = 0.14), CSS (HR 0.91, p = 0.85), or DFS (HR 1.04, p = 0.78) in elderly patients with stage I NSCLC. In contrast, wedge resection showed inferior OS (HR 1.28, p < 0.001), CSS (HR 1.17, p = 0.001) and DFS (HR 1.44, p = 0.042) compared to lobectomy. Segmentectomy also showed comparable local recurrence risk with lobectomy (OR 0.98, p = 0.98), while wedge resection showed increased risk (OR 5.46, p < 0.001). Furthermore, sublobar resections showed a decreased risk of 30/90-day mortality, pneumonia, and leak complications compared to lobectomy. Conclusion: Segmentectomy is promising when applied to elderly patients with stage I NSCLC, while wedge resection should be limited. Randomized controlled trials are warranted to validate these findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Fan Yang
- Correspondence: ; Tel.: +86-(10)-88326657
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Brunswicker A, Taylor M, Grant SW, Abah U, Smith M, Shackcloth M, Granato F, Shah R, Rammohan K. Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation. Interact Cardiovasc Thorac Surg 2021; 34:1054-1061. [PMID: 34871415 PMCID: PMC9159428 DOI: 10.1093/icvts/ivab340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/27/2021] [Accepted: 11/07/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Despite the increased rate of adverse outcomes compared to lobectomy, for selected patients with lung cancer, pneumonectomy is considered the optimal treatment option. The objective of this study was to identify risk factors for mortality in patients undergoing pneumonectomy for primary lung cancer. METHODS Data from all patients undergoing pneumonectomy for primary lung cancer at 2 large thoracic surgical centres between 2012 and 2018 were analysed. Multivariable logistic and Cox regression analyses were used to identify risk factors associated with 90-day and 1-year mortality and reduced long-term survival, respectively. RESULTS The study included 256 patients. The mean age was 65.2 (standard deviation 9.4) years. In-hospital, 90-day and 1-year mortality were 6.3% (n = 16), 9.8% (n = 25) and 28.1% (n = 72), respectively. The median follow-up time was 31.5 months (interquartile range 9-58 months). Patients who underwent neoadjuvant therapy had a significantly increased risk of 90-day [odds ratio 6.451, 95% confidence interval (CI) 1.867-22.291, P = 0.003] and 1-year mortality (odds ratio 2.454, 95% CI 1.079-7.185, P = 0.044). Higher Performance Status score was associated with higher 1-year mortality (odds ratio 2.055, 95% CI 1.248-3.386, P = 0.005) and reduced overall survival (hazard ratio 1.449, 95% CI 1.086-1.934, P = 0.012). Advanced (stage III/IV) disease was associated with reduced overall survival (hazard ratio 1.433, 95% CI 1.019-2.016, P = 0.039). Validation of a pneumonectomy-specific risk model demonstrated inadequate model performance (area under the curve 0.54). CONCLUSIONS Pneumonectomy remains associated with a high rate of perioperative mortality. Neoadjuvant chemoradiotherapy, Performance Status score and advanced disease emerged as the key variables associated with adverse outcomes after pneumonectomy in our cohort.
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Affiliation(s)
- Annemarie Brunswicker
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Udo Abah
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Matthew Smith
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Felice Granato
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Kandadai Rammohan
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
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Mitchell KG, Bostock IC, Antonoff MB. Social Disparities in Thoracic Surgery Database Research: Implications and Impact. Thorac Surg Clin 2021; 32:83-90. [PMID: 34801199 DOI: 10.1016/j.thorsurg.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A complex relationship exists between health care disparities and large databases among the thoracic surgical patient population. Using the example of thoracic malignancies, the ability of investigations leveraging large databases and novel analytical approaches to highlight disparate access to care and discordant outcomes following treatment is illustrated. Large, widely used databases may not be representative of the thoracic surgical patient population as a whole, and caution must be used when interpreting and generalizing results gleaned from such database analyses. Ensuring appropriate representation of all relevant patient subgroups in research databases will improve external generalizability and scientific validity of future investigations.
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Affiliation(s)
- Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1489, Houston, TX 77030, USA
| | - Ian C Bostock
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1489, Houston, TX 77030, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1489, Houston, TX 77030, USA.
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11
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Helminen O, Valo J, Andersen H, Söderström J, Sihvo E. Association of performance in a stair-climbing test with complications and survival after lung cancer resection in the video-assisted thoracoscopic surgery era: population-based outcomes. ERJ Open Res 2021; 7:00110-2021. [PMID: 34409096 PMCID: PMC8365151 DOI: 10.1183/23120541.00110-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/23/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction With a population-based cohort in the video-assisted thoracoscopic surgery (VATS) era, we aimed to evaluate the value of the stair-climbing test (SCT) on short- and long-term outcomes of lung cancer surgery. Methods All patients operated due to primary lung cancer in Central Finland and Ostrobothnia from 2013 to June 2020 were included. For the analysis, clinical variables including the outcome of SCT and cause-specific mortality were available. Short- and long-term outcomes were compared between <11 m (n=66) and >12 m SCT (n=217) groups. Results Patients with poor performance (<11 m) had more comorbidities and worse lung function but did not differ in tumour stage or treatment. No differences between groups were observed in major morbidity rate (10.6% versus 11.1%, p=0.918) or median hospital stay (5 (IQR 4–7) versus 4 (IQR 3–7), p=0.179). At 1-year, fewer patients were alive and living at home in the climbing <11 m group (81.3%) compared to the >12 m group (94.2%), p=0.002. No difference was observed in cancer-specific 5-year survival. Non-cancer-specific survival (62.9% versus 83.1%, p<0.001) and overall survival (49.9% versus 70.0%, p<0.001) were worse in the <11 m group. After adjustment for confounding factors, SCT remained as a significant predictor for non-cancer-specific (HR 4.28; 95% CI 2.10–8.73) and overall mortality (HR 2.38; 95% CI 1.43–3.98). Conclusions With SCT-based exercise testing, VATS can be performed safely, with a similar major morbidity rate in the poor performance group (<11 m) compared to >12 m group. Poor exercise performance increases non-cancer-specific mortality. Being a major predictor of survival, exercise capacity should be included in prognostic models. According to stair-climbing-based testing, VATS surgery is safe, with similar major morbidity rates as in those with better exercise capacity. However, patients with poorer exercise capacity have significantly increased non-cancer-specific mortality.https://bit.ly/3aLB76w
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Affiliation(s)
- Olli Helminen
- Dept of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.,Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Johanna Valo
- Dept of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.,Dept of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Heidi Andersen
- Dept of Pulmonology, Vaasa Central Hospital, Vaasa, Finland
| | | | - Eero Sihvo
- Dept of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
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12
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Hwang JJ, Hur JY, Eo W, An S, Kim DH, Lee S. Clinical significance of C-Reactive Protein to Lymphocyte Count Ratio as a prognostic factor for Survival in Non-small Cell Lung Cancer Patients undergoing Curative Surgical Resection. J Cancer 2021; 12:4497-4504. [PMID: 34149913 PMCID: PMC8210557 DOI: 10.7150/jca.58094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/19/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose: We assessed the clinical feasibility of C-reactive protein to lymphocyte ratio (CLR) as a determinant of survival in patients with non-small cell lung cancer (NSCLC) undergoing curative surgical resection. Methods: A retrospective study was conducted on patients with stage I and II NSCLC undergoing curative resection. Demographic and clinical variables, including CLR, were collected and analyzed. The Cox proportional hazards model was used to calculate hazard ratios for overall survival (OS) and cancer-specific survival (CSS). The Mann-Whitney U test was used to compare differences between two independent groups. Results: The median age of the patients was 69.0 years, and male patients comprised 63.9% of all patients. A total of 164 (75.9%) patients were categorized as having stage I disease and 52 (24.1%) as having stage II disease. Using the multivariate Cox model, age (hazard ratio [HR] 1.08, p<0.001), lymphatic invasion (HR 3.12, p=0.004), stage (HR 5.10, p<0.001), and CLR (HR 1.01, p=0.003) were significant determinants of OS. In addition, age (HR 1.11, p=0.002), lymphatic invasion (HR 3.16, p=0.010), stage (HR 6.89, p<0.001), and CLR (HR 1.05, p=0.002) were significant determinants of CSS. Conclusions: Our findings show that CLR could be a determinant of survival in NSCLC patients undergoing curative surgical resection.
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Affiliation(s)
- Jae-Joon Hwang
- Department of Allergy, Pulmonary and Critical Care Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Joon Young Hur
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Wankyu Eo
- Department of Medical Oncology & Hematology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Soomin An
- College of Nursing, Hallym Polytechnic University, Gangwon-do, Republic of Korea
| | - Dae Hyun Kim
- Department of Thoracic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sookyung Lee
- Department of Clinical Oncology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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13
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Elsayed HH, Moharram AA. Tailored anaesthesia for thoracoscopic surgery promoting enhanced recovery: The state of the art. Anaesth Crit Care Pain Med 2021; 40:100846. [PMID: 33774262 DOI: 10.1016/j.accpm.2021.100846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/30/2020] [Accepted: 12/20/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE OF THE REVIEW The current review focuses on precise anaesthesia for video-assisted thoracoscopic surgery (VATS) with the goal of enhanced recovery. The main aim of an enhanced recovery program after thoracic surgery is to reduce postoperative stress response, protect from postoperative pulmonary complications, give hospitals a better financial option and improve overall patient outcome. This can ultimately reduce hospital stay and increase patient satisfaction. With advances in endoscopic, robotic and endovascular techniques, video-assisted thoracoscopic surgery (VATS) can be performed in a minimally invasive way in managing most pulmonary, pleural and mediastinal diseases. As a minimally invasive technique, video-assisted thoracoscopic surgery (VATS) represents an important element of enhanced recovery program in thoracic surgery as it can achieve most of its goals. Anaesthetic management during preoperative, intraoperative and postoperative period is essential for the establishment of a successful enhanced recovery program. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key anaesthetic elements of the enhanced recovery program during all phases of thoracoscopic surgery. Having reviewed recent literature, a systematic review of literature will highlight successful ERAS protocols published for thoracoscopic surgery.
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Affiliation(s)
| | - Assem Adel Moharram
- Department of Anaesthesia, Intensive Care and Pain Management, Ain Shams University, Cairo, Egypt
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14
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Horgan S, Onaitis M. Commentary: Minimally invasive esophagectomy: Steady progress. J Thorac Cardiovasc Surg 2021; 162:707-708. [PMID: 33832792 DOI: 10.1016/j.jtcvs.2021.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Santiago Horgan
- Division of Minimally Invasive Surgery, University of California, San Diego, La Jolla, Calif
| | - Mark Onaitis
- Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif.
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15
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Lv X, Wu Z, Cao J, Hu Y, Liu K, Dai X, Yuan X, Wang Y, Zhao K, Lv W, Hu J. A nomogram for predicting the risk of lymph node metastasis in T1-2 non-small-cell lung cancer based on PET/CT and clinical characteristics. Transl Lung Cancer Res 2021; 10:430-438. [PMID: 33569324 PMCID: PMC7867781 DOI: 10.21037/tlcr-20-1026] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Accurately predicting the risk level for a lymph node metastasis is critical in the treatment of non-small cell lung cancer (NSCLC). This study aimed to construct a novel nomogram to identify patients with a risk of lymph node metastasis in T1–2 NSCLC based on positron emission tomography/computed tomography (PET/CT) and clinical characteristics. Methods From January 2011 to November 2017, the records of 318 consecutive patients who had undergone PET/CT examination within 30 days before surgical resection for clinical T1–2 NSCLC were retrospectively reviewed. A nomogram to predict the risk of lymph node metastasis was constructed. The model was confirmed using bootstrap resampling, and an independent validation cohort contained 156 patients from June 2017 to February 2020 at another institution. Results Six factors [age, tumor location, histology, the lymph node maximum standardized uptake value (SUVmax), the tumor SUVmax and the carcinoembryonic antigen (CEA) value] were identified and entered into the nomogram. The nomogram developed based on the analysis showed robust discrimination, with an area under the receiver operating characteristic curve of 0.858 in the primary cohort and 0.749 in the validation cohort. The calibration curve for the probability of lymph node metastasis showed excellent concordance between the predicted and actual results. Decision curve analysis suggested that the nomogram was clinically useful. Conclusions We set up and validated a novel and effective nomogram that can predict the risk of lymph node metastasis for individual patients with T1–2 NSCLC. This model may help clinicians to make treatment recommendations for individuals.
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Affiliation(s)
- Xiayi Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhigang Wu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinlin Cao
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yeji Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kai Liu
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaona Dai
- Department of Quality Management, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoshuai Yuan
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yiqing Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kui Zhao
- Departments of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wang Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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16
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Raymond DP. Commentary: Understanding limitations. J Thorac Cardiovasc Surg 2020; 163:274-275. [PMID: 33494915 DOI: 10.1016/j.jtcvs.2020.12.037] [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: 12/03/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel P Raymond
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
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17
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Hennon M, Groman A, Kumar A, Castaldo L, George S, Demmy T, Attwood K, Yendamuri S. Correlation between perioperative outcomes and long-term survival for non-small lung cancer treated at major centers. J Thorac Cardiovasc Surg 2020; 163:265-273. [PMID: 33451832 DOI: 10.1016/j.jtcvs.2020.11.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/01/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The public is placing increased emphasis on specialty specific rankings, thereby affecting patients' choices of clinical care programs. In the spirit of transparency, public reporting initiatives are underway or being considered by various surgical specialties whose databases rank programs based on short-term outcomes. Of concern, short-term risk avoidance excludes important comparative cases from surgical database participation and may adversely affect overall long-term oncologic treatment team results. To assess the validity of comparing short-term perioperative and long-term survival outcomes of all patients treated at major centers, we studied the correlations between these variables. METHODS The National Cancer Database was queried for patients diagnosed with non-small cell lung carcinoma (NSCLC) between 2008 and 2012, yielding 5-year follow-up data for all patients at centers treating at least 100 patients annually. Mortality (30- and 90-day), unplanned 30-day readmissions, and hospital length of stay were modeled using logistic regression with sex, race, age, Charlson-Deyo combined comorbidity, extent of surgery, income, insurance status, histology, grade, and analytic stage as predictors, all with 2-way interaction terms. The differences between the predicted rates and observed rates were calculated for each short-term outcome, and the average of these was used to create a short-term metric (STM). A similar approach was used to create a long-term metric (LTM) that used overall survival as a single dependent variable. Centers were ranked into deciles based on these metrics. Visual plotting as well as correlation coefficients were used to judge correlation between STM and LTM. RESULTS A total of 298,175 patients from 541 centers were included in this analysis, of whom 102,860 underwent surgical resection for NSCLC. The correlation between STM and LTM was negative using parametric estimates (Pearson correlation coefficient = -0.09 [P = .03] and -0.22 [P < .01]) and nonparametric estimates (Spearman rank correlation coefficient = -0.09 [P = .02] and -0.22 [P < .01]) for squamous cell carcinoma and adenocarcinoma, respectively. CONCLUSIONS Short-term perioperative outcome rankings correlate poorly with long-term survival outcome rankings when cancer treatment centers are compared. Factors explaining this discrepancy merit further study. Rankings based on short-term outcomes alone may be incomplete for public reporting.
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Affiliation(s)
- Mark Hennon
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Adrienne Groman
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Abhinav Kumar
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lawson Castaldo
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Sabrina George
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Todd Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
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18
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Costs Associated With Lobectomy for Lung Cancer: An Analysis Merging STS and Medicare Data. Ann Thorac Surg 2020; 111:1781-1790. [PMID: 33188754 DOI: 10.1016/j.athoracsur.2020.08.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/07/2020] [Accepted: 08/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Costs related to care of patients who undergo lobectomy for lung cancer may vary depending on patient, disease, and treating facility characteristics. We aimed to identify underlying case mix factors that contribute to variability of 90-day costs of lobectomy for early-stage lung cancer. METHODS The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for lobectomy for clinical stage I lung cancer (2008-2013). Demographics, clinical outcomes, and 90-day episode-of-care costs across all care settings were analyzed for patients successfully linked to Medicare data. Hospital costs were estimated from charges using cost-to-charge ratios. Comprehensive regression models were created to identify impact of preoperative patient factors and hospital characteristics on costs, and to delineate additive costs due to perioperative outcomes and complications. RESULTS The mean 90-day cost for lobectomy was $45,080 ± $38,239. Variables associated with significant additive costs were age greater than or equal to 75 years, American Society of Anesthesiologists classification III or IV, forced expiratory volume in 1 second less than 80% predicted, body mass index less than 18.5 or greater than 35, current or past smoker, cerebrovascular disease, chronic kidney disease, impaired functional status, open thoracotomy, prolonged operative time, government hospitals, metropolitan setting, and geographic location. Patients with 1 or more postoperative complication resulted in an overall mean added cost of $27,259. Added costs increased with the number of complications; isolated recurrent laryngeal nerve paresis ($3,911) and respiratory failure ($35,011) were associated with the least and most additive cost, respectively. CONCLUSIONS Lobectomy is associated with substantial variability of episode-of-care costs. Variability is driven by patient demographic and clinical factors, hospital characteristics, and the occurrence and severity of complications.
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19
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Topolnitskiy EB, Borodina YA. [Immediate results of surgical treatment of advanced age patients with non-small cell lung cancer]. Khirurgiia (Mosk) 2020:23-28. [PMID: 33047582 DOI: 10.17116/hirurgia202010123] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the immediate results of surgical treatment of advanced age patients with non-small cell lung cancer (NSCLC). MATERIAL AND METHODS We included 190 elderly and senile patients with NSCLC who underwent surgery at the thoracic department of the Tomsk Regional Clinical Hospital in 2010-2018. There were 149 men and 41 women. Cancer stage I was observed in 67 (35%) cases, stage II - 49 (26%) patients, stage III - 69 (37%) patients, stage IV - 5 (2%) patients. Squamous cell cancer was diagnosed in 94 patients, adenocarcinoma - 78 patients, large cell lung cancer - 18 patients. Paraneoplastic inflammatory complications occurred in 26% of patients, concomitant diseases - in 99% of patients. The research included anatomic lung resection with systematic mediastinal lymph node dissection and the absence of tumor at the resection line. There were 118 lobectomies and 47 pneumonectomies. In 74 cases, combined procedures were carried out. Lobectomy with pulmonary artery resection was performed in 18 patients, lobectomy with bronchial resection - in 10 cases. Twenty-five patients underwent video-assisted lobectomy. CONCLUSION An acceptable morbidity and mortality allow you to expand the indications for radical surgery in geriatric patients with NSCLC. However, we must establish strict indications for pneumonectomy. Bronchial and angioplastic lobectomy may be an alternative to pneumonectomy in NSCLC patients.
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Affiliation(s)
- E B Topolnitskiy
- Siberian State Medical University, Tomsk, Russia.,Regional Clinical Hospital, Tomsk, Russia
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20
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Cowper PA, Feng L, Kosinski AS, Tong BC, Habib RH, Putnam JB, Onaitis MW, Furnary AP, Wright CD, Jacobs JP, Fernandez FG. Initial and Longitudinal Cost of Surgical Resection for Lung Cancer. Ann Thorac Surg 2020; 111:1827-1833. [PMID: 33031776 DOI: 10.1016/j.athoracsur.2020.07.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/18/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The longitudinal cost of treating patients with non-small cell lung cancer (NSCLC) undergoing surgical resection has not been evaluated. We describe initial and 4-year resource use and cost for NSCLC patients aged 65 years of age or greater who were treated surgically between 2008 and 2013. METHODS Using clinical data for NSCLC resections from The Society of Thoracic Surgeons General Thoracic Surgery Database linked to Medicare claims, resource use and cost of preoperative staging, surgery, and subsequent care through 4 years were examined ($2017). Cost of hospital-based care was estimated using cost-to-charge ratios; professional services and care in other settings were valued using reimbursements. Inverse probability weighting was used to account for administrative censoring. Outcomes were stratified by pathologic stage and by surgical approach for stage I lobectomy patients. RESULTS Resection hospitalizations averaged 6 days and cost $31,900. In the first 90 days, costs increased with stage ($12,430 for stage I to $26,350 for stage IV). Costs then declined toward quarterly means more similar among stages. Cumulative costs ranged from $131,032 (stage I) to $205,368 (stage IV). In the stage I lobectomy cohort, patients selected for minimally invasive procedures had lower 4-year costs than did thoracotomy patients ($120,346 versus $136,250). CONCLUSIONS The 4-year cost of surgical resection for NSCLC was substantial and increased with pathologic stage. Among stage I lobectomy patients, those selected for minimally invasive surgery had lower costs, particularly through 90 days. Potential avenues for improving the value of surgical resection include judicious use of postoperative intensive care and earlier detection and treatment of disease.
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Affiliation(s)
| | | | | | - Betty C Tong
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, North Carolina
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | - Joe B Putnam
- Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Mark W Onaitis
- Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, California
| | | | - Cameron D Wright
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Felix G Fernandez
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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21
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Ahn SS, Tahara RW, Jones LE, Carr JG, Blebea J. Preliminary Results of the Outpatient Endovascular and Interventional Society National Registry. J Endovasc Ther 2020; 27:956-963. [PMID: 32813592 PMCID: PMC8685594 DOI: 10.1177/1526602820949970] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose To present a new outcomes-based registry to collect data on outpatient endovascular
interventions, a relatively new site of service without adequate historical data to
assess best clinical practices. Quality data collection with subsequent outcomes
analysis, benchmarking, and direct feedback is necessary to achieve optimal care. Materials and Methods The Outpatient Endovascular and Interventional Society (OEIS) established the OEIS
National Registry in 2017 to collect data on safety, efficacy, and quality of care for
outpatient endovascular interventions. Since then, it has grown to include a peripheral
artery disease (PAD) module with plans to expand to include cardiac, venous, dialysis
access, and other procedures in future modules. As a Qualified Clinical Data Registry
approved by the Centers for Medicare and Medicaid Services, this application also
supports new quality measure development under the Quality Payment Program. All
physicians operating in an office-based laboratory or ambulatory surgery center can use
the Registry to analyze de-identified data and benchmark performance against national
averages. Major adverse events were defined as death, stroke, myocardial infarction,
acute onset of limb ischemia, index bypass graft or treated segment thrombosis, and/or
need for urgent/emergent vascular surgery. Results Since Registry inception in 2017, 251 participating physicians from 64 centers located
in 18 states have participated. The current database includes 18,134 peripheral
endovascular interventions performed in 12,403 PAD patients (mean age 72.3±10.2 years;
60.1% men) between January 2017 and January 2020. Cases were performed primarily in an
office-based laboratory (85.1%) or ambulatory surgery center setting (10.4%). Most
frequently observed procedure indications from 16,086 preprocedure form submissions
included claudication (59%), minor tissue loss (16%), rest pain (9%), acute limb
ischemia (5%), and maintenance of patency (3%). Planned diagnostic procedures made up
12.2% of cases entered, with the remainder indicated as interventional procedures
(87.6%). The hospital transfer rate was 0.62%, with 88 urgent/emergent transfers and 24
elective transfers. The overall complication rate for the Registry was 1.87% (n=338),
and the rate of major adverse events was 0.51% (n=92). Thirty-day mortality was 0.03%
(n=6). Conclusion This report describes the current structure, methodology, and preliminary results of
OEIS National Registry, an outcomes-based registry designed to collect quality
performance data with subsequent outcome analysis, benchmarking, and direct feedback to
aid clinicians in providing optimal care.
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Affiliation(s)
- Samuel S Ahn
- DFW Vascular Group, Dallas, TX, USA.,University Vascular Associates, Los Angeles, CA, USA.,TCU School of Medicine, Ft. Worth, TX, USA
| | | | - Lauren E Jones
- Outpatient Endovascular and Interventional Society, Hoffman Estates, IL, USA
| | | | - John Blebea
- Central Michigan University College of Medicine, Saginaw, MI, USA
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22
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Porter ED, Kelly JL, Fay KA, Hasson RM, Millington TM, Finley DJ, Phillips JD. Reducing Unnecessary Chest X-Ray Films After Thoracic Surgery: A Quality Improvement Initiative. Ann Thorac Surg 2020; 111:1012-1018. [PMID: 32739255 DOI: 10.1016/j.athoracsur.2020.05.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Previous work has identified that inpatient post-thoracic surgery chest x-ray films (CXR) are overutilized. METHODS A three-phase rapid cycle quality improvement initiative was performed to reduce empiric post-thoracic surgery CXR use by 25% over 1 year. We adapted evidence-based guidelines and implemented "plan-do-study-act" (PDSA) cycle methodology. The PDSA cycles included (1) education with literature and preintervention statistics; (2) electronic medical record order-set modification; and (3) audit and feedback with monthly status reports. Each cycle lasted 3 months. Use of CXR was tracked in the post-anesthesia care unit and as a daily rate of non-post-anesthesia care unit CXRs. Cost data were estimated from Centers for Medicare & Medicaid Services fees. RESULTS During the initiative, 292 thoracic surgery inpatients were monitored. Before intervention, 99% of patients (69 of 70) received a post-anesthesia care unit CXR, and the daily rate of other CXRs was 1.6. Overall, there was a significant reduction in CXR utilization (P < .001). Post-anesthesia care unit CXRs decreased by 42%, lowering to 89% (68 of 76) to 68% (50 of 74) to 57% (41 of 72) in PDSA cycles 1 through 3, respectively. The daily rate of other CXRs decreased by 38%, lowering to 1.4 to 1.3 to 1.0. Patient perioperative characteristics and health care quality measures were not different between cycles. After quality improvement implementation, cost savings were estimated to be at least $73,292 per year. CONCLUSIONS Implementation of our quality improvement initiative safely and systematically reduced empiric CXR use after inpatient thoracic surgery. Results will be used in future quality improvement initiatives to reduce unnecessary postoperative testing.
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Affiliation(s)
- Eleah D Porter
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Kayla A Fay
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Rian M Hasson
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| | - Timothy M Millington
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| | - David J Finley
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| | - Joseph D Phillips
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire.
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Phillips JD, Porter ED, Beaulieu-Jones BR, Fay KA, Hasson RM, Millington TM, Finley DJ. Postoperative atrial fibrillation prophylaxis using a novel amiodarone order set. J Thorac Dis 2020; 12:3110-3124. [PMID: 32642233 PMCID: PMC7330745 DOI: 10.21037/jtd-20-180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Studies have demonstrated that chemoprophylaxis following anatomic lung resection can reduce post-operative atrial fibrillation (POAF). However, it is unclear if non-anatomic wedge resection warrants prophylaxis, as previously published rates vary widely. The primary goal of this study was to assess an institutional rate of POAF following anatomic resections with implementation of a novel amiodarone administration regimen compared to wedge resections without prophylaxis. Methods We performed a retrospective cohort study of a prospectively maintained database and compared anatomic and wedge lung resection patients from 1/2015 to 4/2018. During the study period, a previously unpublished amiodarone order set consisting of a 300 mg IV bolus followed by 400 mg tablets TID ×3 days was administered to anatomic resection patients ≥65 who met criteria. Wedge resection patients were not intended to receive amiodarone prophylaxis. The primary outcome was POAF incidence. Risk factors for developing POAF were assessed. Results A total of 537 patients met inclusion where 56% underwent anatomic resection and 44% wedge resection. Overall, 5.4% of patients experienced POAF. There was a significant reduction in post-anatomic resection POAF as compared to historic rates without prophylaxis (9.3% vs. 20.3%, P<0.001). A single wedge resection patient (0.4%) developed POAF. On multivariable analysis, the only independent POAF risk factor was age ≥65 (OR: 5.41, 95% CI: 1.47-19.85). Conclusions Administration of our novel amiodarone order set reduces POAF after anatomic resection; however, POAF following wedge resection is too rare to warrant chemoprophylaxis.
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Affiliation(s)
- Joseph D Phillips
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Eleah D Porter
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
| | | | - Kayla A Fay
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
| | - Rian M Hasson
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Timothy M Millington
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - David J Finley
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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24
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Welp AM, Abbott SE, Samson P, Cameron RB, Cornwell LD, Harpole D, Moghanaki D. The Quality of Peer-Reviewed Publications on Surgery for Early Stage Lung Cancer Within the Veterans Health Administration. Semin Thorac Cardiovasc Surg 2020; 32:1066-1073. [PMID: 32433987 DOI: 10.1053/j.semtcvs.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/20/2020] [Indexed: 11/11/2022]
Abstract
The peer-reviewed literature is often referenced to generalize outcomes for lung cancer surgeries performed within the Veterans Health Administration (VHA) and include assessments following resection of early stage non-small-cell lung cancer (NSCLC). We sought to determine the reliability of these reports that are publicly available. A systematic review was undertaken to identify PubMed indexed articles that report postoperative outcomes following surgical resections for stage I NSCLC within the VHA. Only studies that reported American Joint Committee on Cancer staging were included. Eleven studies spanning 49 years (1966-2015) met the inclusion criteria. Two reported findings from national VHA databases while 9 reported outcomes from single institutions. Reporting of outcomes and prognostic factors varied widely between studies and were frequently omitted. This made it difficult to evaluate prognostic factors that may be associated with a wide range of 30- and 90-day perioperative mortality (0-3.8% and 0-6.4%), 3- and 5-year cause-specific survival (72-92% and 32-84%), and 3- and 5- year overall survival (47-85.7% and 24-74%). The quality of peer-reviewed literature that reports outcomes following thoracic surgery for stage I NSCLC in the VHA is inconsistent and precludes accurate assessments for generalizations about the quality of care in this healthcare system. Efforts to develop a dedicated outcome tracking and registry system can provide more meaningful evidence to identify areas for improvement for this often-curable malignancy.
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Affiliation(s)
- Annalyn M Welp
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Sarah E Abbott
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St. Louis/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Robert B Cameron
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Los Angeles, Los Angeles, California; Department of Cardiothoracic Surgery, West Los Angeles VA Medical Center, Los Angeles, California
| | - Lorraine D Cornwell
- Division of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas; Operative Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - David Harpole
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Department of Cardiothoracic Surgery, Durham VA Medical Center, Durham, North Carolina
| | - Drew Moghanaki
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia; Department of Radiation Oncology, Atlanta VA Health Care System, Decatur, Georgia.
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25
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Mewhort HEM, Ramakrishna H. The Society of Thoracic Surgeons General Thoracic Surgery Database: Research Applications and Results. J Cardiothorac Vasc Anesth 2020; 34:2297-2298. [PMID: 32360004 DOI: 10.1053/j.jvca.2020.03.033] [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: 03/06/2020] [Accepted: 03/17/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Holly E M Mewhort
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic Rochester, MN
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, MN
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26
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Groth SS, Habermann EB, Massarweh NN. United States Administrative Databases and Cancer Registries for Thoracic Surgery Health Services Research. Ann Thorac Surg 2020; 109:636-644. [DOI: 10.1016/j.athoracsur.2019.08.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/18/2019] [Indexed: 12/20/2022]
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27
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Onaitis MW, Furnary AP, Kosinski AS, Feng L, Boffa D, Tong BC, Cowper P, Jacobs JP, Wright CD, Habib R, Putnam JB, Fernandez FG. Equivalent Survival Between Lobectomy and Segmentectomy for Clinical Stage IA Lung Cancer. Ann Thorac Surg 2020; 110:1882-1891. [PMID: 32119855 DOI: 10.1016/j.athoracsur.2020.01.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The oncologic efficacy of segmentectomy is controversial. We compared long-term survival in clinical stage IA (T1N0) Medicare patients undergoing lobectomy and segmentectomy in The Society of Thoracic Surgeons database. METHODS The Society of Thoracic Surgeons General Thoracic Surgery Database was linked to Medicare data in 14,286 lung cancer patients who underwent segmentectomy (n = 1654) or lobectomy (n = 12,632) for clinical stage IA disease from 2002 to 2015. Cox regression was used to create a long-term survival model. Patients were then propensity matched on demographic and clinical variables to derive matched pairs. RESULTS In Cox modeling segmentectomy was associated with survival similar to lobectomy in the entire cohort (hazard ratio, 1.04; 95% confidence interval, 0.89-1.20; P = .64) and in the matched subcohort. A subanalysis restricted to the 2009 to 2015 population (n = 11,811), when T1a tumors were specified and positron emission tomography results and mediastinal staging procedures were accurately recorded in the database, also showed that segmentectomy and lobectomy continue to have similar survival (hazard ratio, 1.00; 95% confidence interval, 0.87-1.16). Subanalysis of the pathologic N0 patients demonstrated the same results. CONCLUSIONS Lobectomy and segmentectomy for early-stage lung cancer are equally effective treatments with similar survival. Surgeons from The Society of Thoracic Surgeons database appear to be selecting patients appropriately for sublobar procedures.
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Affiliation(s)
- Mark W Onaitis
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California.
| | | | - Andrzej S Kosinski
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Liqi Feng
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Daniel Boffa
- Division of Cardiothoracic Surgery, Yale University, New Haven, Connecticut
| | - Betty C Tong
- Division of Cardiothoracic Surgery, Duke University, Durham, North Carolina
| | - Patricia Cowper
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Jeffrey P Jacobs
- Johns Hopkins All Children's Heart Institute, St Petersburg, Florida
| | - Cameron D Wright
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert Habib
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Joe B Putnam
- Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Felix G Fernandez
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
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Ferguson MK, Mitzman B, Derstine B, Lee SM, Pienta MJ, Wang SC, Lin J. A Morphomic Index Is an Independent Predictor of Survival After Lung Cancer Resection. Ann Thorac Surg 2019; 109:873-878. [PMID: 31862495 DOI: 10.1016/j.athoracsur.2019.10.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/17/2019] [Accepted: 10/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sarcopenia, visceral fat volume, and bone density have been associated with lung cancer survival. We developed a morphomic index based on computed tomographic measurements of these components, and assessed its relationship to survival after lung cancer resection. METHODS Patients who underwent lung cancer resection from 1995 to 2014 were evaluated. A morphomic index (range of 0 to 3) was developed as the sum of the scores for three body components-dorsal muscle area, vertebral trabecular bone density, and visceral fat area-measured at vertebral levels T10 to T12, with a point assigned to each component when in the lowest tercile. The relationship of the morphomic index to overall survival was assessed by the log rank test. Overall survival was assessed using Cox proportional hazards models adjusted for relevant covariates. RESULTS We included 944 patients (451 women; 48%). The mean age was 66.4 ± 10.3 years. Median follow-up was 4.5 years. Median survival was associated with the morphomic index scores on univariate analysis (P < .001). Morphomic index scores of 2 (P = .026) and 3 (P = .004) referenced to score 0 or 1 were independent predictors of survival on Cox regression analysis. CONCLUSIONS A morphomic index is an independent predictor of survival after lung cancer resection. The index may help in calibrating patient expectations and in shared decision making regarding lung cancer surgery.
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Affiliation(s)
- Mark K Ferguson
- Department of Surgery, University of Chicago, Chicago, Illinois.
| | - Brian Mitzman
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Brian Derstine
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sang Mee Lee
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Michael J Pienta
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Stewart C Wang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jules Lin
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Crabtree TD, Boffa DJ, Lobdell KW, Habib RH, Gaissert HA. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2019 Update on Research. Ann Thorac Surg 2019; 108:1293-1298. [DOI: 10.1016/j.athoracsur.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 12/20/2022]
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30
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Demmy TL, Yendamuri S. Oncologic validity of minimally invasive lobectomy for early stage lung cancer. J Thorac Dis 2019; 11:E163-E167. [PMID: 31737329 DOI: 10.21037/jtd.2019.09.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
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31
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Hohenwarter MR, Denlinger CE. Commentary: A life worth living. J Thorac Cardiovasc Surg 2019; 158:579-580. [PMID: 31005302 DOI: 10.1016/j.jtcvs.2019.03.017] [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: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Marian R Hohenwarter
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Chadrick E Denlinger
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
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Abstract
Purpose of review The current review focuses on precise anesthesia for video-assisted thoracoscopic surgery (VATS) with the goal of enhanced recovery. Recent findings VATS has become an established and widely used minimally invasive approach with broad implementation on a variety of thoracic operations. In the current environment of enhanced recovery protocols and cost containment, minimally invasive VATS operations suggest adoption of individualized tailored, precise anesthesia. In addition to a perfect lung collapse for surgical interventions with adequate oxygenation during one lung ventilation, anesthesia goals include a rapid, complete recovery with adequate postoperative analgesia leading to early discharge and minimized costs related to postoperative inpatient services. The components and decisions related to precise anesthesia are reviewed and discussed including: letting patients remain awake versus general anesthesia, whether the patient should be intubated or not, operating with or without muscle relaxation, whether to use different separation devises, operating with different local and regional blocks and monitors. Conclusion The determining factors in designing a precise anesthesic for VATS operations involve consensus on patients’ tolerance of the associated side effects, the best practice or techniques for surgery and anesthesia, the required postoperative support, and the care team's experience.
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Lack of correlation between short- and long-term performance after lung cancer surgery. J Thorac Cardiovasc Surg 2019; 157:1633-1643.e3. [DOI: 10.1016/j.jtcvs.2018.09.141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/07/2018] [Accepted: 09/30/2018] [Indexed: 01/24/2023]
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34
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Raymond DP. Commentary: Pursuit of the green jacket: Mastery of the long and short games. J Thorac Cardiovasc Surg 2019; 157:1644-1645. [DOI: 10.1016/j.jtcvs.2018.10.042] [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: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 11/25/2022]
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Tantraworasin A, Siwachat S, Tanatip N, Lertprasertsuke N, Kongkarnka S, Euathrongchit J, Wannasopha Y, Suksombooncharoen T, Chewaskulyong B, Taioli E, Saeteng S. Outcomes of pulmonary resection in non-small cell lung cancer patients older than 70 years old. Asian J Surg 2019; 43:154-165. [PMID: 30898491 DOI: 10.1016/j.asjsur.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/23/2019] [Accepted: 03/05/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND An appropriate treatment of older lung cancer patients has become an important issue. The aim of this study is to evaluate the short and long-term surgical outcomes in lung cancer patients using 70 years as a cut-point, and to identify prognostic factors of cancer-specific mortality in patients older than 70 years. METHODS Medical records of non-small cell lung cancer (NSCLC) patients who underwent pulmonary resection at Chiang Mai University Hospital from January 2002 through December 2016 were retrospectively reviewed. Patients were divided into age less than 70 years (control group) and 70 years or more (study group). Primary outcomes were major post-operative complications and in-hospital death (POM); secondary outcome was long-term survival. Multivariable regression analysis was used. RESULTS This study included 583 patients, 167 for study group, and 416 for control group. There were no differences in POM, both at univariable and multivariable analyses, however, for long-term cancer-specific mortality, the study group was more likely to die (HRadj = 1.40, 95%CI = 1.03-1.89). Adverse prognostic factors for long-term mortality in study group were having universal coverage scheme (HRadj = 1.70, 95%CI = 1.03-2.79), the presence of intratumoral lymphatic invasion (HRadj = 2.83, 95%CI = 1.28-6.29), perineural invasion (HRadj = 2.80, 95%CI = 1.13-6.94), underwent lymph node sampling (HRadj = 2.23, 95%CI = 1.16-4.30) and higher stage of disease (HRadj = 2.02, 95%CI = 1.06-3.85 for stage III, HRadj = 3.40, 95%CI = 1.29-8.94 for stage IV). CONCLUSIONS In-hospital mortality and composite post-operative complications are acceptable in pulmonary resection for NSCLC patients older than 70 years. However, these patients had shorter long-term survival, especially who have some adverse prognostic factors. Further studies with larger sample size are warranted.
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Affiliation(s)
- Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Sophon Siwachat
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narumon Tanatip
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nirush Lertprasertsuke
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sarawut Kongkarnka
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juntima Euathrongchit
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yutthaphan Wannasopha
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Busayamas Chewaskulyong
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Emanuela Taioli
- Tisch Cancer Institute, Institute for Translational Epidemiology, Department of Population Health Science and Policy, Icahn Medical School at Mount Sinai, New York, NY, USA
| | - Somcharoen Saeteng
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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36
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Falcoz PE. Commentary: Too old or not too old, that is the question: Video-assisted thoracoscopic surgery is (part of) the answer. J Thorac Cardiovasc Surg 2019; 157:1668-1669. [PMID: 30661816 DOI: 10.1016/j.jtcvs.2018.12.022] [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: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Pierre-Emmanuel Falcoz
- Strasbourg University School of Medicine, Strasbourg, France; INSERM (French National Institute of Health and Medical Research), Regenerative Nanomedicine, Strasbourg, France; Université de Strasbourg, Faculté de Médecine et Pharmacie, Strasbourg, France; Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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Hao J, Kim Y, Kim TK, Kang M. PASNet: pathway-associated sparse deep neural network for prognosis prediction from high-throughput data. BMC Bioinformatics 2018; 19:510. [PMID: 30558539 PMCID: PMC6296065 DOI: 10.1186/s12859-018-2500-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/16/2018] [Indexed: 12/13/2022] Open
Abstract
Background Predicting prognosis in patients from large-scale genomic data is a fundamentally challenging problem in genomic medicine. However, the prognosis still remains poor in many diseases. The poor prognosis may be caused by high complexity of biological systems, where multiple biological components and their hierarchical relationships are involved. Moreover, it is challenging to develop robust computational solutions with high-dimension, low-sample size data. Results In this study, we propose a Pathway-Associated Sparse Deep Neural Network (PASNet) that not only predicts patients’ prognoses but also describes complex biological processes regarding biological pathways for prognosis. PASNet models a multilayered, hierarchical biological system of genes and pathways to predict clinical outcomes by leveraging deep learning. The sparse solution of PASNet provides the capability of model interpretability that most conventional fully-connected neural networks lack. We applied PASNet for long-term survival prediction in Glioblastoma multiforme (GBM), which is a primary brain cancer that shows poor prognostic performance. The predictive performance of PASNet was evaluated with multiple cross-validation experiments. PASNet showed a higher Area Under the Curve (AUC) and F1-score than previous long-term survival prediction classifiers, and the significance of PASNet’s performance was assessed by Wilcoxon signed-rank test. Furthermore, the biological pathways, found in PASNet, were referred to as significant pathways in GBM in previous biology and medicine research. Conclusions PASNet can describe the different biological systems of clinical outcomes for prognostic prediction as well as predicting prognosis more accurately than the current state-of-the-art methods. PASNet is the first pathway-based deep neural network that represents hierarchical representations of genes and pathways and their nonlinear effects, to the best of our knowledge. Additionally, PASNet would be promising due to its flexible model representation and interpretability, embodying the strengths of deep learning. The open-source code of PASNet is available at https://github.com/DataX-JieHao/PASNet.
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Affiliation(s)
- Jie Hao
- Kennesaw State University, Kennesaw, USA
| | | | - Tae-Kyung Kim
- University of Texas Southwestern Medical Center, Dallas, USA.,Department of Life Sciences, Pohang Institute of Science and Technology (POSTECH), Dallas, USA
| | - Mingon Kang
- Kennesaw State University, Kennesaw, USA. .,Kennesaw State University, Marietta, USA.
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Risk factors for postoperative complications and long-term survival in elderly lung cancer patients: a single institutional experience in Turkey. Gen Thorac Cardiovasc Surg 2018; 67:442-449. [DOI: 10.1007/s11748-018-1031-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/01/2018] [Indexed: 12/25/2022]
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Crabtree TD, Gaissert HA, Jacobs JP, Habib RH, Fernandez FG. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2018 Update on Research. Ann Thorac Surg 2018; 106:1288-1293. [PMID: 30267695 DOI: 10.1016/j.athoracsur.2018.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Traves D Crabtree
- Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
| | - Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey P Jacobs
- Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, St. Petersburg, Tampa, and Orlando, Florida
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
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40
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Nelson DB, Lapid DJ, Mitchell KG, Correa AM, Hofstetter WL, Mehran RJ, Rice DC, Sepesi B, Walsh GL, Vaporciyan AA, Swisher SG, Roth JA, Antonoff MB. Perioperative Outcomes for Stage I Non-Small Cell Lung Cancer: Differences Between Men and Women. Ann Thorac Surg 2018; 106:1499-1503. [PMID: 30118712 DOI: 10.1016/j.athoracsur.2018.06.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/26/2018] [Accepted: 06/22/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous studies have highlighted important biologic and survival-related differences among men and women with non-small cell lung cancer (NSCLC). However, differences in perioperative or short-term outcomes have not been as well characterized. In this study, we investigated differences in the perioperative period and postoperative emergency department (ED) visits among men and women after lobectomy for stage I NSCLC. METHODS A retrospective review was performed of patients who underwent a lobectomy for clinical stage I NSCLC at a single institution from 2010 to 2015. RESULTS We identified 559 patients for inclusion, including 293 women (52%) and 266 men (48%). Women were more likely to present with clinical T1 status (p = 0.005) and to undergo a minimally invasive operation (p = 0.058). To reduce confounding, 206 case-matched pairs were identified. After matching, no differences were found in length of stay (p = 0.551) or pulmonary complications (p = 0.509); however, men experienced more cardiac complications (18% versus 7%, p = 0.001). Of importance, although rates of 30- and 90-day ED visits between sexes were similar (p = 0.531, p = 0.890, respectively) and no sex-related differences were found in presenting symptom on return to the ED (p = 0.478), women were more likely to be readmitted after presenting to the ED within 30 days (p = 0.038). CONCLUSIONS Women demonstrated an increased likelihood of being admitted after presenting to the ED within 30 days after discharge, indicating important differences between men and women in the short-term period after lobectomy. Further research will be required to further understand the cause for these differences.
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Affiliation(s)
- David B Nelson
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Danica J Lapid
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
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41
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Differential effects of operative complications on survival after surgery for primary lung cancer. J Thorac Cardiovasc Surg 2018; 155:1254-1264.e1. [DOI: 10.1016/j.jtcvs.2017.09.149] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/30/2017] [Accepted: 09/09/2017] [Indexed: 02/04/2023]
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42
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Lazar JF. Predicting a New Reality. Ann Thorac Surg 2018; 106:317. [PMID: 29410125 DOI: 10.1016/j.athoracsur.2017.12.040] [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: 12/14/2017] [Accepted: 12/31/2017] [Indexed: 10/18/2022]
Affiliation(s)
- John F Lazar
- Medstar, Washington Hospital Center, 110 Irving St NW, Ste G253, Washington, DC 20010.
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