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Wang J, Guo J, Shi H, Chen X, He W, Li Z. A middle lobe sparing sleeve resection versus bilobectomy for right lower central non-small cell lung cancer: a retrospective propensity score matched cohort study. J Cardiothorac Surg 2024; 19:234. [PMID: 38627841 PMCID: PMC11020639 DOI: 10.1186/s13019-024-02744-5] [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: 12/10/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The right lower sleeve lobectomy is a rarely performed major lung resection.This study aims to evaluate the safety and effectiveness of this procedure by comparing to right lower bilobectomy in non-small cell lung cancer patients. METHODS We retrospectively reviewed a prospective database of non-small cell lung cancer patients who underwent right lower sleeve lobectomy (group S) or right lower bilobectomy (group B) from January 2014 to January 2020 in Shanghai Pulmonary Hospital. Propensity score matching method was applied to balance confounders between the two groups, resulting in 41 matched pairs.The analysis was performed to compare perioperative outcomes, long-term survival, and postoperative pulmonary volume between the two groups. RESULTS No significant differences in the characteristics were observed between the two matched groups.Major postoperative complications developed in 31.7% of the patients in group B and 12.1% of the patients in group S (P = 0.032).Intervention rate for surgical residual cavity in group B is significantly higher than those patients in group S(21.9%vs7.3%,p = 0.037).The postoperative right lateral and overall lung volume in group S were both significantly larger than that in group B (P = 0.026,P = 0.001,respectively). CONCLUSIONS Compared to bi-lobectomy, a middle lobe sparing sleeve resection obtains a less prevalence of major complications, smaller postoperative residual air space and similar long-term survival for selected central right lower NSCLC patients.
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Affiliation(s)
- Jiongjie Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou, 221000, China
| | - Jichao Guo
- Department of Thoracic Surgery, Lanshan District People's Hospital of Linyi City, Linyi, 276000, China
| | - Haizhan Shi
- Department of Thoracic Surgery, The Third Clinical Medical College of Fujian Medical University, The First Hospital of Putian, Putian, 351100, China
| | - Xiangru Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, China
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, China.
| | - Zhixin Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, China.
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Ning Y, Zhang L, Deng J, Li Q, He W. A novel technique for pulmonary artery retraction during uniportal video-assisted bronchial sleeve lobectomy of left upper lobe. JTCVS Tech 2024; 24:207-209. [PMID: 38835570 PMCID: PMC11145374 DOI: 10.1016/j.xjtc.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/12/2024] [Accepted: 01/24/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Ye Ning
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenxin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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3
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Uchida S, Matsunaga T, Takamochi K, Suzuki K. Hybrid robotic-assisted and minithoracotomy for pulmonary arterioplasty using autologous pulmonary vein graft. JTCVS Tech 2023; 20:166-168. [PMID: 37555032 PMCID: PMC10405306 DOI: 10.1016/j.xjtc.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/14/2023] [Accepted: 05/30/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Shinsuke Uchida
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Acar A, Ceylan KC. VATS sleeve resections. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:S45-S53. [PMID: 38344124 PMCID: PMC10852208 DOI: 10.5606/tgkdc.dergisi.2023.24737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/21/2023] [Indexed: 02/21/2024]
Abstract
Sleeve resections in central tumors is a surgical method preferred over pneumonectomy owing to its parenchymasparing features. With the increasing surgical experience and developing technology in recent years, sleeve resections can be performed using the video-assisted thoracoscopic surgery method. However, these resections are technically challenging and require significant experience. In this review, we discuss sleeve resections with video-assisted thoracoscopic surgery in the light of the literature.
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Affiliation(s)
- Arkın Acar
- Department of Thoracic Surgery, Katip Çelebi University, Izmir Atatürk Training and Research Hospital, Izmir, Türkiye
| | - Kenan Can Ceylan
- Department of Thoracic Surgery, SBÜ Izmir Dr. Suat Seren Chest Diseases and Surgery SUAM, Izmir, Türkiye
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5
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VATS versus Open Lobectomy following Induction Therapy for Stage III NSCLC: A Propensity Score-Matched Analysis. Cancers (Basel) 2023; 15:cancers15020414. [PMID: 36672363 PMCID: PMC9857329 DOI: 10.3390/cancers15020414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Objectives: This study aims to evaluate the perioperative and oncologic outcomes of thoracoscopic lobectomy for advanced stage III NSCLC. Methods: We retrospectively reviewed 205 consecutive patients who underwent VATS or open lobectomy for clinical stage III lung cancer between January 2013 and December 2020. The perioperative and oncologic outcomes of the two approaches were compared. Long-term survival was assessed using the Kaplan−Meier estimator. Propensity score-matched (PSM) comparisons were used to obtain a well-balanced cohort of patients undergoing VATS and open lobectomy. Results: VATS lobectomy was performed in 77 (37.6%) patients and open lobectomy in 128 (62.4%) patients. Twelve patients (15.6%) converted from VATS to the open approach. PSM resulted in 64 cases in each group, which were well matched according to twelve potential prognostic factors, including tumor size, histology, and pTNM stage. Between the VATS and the open group, there were no significant differences in unmatched and matched analyses, respectively, of the overall postoperative complications (p = 0.138 vs. p = 0.109), chest tube duration (p = 0.311 vs. p = 0.106), or 30-day mortality (p = 1 vs. p = 1). However, VATS was associated with shorter hospital stays (p < 0.0001). The five-year overall survival (OS) and five-year Recurrence-free survival (RFS) were comparable between the VATS and the open groups. There was no significant difference in the recurrence pattern between the two groups in both the unmatched and matched analyses. Conclusion: For the advanced stage III NSCLC, VATS lobectomy achieved equivalent postoperative and oncologic outcomes when compared with open lobectomy without increasing the risk of procedure-related locoregional recurrence.
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Geropoulos G, Esagian SM, Skarentzos K, Ziogas IA, Katsaros I, Kosmidis D, Tsoulfas G, Lawrence D, Panagiotopoulos N. Video-assisted thoracoscopic versus open sleeve lobectomy for non-small cell lung cancer: A systematic review and meta-analysis from six comparative studies. Asian Cardiovasc Thorac Ann 2022; 30:881-893. [DOI: 10.1177/02184923221115970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Lung sleeve resection is indicated for centrally located lung tumors, especially for patients who cannot tolerate pneumonectomy. With video-assisted thoracoscopic surgery (VATS) being increasingly implemented for a wide variety of thoracic pathologies, this study aims to compare the intraoperative, postoperative, and long-term outcomes of VATS and open bronchial sleeve lobectomy for non-small cell lung cancer (NSCLC). Methods The MEDLINE (via PubMed), Cochrane Library, and Scopus databases were searched. Original clinical studies, comparing VATS and open sleeve lobectomy for NSCLC were included. Evidence was synthesized as odds ratios for categorical and weighted mean difference (WMD) for continuous variables. Results Our analysis included six studies with non-overlapping populations reporting on 655 patients undergoing bronchial sleeve lobectomy for NSCLC (229 VATS and 426 open). VATS sleeve lobectomy was associated with significantly longer operative time ((WMD): 45.85 min, 95% confidence interval (CI): 12.06 to 79.65, p = 0.01) but less intraoperative blood loss ((WMD): −34.57 mL, 95%CI: −58.35 to −10.78, p < 0.001). No significant difference was found between VATS and open bronchial sleeve lobectomy in margin-negative resection rate, number of lymph nodes resected, postoperative outcomes (drainage duration, length of hospital stay, 30-day mortality), postoperative complications (pneumonia, bronchopleural fistula/empyema, prolonged air leakage, chylothorax, pulmonary embolism, and arrhythmia), and long-term outcomes (overall survival, recurrence-free survival). Conclusions The limitation of our study arises mainly due to the heterogeneity of the included studies. Nevertheless, VATS bronchial sleeve lung resection constitutes a feasible and safe alternative to the open sleeve lung resection surgery for the management of centrally located lung tumors.
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Affiliation(s)
- Georgios Geropoulos
- Department of Thoracic Surgery, University College London Hospitals, NHS Foundation Trust, London, UK
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Stepan M Esagian
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Ioannis Katsaros
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Department of Surgery, Metaxa Cancer Hospital, Piraeus, Greece
| | | | - Georgios Tsoulfas
- Department of Transplant Surgery, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - David Lawrence
- Department of Thoracic Surgery, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Nikolaos Panagiotopoulos
- Department of Thoracic Surgery, University College London Hospitals, NHS Foundation Trust, London, UK
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Hireche K, Canaud L, Lounes Y, Aouinti S, Molinari N, Alric P. Thoracoscopic Versus Open Lobectomy After Induction Therapy for Nonsmall Cell Lung Cancer: New Study Results and Meta-analysis. J Surg Res 2022; 276:416-432. [PMID: 35465975 DOI: 10.1016/j.jss.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/23/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The use of video-assisted thoracoscopic surgery (VATS) lobectomy has become a mainstay of modern thoracic surgery practice and the technique of choice for resection of early-stage lung cancers. However, the benefits of VATS following induction therapy are yet to be clarified. This study aims to assess whether VATS lobectomy achieves similar perioperative and oncologic outcomes compared to thoracotomy for nonsmall cell lung cancer after induction therapy. METHODS We retrospectively reviewed the outcomes of 72 patients who underwent lung lobectomy after induction therapy in our institution from January 2017 to January 2020. Subsequently, we carried out a comprehensive literature search and pooled our results with available data from previously published studies to perform a meta-analysis. RESULTS VATS was associated with reduced intraoperative blood loss (P = 0.05) and less perioperative complications (P = 0.04) in our local institution. The meta-analysis comprised nine studies. A total of 943 patients underwent VATS and 2827 patients underwent open lobectomy. VATS was associated with significant shorter surgery duration (P < 0.0001), shorter chest-tube drainage duration (P < 0.0001), and shorter hospital stays (P < 0.0001). Furthermore, there was significantly less perioperative complications (P = 0.006) and less intraoperative blood loss (P = 0.036) in the VATS group. However, there were no significant differences in 3-y overall survival and 3-y disease-free survival rates. CONCLUSIONS In some selected patients undergoing induction therapy, VATS lobectomy could achieve equivalent perioperative outcomes to thoracotomy but evidence is lacking on oncologic outcomes. Further trials with a focus on oncologic outcomes and longer follow-up are required.
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Affiliation(s)
- Kheira Hireche
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Youcef Lounes
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Safa Aouinti
- IDESP, INSERM, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- IDESP, INSERM, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
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Frick AE, Hoetzenecker K. Minimally invasive carinal reconstruction-is less really more? Transl Lung Cancer Res 2022; 10:4313-4316. [PMID: 35004261 PMCID: PMC8674610 DOI: 10.21037/tlcr-21-759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/08/2021] [Indexed: 11/15/2022]
Affiliation(s)
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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Cilleruelo-Ramos A, Cladellas-Gutiérrez E, de la Pinta C, Quintana-Cortés L, Sosa-Fajardo P, Couñago F, Mielgo-Rubio X, Trujillo-Reyes JC. Advances and controversies in the management of early stage non-small cell lung cancer. World J Clin Oncol 2021; 12:1089-1100. [PMID: 35070733 PMCID: PMC8716990 DOI: 10.5306/wjco.v12.i12.1089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Complete resection continues to be the gold standard for the treatment of early-stage lung cancer. The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the management of early-stage non-small cell lung cancer, as it was associated with lower recurrence and metastasis rates than sublobar resection and lower postoperative morbidity and mortality than pneumonectomy. There is a growing tendency to perform sublobar resection in selected cases, as, depending on factors such as tumor size, histologic subtype, lymph node involvement, and resection margins, it can produce similar oncological results to lobectomy. Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery.
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Affiliation(s)
- Angel Cilleruelo-Ramos
- Department of Thoracic Surgery, Clinic Universitary Hospital, Valladolid 47005, Spain
- Department of Surgery, Universidad de Valladolid, Valladolid 47001, Spain
| | | | - Carolina de la Pinta
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Laura Quintana-Cortés
- Department of Medical Oncology, Hospital Don Benito-Villanueva, Badajoz 06400, Spain
| | - Paloma Sosa-Fajardo
- Department of Radiation Therapy, Complejo Hospitalario Universitario, Santiago de Compostela, La Coruña 15706, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28223, Spain
- Department of Medicine, School of Biomedical Sciences, Universidad Europea, Madrid 28223, Spain
| | - Xabier Mielgo-Rubio
- Department of Medical Oncology Unit, Hospital Universitario Fundación Alcorcón, Madrid 28922, Spain
| | - Juan Carlos Trujillo-Reyes
- Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona 08029, Spain
- Department of Surgery, Universitat Autónoma, Barcelona 08029, Spain
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10
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Deng J, Jiang L, Li S, Zhang L, Zhong Y, Xie D, Chen C. The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary center. JTCVS Tech 2021; 9:143-152. [PMID: 34647085 PMCID: PMC8501212 DOI: 10.1016/j.xjtc.2021.07.006] [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: 01/12/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives To evaluate the time course and caseload required to achieve proficiency by plotting the learning curve of video-assisted thoracoscopic sleeve lobectomy. Methods We reviewed 127 cases of video-assisted thoracoscopic sleeve lobectomy by a single surgeon at Shanghai Pulmonary Hospital to evaluate its learning curve using the cumulative sum (CUSUM) analysis. The changes of perioperative outcomes were assessed. Results The inflection points of the CUSUM curve were around case 30 and 90, according to which 3 phases were identified: Phase I, Phase II, and Phase III. Significant downtrends were observed regarding operative time (Phase I, 194 [173-233 minutes] vs Phase II, 172 [142-215 minutes] vs Phase III, 138 [117-164 minutes], P < .05, all), blood loss (Phase I, 200 [100-238 mL] vs Phase II, 100 [50-200 mL] vs Phase III, 50 [50-100 mL]; P < .05, all), drainage duration (Phase I [5.53 ± 1.11 days] vs Phase II [4.52 ± 1.38 days]; P < .05), and length of postoperative stays (Phase I [6.60 ± 1.13 days] vs Phase II [5.68 ± 1.47 days], P < .05). The rate of severe complications significantly decreased from Phase I to Phase II (P = .03). Conclusions Thirty cases should be accumulated to lay the technical foundation, and 90 cases were required to achieve proficiency. The focus should now shift to providing sufficient training opportunities for centers wanting to implement this technique.
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Affiliation(s)
- Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shenghui Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yifan Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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11
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Kim HK. Video-Assisted Thoracic Surgery Lobectomy. J Chest Surg 2021; 54:239-245. [PMID: 34353962 PMCID: PMC8350467 DOI: 10.5090/jcs.21.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/11/2022] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) has been established as the surgical approach of choice for lobectomy in patients with early-stage non-small cell lung cancer (NSCLC). Patients with clinical stage I NSCLC with no lymph node metastasis are considered candidates for VATS lobectomy. To rule out the presence of metastasis to lymph nodes or distant organs, patients should undergo meticulous clinical staging. Assessing patients' functional status is required to ensure that there are no medical contraindications, such as impaired pulmonary function or cardiac comorbidities. Although various combinations of the number, size, and location of ports are available, finding the best method of port placement for each surgeon is fundamental to maximize the efficiency of the surgical procedure. When conducting VATS lobectomy, it is always necessary to comply with the following oncological principles: (1) the vessels and bronchus of the target lobe should be individually divided, (2) systematic lymph node dissection is mandatory, and (3) touching the lymph node itself and rupturing the capsule of the lymph node should be minimized. Most surgeons conduct the procedure in the following sequence: (1) dissection along the hilar structure, (2) fissure division, (3) perivascular and peribronchial dissection, (4) individual division of the vessels and bronchus, (5) specimen retrieval, and (6) mediastinal lymph node dissection. Surgeons should obtain experience in enhancing the exposure of the dissection target and facilitating dissection. This review article provides the basic principles of the surgical techniques and practical maneuvers for performing VATS lobectomy easily, safely, and efficiently.
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Affiliation(s)
- Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Shen H, Wang X, Nie Y, Zhang K, Wei Z, Yang F, Wang J, Chen K. Minimally invasive surgery versus thoracotomy for resectable stage II and III non-small-cell lung cancers: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 59:940-950. [PMID: 33370437 DOI: 10.1093/ejcts/ezaa437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/23/2020] [Accepted: 11/04/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The study aimed to compare the long-term oncological efficacy and perioperative outcomes of patients with locally advanced non-small-cell lung cancers who underwent minimally invasive surgery (MIS) or thoracotomy. METHODS Cochrane Library, PubMed and EMBASE databases, ClinicalTrials.gov and reference lists were searched for relevant studies. Two reviewers independently assessed the quality of the studies. Recurrence-free survival (RFS) and overall survival (OS) and perioperative outcomes were synthesized. Random-effects models were used to summarize hazard ratios (HRs), relative risks and standardized mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS Twenty-three retrospective cohort studies were reviewed with a total of 3281 patients, of whom 1376 (41.9%) received MIS and 1905 (58.1%) received thoracotomy. Meta-analysis showed no significant differences in both RFS (HR, 1.02; 95% CI, 0.89-1.17; P = 0.78) and OS (HR, 0.91; 95% CI, 0.80-1.03; P = 0.15) between MIS versus thoracotomy approaches. Similar results were observed in propensity score matched studies (RFS, HR, 0.94; 95% CI, 0.73-1.20; P = 0.62; OS, HR, 0.96; 95% CI, 0.72-1.30; P = 0.81). No significant difference was found in lymph node clearance and margin positivity. As for perioperative outcomes, MIS was associated with a significant reduction in postoperative complications (relative risk, 0.83; P = 0.01), intraoperative blood loss (standardized mean difference, -0.68; P = 0.007), chest tube drainage (standardized mean difference, -0.38; P = 0.03) and length of hospital stay (standardized mean difference, -0.79; P = 0.002) when compared with thoracotomy. CONCLUSIONS The use of MIS for resectable stage II and III non-small-cell lung cancers is an eligible alternative to conventional thoracotomy without compromising the long-term survival and short-term outcomes.
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Affiliation(s)
- Haifeng Shen
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Xin Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Yuntao Nie
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Kai Zhang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Zihan Wei
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Kezhong Chen
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing, China
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13
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Jeon YJ, Yun J, Choi YS, Kim MS, Choi JW. Feasibility of video-assisted thoracoscopic sleeve lobectomy for non-small cell lung cancer. PRECISION AND FUTURE MEDICINE 2021. [DOI: 10.23838/pfm.2020.00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Scheinerman JA, Jiang J, Chang SH, Geraci TC, Cerfolio RJ. Extended Robotic Pulmonary Resections. Front Surg 2021; 8:597416. [PMID: 33693026 PMCID: PMC7937914 DOI: 10.3389/fsurg.2021.597416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Abstract
While lung cancer remains the most common cause of cancer-related mortality in the United States, surgery for curative intent continues to be a mainstay of therapy. The robotic platform for pulmonary resection for non-small cell lung cancer (NSCLC) has been utilized for more than a decade now. With respect to more localized resections, such as wedge resection or lobectomy, considerable data exist demonstrating shorter length of stay, decreased postoperative pain, improved lymph node dissection, and overall lower complication rate. There are a multitude of technical advantages the robotic approach offers, such as improved optics, natural movement of the operator's hands to control the instruments, and precise identification of tissue planes leading to a more ergonomic and safe dissection. Due to the advantages, the scope of robotic resections is expanding. In this review, we will look at the existing data on extended robotic pulmonary resections, specifically post-induction therapy resection, sleeve lobectomy, and pneumonectomy. Additionally, this review will examine the indications for these more complex resections, as well as review the data and outcomes from other institutions' experience with performing them. Lastly, we will share the strategy and outlook of our own institution with respect to these three types of extended pulmonary resections. Though some controversy remains regarding the use and safety of robotic surgery in these complex pulmonary resections, we hope to shed some light on the existing evidence and evaluate the efficacy and safety for patients with NSCLC.
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Affiliation(s)
- Joshua A Scheinerman
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Jeffrey Jiang
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
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15
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Li Z, Xia M, Liu C, Wang T, Ren Y, Liu Y. A meta-analysis of minimally invasive surgery versus thoracotomy for centrally located non-small cell lung cancer. J Thorac Dis 2021; 13:252-261. [PMID: 33569205 PMCID: PMC7867798 DOI: 10.21037/jtd-20-3273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Surgery is established as the most effective treatment for central lung cancer. Minimally invasive surgery (MIS) is gaining popularity. The decision of whether surgical treatment of central lung cancer should be minimally invasive or a conventional thoracotomy is a critical decision for the thoracic surgeon. However, whether MIS is more advantageous than other surgical treatments for central lung cancer. This study aimed to compare the short- and long-term results of MIS and conventional thoracotomy in patients with central lung cancer. Methods This meta-analysis was conducted using the PubMed, Embase, Wiley Online Library, Google Scholar, Wanfang, and China National Knowledge Infrastructure databases. Searches for relevant studies were conducted in strict accordance with research protocols detailed in the Cochrane handbook. The primary endpoints for comparison between the two surgical methods were perioperative and long-term survival. A 95% confidence interval (CI) for relative risk (RR)/mean difference (MD) was calculated to assess the strength of the correlation. Results Nine studies that met the inclusion and exclusion criteria were eventually included in this meta-analysis. These studies involved a total of 5,869 patients [MIS, n =1,140 versus thoracotomy (TH), n =4,729]. The 3- and 5-year disease-free survival (DFS) and the 2-, 3-, and 5-year overall survival (OS) were similar for the MIS and TH groups [OR: 0.86 (95% CI: 0.51–1.43); P=0.55; OR: 1.01 (95% CI: 0.43–2.36); P=0.99, OR: 0.91 (95% CI: 0.78–1.05); P=0.18; OR: 0.90 (95% CI: 0.77–1.06); P=0.22; OR: 0.95 (95% CI: 0.25–1.53); P=0.30]. A subgroup analysis of 8 articles revealed no statistical difference in the pathological type of non-small cell lung cancer (squamous cell carcinoma or adenocarcinoma) between the two groups [OR: 0.99 (95% CI: 0.89–1.09); P =0.81]. However, the MIS group had a lower incidence of blood loss, duration of hospital stay, and fewer complications [MD: −46.25 (95% CI: −85.05 to −7.46); P=0.02; MD: −1.93 (95% CI: −3.15 to −0.7); P=0.002; MD: 0.73 (95% CI: 0.61–0.88); P=0.001]. Conclusions MIS was shown to be a more effective option to conventional thoracotomy for the treatment of central lung cancer.
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Affiliation(s)
- Zhengjun Li
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Mozhu Xia
- Department of Operation Room, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Chang Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Tao Wang
- Department of Anesthesia, Shenyang Chest Hospital, Shenyang, China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
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16
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Deng HY, Qiu XM, Zhu DX, Tang X, Zhou Q. Video-Assisted Thoracoscopic Sleeve Lobectomy for Centrally Located Non-small Cell Lung Cancer: A Meta-analysis. World J Surg 2020; 45:897-906. [PMID: 33230587 DOI: 10.1007/s00268-020-05877-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Whether video-assisted thoracoscopic surgery (VATS) sleeve lobectomy could be an alternative to traditional thoracotomy sleeve lobectomy in treating centrally located non-small cell lung cancer (NSCLC) remains unclear. Therefore, we conducted the first meta-analysis to compare the effects of VATS sleeve lobectomy with thoracotomy sleeve lobectomy. METHODS We systematically searched relevant studies from Pubmed, Embase, and Web of Science on May 12, 2020. Data for analysis included short-term outcomes (blood loss, lymph node dissected, operation time, hospital stay, complications) and long-term outcomes (3-year overall survival (OS) and progression-free survival (PFS) rates). We calculated the weighted mean differences (WMDs) for continuous data and risk ratio (RR) for pooling categorical data. RESULTS We finally included 5 retrospective cohort study consisting of 436 patients. VATS sleeve lobectomy yielded significantly less blood loss (WMD = -37.83; 95% confidence intervals (CIs) = [-58.56, -17.11]; P < 0.001) than thoracotomy sleeve lobectomy and comparable total number of dissected lymph node to thoracotomy sleeve lobectomy (WMD = - 0.07; 95%CI = [-1.14, 0.99]; P = 0.89). However, VATS sleeve lobectomy consumed significantly more operation time than thoracotomy sleeve lobectomy (WMD = 49.00; 95%CI = [14.67, 83.34]; P = 0.005). VATS sleeve lobectomy yielded significantly less postoperative hospital stay time than thoracotomy sleeve lobectomy (WMD = -1.68; 95%CI = [-2.98, -0.39]; P = 0.011) and comparable postoperative complication rate to thoracotomy sleeve lobectomy (RR = 0.84; 95%CI = [0.49, 1.44]; P = 0.52). Moreover, VATS sleeve lobectomy yielded comparable 3-year OS (RR = 1.08; 95%CI = [0.95, 1.22]; P = 0.23) and PFS (RR = 1.15; 95%CI = [0.96, 1.37]; P = 0.13) rates to thoracotomy sleeve lobectomy. No significant heterogeneities were observed. CONCLUSIONS VATS sleeve lobectomy yielded less surgical trauma than thoracotomy sleeve lobectomy and improved postoperative recovery without compromising oncological prognosis. Even though VATS sleeve lobectomy may consume more operation time, it could be recommended as an alternative to thoracotomy sleeve lobectomy for treating centrally located NSCLC in carefully selected cases.
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Affiliation(s)
- Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Ming Qiu
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Da-Xing Zhu
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiaojun Tang
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
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17
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Seastedt KP, Hoang CD. Commentary: Keeping Both Techniques Up One's Sleeve: VATS and Open Sleeve Lobectomy. Semin Thorac Cardiovasc Surg 2020; 33:533-534. [PMID: 33181298 DOI: 10.1053/j.semtcvs.2020.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/14/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Kenneth P Seastedt
- Department of Surgery, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, MD
| | - Chuong D Hoang
- Thoracic Surgery Branch, National Cancer Institute, NIH, CCR and The Clinical Center, Bethesda, MD.
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18
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Dell'Amore A, Chen L, Monaci N, Campisi A, Wang Z, Mammana M, Pangoni A, Zhao H, Schiavon M, Yao F, Rea F. Total Lung-sparing Surgery for Tracheobronchial Low-grade Malignancies. Ann Thorac Surg 2020; 112:450-458. [PMID: 33096073 DOI: 10.1016/j.athoracsur.2020.08.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/16/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Total lung-sparing tracheobronchial sleeve resections are a step forward in the treatment of low-grade bronchial tumors in which minimal resection margins are required to achieve complete control of the disease. METHODS This study retrospectively collected data on patients who underwent total lung-sparing procedures for low-grade tracheobronchial tumors at 2 thoracic surgical centers from January 1984 to October 2019. RESULTS The study included 98 patients, 46 -female (47%) and 52 -male (53%), with a median age of 39 years (range, 7 to 70 years). Thirty-four patients underwent operative endoscopy before surgery (32 had laser treatment, and 2 had endobronchial stenting). The surgical resections were as follows: 9 (9%), tracheal carina; 18 (18%), second carina; 31 (32%), left main bronchi; 25 (26%), right main bronchi; and 15 (15%), intermediate bronchus. The median length of the resected bronchus was 2.2 cm. The median postoperative in-hospital stay was 8 days, and no perioperative mortality was observed. Postoperative complications were recorded in 26-patients (27%). The final histologic classification was as follows: 37 typical carcinoids (38%); 10 atypical carcinoids (10%); 29 adenoid cystic carcinomas (30%); 15 mucoepidermoid carcinomas (15%); 6 inflammatory myofibroblastic tumors (6%); and 1 glomic tumor (1%). Twenty-two patients had positive resection margins and underwent adjuvant radiotherapy. Three patients with adenoid cystic carcinoma had recurrences (1 local and 2 systemic). After a median follow-up time of 54.5 months (range, 4 to 360 months), the overall actuarial 5-year survival was 97%. CONCLUSIONS Total lung-sparing tracheobronchial sleeve resection for low-grade malignant disease requires advanced surgical skills, but the hospital morbidity and mortality are very low. This technique is adequate and safe for highly selected patients with low-grade endobronchial malignant diseases, and its use should be encouraged in experienced centers.
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Affiliation(s)
- Andrea Dell'Amore
- Thoracic-Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.
| | - Liang Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Nicola Monaci
- Thoracic-Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessio Campisi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhexin Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Marco Mammana
- Thoracic-Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessandro Pangoni
- Thoracic-Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Marco Schiavon
- Thoracic-Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Federico Rea
- Thoracic-Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
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19
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Zhong Y, Wang Y, Hu X, Wang G, She Y, Deng J, Zhang L, Peng Q, Zhu Y, Jiang G, Yang M, Xie D, Chen C. A systematic review and meta-analysis of thoracoscopic versus thoracotomy sleeve lobectomy. J Thorac Dis 2020; 12:5678-5690. [PMID: 33209400 PMCID: PMC7656351 DOI: 10.21037/jtd-20-1855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Operative safety and oncologic adequacy of thoracoscopic sleeve lobectomy remain controversial. As such, the purpose of this meta-analysis was to evaluate evidence comparing thoracoscopy and thoracotomy in sleeve lobectomy for centrally located non-small cell lung cancer (NSCLC). Methods Electronic searches of PubMed and Web of Science databases were undertaken from inception to March 2020. Comparative studies about thoracoscopic and thoracotomy sleeve lobectomy, with evaluation for perioperative outcomes and oncological results were identified. The following outcomes were measured in this meta-analysis: operating time, blood loss, numbers of lymph node, postoperative hospital stay, chest drainage time, postoperative complication rate, mortality, overall survival (OS). The standardized difference (SMD), relative risk (RR) and hazard ratio (HR) with 95% confidence intervals (CI) were pooled using Stata software. Results Six studies generating 281 thoracoscopy and 369 thoracotomy cases were finally included. There was no significant difference in intraoperative blood loss, number of resected lymph nodes, chest drainage time, postoperative complication rate and mortality between two groups. However, thoracoscopic sleeve lobectomy was associated with longer operation time (SMD 0.59, 95% CI: 0.14 to 1.03, P=0.010). And shorter postoperative hospital stays (SMD −0.24, 95% CI: −0.51 to 0.03, P=0.078) were observed in the thoracoscopy group with marginal significance. Furthermore, sleeve lobectomy via thoracoscopy could achieve comparable OS compared to that via thoracotomy (HR 0.69, 95% CI: 0.38 to 1.00; P<0.001). In addition, there were no evident publication bias in all observational outcomes. Conclusions Current evidence suggests that thoracoscopic sleeve lobectomy is a safe and efficient surgical procedure for centrally located NSCLC, with comparable perioperative outcomes and equivalent oncological results compared to thoracotomy sleeve lobectomy.
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Affiliation(s)
- Yifan Zhong
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Wang
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuefei Hu
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gege Wang
- Institute of Clinical Epidemiology and Evidence - based Medicine, Tongji University School of Medicine, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiajun Deng
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiao Peng
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Minglei Yang
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Ningbo, China
| | - Dong Xie
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Tongji University Affiliated Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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20
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Comparison of the Video-assisted Thoracoscopic Lobectomy versus Open Thoracotomy for Primary Non-Small Cell Lung Cancer: Single Cohort Study with 269 Cases. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:291-296. [PMID: 33312025 PMCID: PMC7729729 DOI: 10.14744/semb.2020.60963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 11/20/2022]
Abstract
Objectives: This study aims to compare the outcomes of video-assisted thoracoscopic surgery (VATS) lobectomy with open thoracotomy lobectomy in patients with non-small cell lung cancer (NSCLC). Methods: There were 269 cases with NSCLC who underwent lobectomy between 2017-2019; these cases were retrospectively studied. VATS lobectomy (VATS Group) and open thoracotomy lobectomy (Thoracotomy Group) patients’ results were compared according to the length of hospitalizations, early postoperative complications and tumor size and stages. Results: VATS lobectomy was performed in 89 (33%) of these patients, whereas 180 (67%) patients underwent lobectomy using open thoracotomy for NSCLC. The findings showed that the average length of hospitalization was shorter in the VATS Group compared to the Thoracotomy Group (4 vs. 5.5 days) (p<0.05). It was found that the mean size of the tumour was smaller in the VATS Group when compared to the Thoracotomy Group (2.66 cm vs 3.97 cm) (p<0.001). Early postoperative complications were lower in the VATS Group (n=15, 16.8% vs n=58, 32.2%; p<0.021). Conclusion: In VATS lobectomy cases, postoperative complications are less, and the length of hospitalization is shorter. VATS lobectomy is mostly preferred smaller than 3 cm tumor size.
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21
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Mayne NR, Darling AJ, Raman V, Balderson S, Berry MF, Harpole DH, D'Amico TA, Yang CFJ. Perioperative Outcomes and 5-year Survival After Open versus Thoracoscopic Sleeve Resection for Lung Cancer. Semin Thorac Cardiovasc Surg 2020; 33:522-530. [PMID: 32858216 DOI: 10.1053/j.semtcvs.2020.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/21/2020] [Indexed: 01/09/2023]
Abstract
The objective of this study was to evaluate the impact of a video-assisted thoracoscopic (VATS) approach on outcomes in patients who underwent sleeve lobectomy for non-small-cell lung cancer (NSCLC). Outcomes of patients with cT1-T3, N0-N2, M0 NSCLC who underwent sleeve lobectomy in the National Cancer Data Base (NCDB) from 2010-2015 were assessed using Kaplan-Meier, propensity score-matching, and Cox proportional hazards analyses. An "intent-to-treat" analysis was performed. In the NCDB, 210 sleeve lobectomy patients met inclusion criteria (VATS 44 [21%], thoracotomy 166 [79%]). Nine (20%) of the VATS cases were converted to open. Compared to an open approach, VATS was associated with no significant differences in lymph nodes examined (median 9.5 vs 9.0; p = 0.72), length of stay (median 6 days vs 6 days; p = 0.36), 30-day mortality (4.5% vs 1.8%; p = 0.28), and 90-day mortality (6.8% vs 4.8%; p = 0.70). There were no significant differences in 5-year survival between the VATS and open groups in both the entire cohort (VATS [85%] vs open [79%]; log-rank p = 0.91) and in a propensity score-matched analysis of 86 patients (log-rank p = 0.75). Furthermore, a VATS approach was also not associated with worse survival in multivariable analysis (HR = 0.64; 95% CI [0.23-1.78]; p = 0.39). In this national analysis, a VATS approach for sleeve lobectomy for NSCLC was not associated with worse short-term or long-term outcomes when compared to an open approach.
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Affiliation(s)
- Nicholas R Mayne
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
| | - Alice J Darling
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Vignesh Raman
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Scott Balderson
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA; VA Palo Alto Health Care System, Palo Alto, CA
| | - David H Harpole
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Thomas A D'Amico
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC
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22
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Yang Y, Mei J, Lin F, Pu Q, Ma L, Liu C, Zhu Y, Guo C, Xia L, Liu L. Comparison of the Short- and Long-term Outcomes of Video-assisted Thoracoscopic Surgery versus Open Thoracotomy Bronchial Sleeve Lobectomy for Central Lung Cancer: A Retrospective Propensity Score Matched Cohort Study. Ann Surg Oncol 2020; 27:4384-4393. [PMID: 32642997 DOI: 10.1245/s10434-020-08805-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 05/25/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the short- and long-term outcomes of video-assisted thoracoscopic surgery (VATS) versus open thoracotomy bronchial sleeve lobectomy (BSL) for patients with central lung cancer. METHODS This is a retrospective cohort study. Perioperative outcomes and long-term survival of patients who underwent VATS versus open thoracotomy BSL for central lung cancer from June 2010 and June 2018 in the Western China Lung Cancer Database were compared using propensity score matching (PSM) between the two surgical approaches. RESULTS The retrospective study included 187 patients who divided into VATS group (n = 44) and open group (n = 143) according to surgical approach, and PSM resulted in 43 patients in each group, which were well matched by 11 potential prognostic factors. The VATS group was associated with lower overall incidence of postoperative complications (20.3% vs. 30.2%, P = 0.029), less postoperative drainage (875 ml [250-3960] vs. 1280 ml [100-4890], P = 0.039). The 5-year overall survival (OS) and disease-free survival (DFS) were comparable between the VATS and open groups (55.9% vs. 65.2% P = 0.836 and 54.1% vs. 60.2% P = 0.391, respectively) after matching. Multivariable adjusted analysis demonstrated that the surgical approach was not an independent favorable prognostic factor for OS (hazard ratio [HR] = 0.922; 95% confidence interval [CI], 0.427-1.993; P = 0.836) but just the pTNM stage (HR = 2.003; 95% CI 1.187-3.382; P = 0.009). CONCLUSIONS VATS BSL may achieve equivalent long-term outcomes for central lung cancer patients when comparing with open thoracotomy. Although slightly longer duration of surgery, VATS approach may be a feasible option for lung cancer patients requiring BSL.
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Affiliation(s)
- Yanbo Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Feng Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lin Ma
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Yunke Zhu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Chenglin Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Liang Xia
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, People's Republic of China.
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23
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Imai T, Weksler B. Commentary: Open or VATS? Roll up your sleeve. J Thorac Cardiovasc Surg 2020; 161:414-415. [PMID: 32475499 DOI: 10.1016/j.jtcvs.2020.03.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Taryne Imai
- Division of Thoracic Surgery, Department of Surgery, Cedar Sinai Medical Center, Los Angeles, Calif
| | - Benny Weksler
- Division of Thoracic and Esophageal Surgery, Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh, Pa.
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24
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Xie D, Deng J, Gonzalez-Rivas D, Zhu Y, Jiang L, Jiang G, Chen C. Comparison of video-assisted thoracoscopic surgery with thoracotomy in bronchial sleeve lobectomy for centrally located non-small cell lung cancer. J Thorac Cardiovasc Surg 2020; 161:403-413.e2. [PMID: 32386762 DOI: 10.1016/j.jtcvs.2020.01.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 12/31/2019] [Accepted: 01/31/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the adequacy of bronchial sleeve lobectomy by video-assisted thoracoscopic surgery in perioperative outcomes and its oncological efficacy by comparing with thoracotomy in a balanced population. METHODS A total of 363 patients who received bronchial sleeve lobectomy for non-small cell lung cancer from January 2013 to December 2017 were included and placed in the thoracotomy (n = 251) and video-assisted thoracoscopic surgery (n = 112) groups. Statistical analyses were performed to compare patients' demographics, perioperative outcomes, and survival between the 2 groups. RESULTS A total of 116 thoracotomy cases were matched with 72 video-assisted thoracoscopic surgery cases by propensity score. Compared with thoracotomy, patients in the video-assisted thoracoscopic surgery group after matching had less intraoperative blood loss (P < .01) and length of postoperative hospital stay (P < .01), duration of chest tube drainage (P < .01), and intensive care unit stay (P = .03) despite comparable operative time, complication rate, and 30- to 90-day mortality rate. The overall survival and recurrence-free survival were similar in patients who received sleeve lobectomy by thoracotomy and video-assisted thoracoscopic surgery (log-rank, P = .24 and .20, respectively) at 3 years. Although advanced TNM stage was independently associated with worse overall survival and recurrence-free survival in multivariable analysis, older age was only predictive for worse overall survival (hazard ratio, 1.04; 95% confidence interval, 1.01-1.07; P = .02). Body mass index was also found be a predictive factor (overall survival: hazard ratio, 0.93; 95% confidence interval, 0.86-0.99, P = .03; recurrence-free survival: hazard ratio, 0.93; 95% confidence interval, 0.87-0.99, P = .02). CONCLUSIONS With appropriate patient selection and continued experience, video-assisted thoracoscopic surgery appears to be safe in the short-term perioperative period and does not appear to comprise oncologic outcomes in performing sleeve lobectomy.
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Affiliation(s)
- Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
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25
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Geraci TC, Ferrari-Light D, Wang S, Mitzman B, Chang SH, Kent A, Pass HI, Bizekis C, Zervos M, Cerfolio RJ. Robotic Sleeve Resection of the Airway: Outcomes and Technical Conduct Using Video Vignettes. Ann Thorac Surg 2020; 110:236-240. [PMID: 32151577 DOI: 10.1016/j.athoracsur.2020.01.077] [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: 11/09/2019] [Revised: 01/21/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Our objectives are to report our outcomes and to demonstrate our evolving technique for robotic sleeve resection of the airway, with or without lobectomy, using video vignettes. METHODS We retrospectively reviewed a single-surgeon prospective database from October 2010 to October 2019. RESULTS Over 9 years, of 5573 operations 1951 were planned for a robotic approach. There were 755 robotic lobectomies and 306 robotic segmentectomies, and 23 consecutive patients were scheduled for elective completely portal, robotic sleeve resection. Sleeve lobectomy was performed in 18 patients: 10 right upper lobe, 6 left upper lobe, and 2 right lower lobe. Two patients had mainstem bronchus resections and 2 underwent right bronchus intermedius resections that preserved the entire lung. One patient had a robotic pneumonectomy. One operation was converted to open thoracotomy because of concern for anastomotic tension in a patient who received neoadjuvant therapy. All patients had an R0 resection. In the last 10 operations we modified our airway anastomosis, using a running self-locking absorbable suture. The median length of hospital stay was 3 days (range, 1-11), with no 30- or 90-day mortalities. Within a median follow-up of 18 months, there were no anastomotic strictures and no recurrent cancers. CONCLUSIONS Our early and midterm results show that a completely portal robotic sleeve resection is safe and oncologically effective. Trhe technical aspects of a robotic sleeve resection of the airway are demonstrated using video vignettes.
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Affiliation(s)
- Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
| | | | - Simeng Wang
- Department of General Surgery, New York University Langone Health, New York, New York
| | - Brian Mitzman
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Amie Kent
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Costas Bizekis
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Michael Zervos
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
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26
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Gao HJ, Wei YC. Reply. Ann Thorac Surg 2019; 109:612. [PMID: 31580853 DOI: 10.1016/j.athoracsur.2019.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/17/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Hui-Jiang Gao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Qingdao 266003, China
| | - Yu-Cheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Qingdao 266003, China.
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27
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Deng HY. Sleeve Lobectomy for Centrally Located Non-Small Cell Lung Cancer: Does Incision Size Really Matter? Ann Thorac Surg 2019; 109:612. [PMID: 31400316 DOI: 10.1016/j.athoracsur.2019.06.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/05/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China.
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