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Sun L, Lu Y, Zhang Y, Jin C, Yuan Z, Xu R. Risk factors for enhanced recovery after surgery failure in patients undergoing lung cancer resection with concomitant cardiovascular disease: A single-center retrospective study. Asia Pac J Oncol Nurs 2024; 11:100532. [PMID: 39092140 PMCID: PMC11292427 DOI: 10.1016/j.apjon.2024.100532] [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: 04/08/2024] [Accepted: 06/02/2024] [Indexed: 08/04/2024] Open
Abstract
Objective Enhanced recovery after surgery (ERAS) has been widely used in patients with lung cancer, and its effectiveness has been confirmed; however, some lung cancers with poor clinical outcomes lead to ERAS failure after radical resection. This study aimed to analyze risk factors associated with ERAS failure after radical resection in patients with lung cancer and concomitant cardiovascular disease. Methods In total, 198 patients who underwent ERAS following radical lung cancer surgery for concomitant cardiovascular disease between January 2022 and September 2023 were enrolled in this retrospective study. The patients were categorized into two groups based on the definition of ERAS failure: ERAS success group (n = 152) and ERAS failure group (n = 46). Univariate and multivariate analyses were performed to investigate the risk factors of ERAS failure. Results Univariate analysis showed that gender, tumor location, operation time, estimated blood loss (EBL), suction drainage, and total cholesterol were associated with ERAS failure. Multivariate analysis showed that operation time (odds ratio [OR] = 1.015; P = 0.011) and suction drainage (OR = 3.343; P = 0.008) were independent risk factors for ERAS failure. Conclusions Operation time and suction drainage were independent risk factors for ERAS failure after radical resection of combined cardiovascular lung cancer. Therefore, improving surgical efficiency and postoperative chest drain management are important for successful ERAS.
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Affiliation(s)
- Lili Sun
- School of Nursing (School of Gerontology), Binzhou Medical University, Yantai, China
| | - Yutong Lu
- School of Nursing (School of Gerontology), Binzhou Medical University, Yantai, China
| | - Yanfang Zhang
- School of Nursing (School of Gerontology), Binzhou Medical University, Yantai, China
| | - Chan Jin
- School of Nursing (School of Gerontology), Binzhou Medical University, Yantai, China
| | - Zhenwei Yuan
- Library, Binzhou Medical University, Yantai, China
| | - Renhua Xu
- School of Nursing (School of Gerontology), Binzhou Medical University, Yantai, China
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Ma S, Li F, Li J, Wang L, Song H. Risk factor analysis and nomogram prediction model construction of postoperative complications of thoracoscopic non-small cell lung cancer. J Thorac Dis 2024; 16:3655-3667. [PMID: 38983183 PMCID: PMC11228728 DOI: 10.21037/jtd-24-113] [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: 01/18/2024] [Accepted: 04/30/2024] [Indexed: 07/11/2024]
Abstract
Background A series of complications will inevitably occur after thoracoscopic pulmonary resection. How to avoid or reduce postoperative complications is an important research area in the perioperative treatment of thoracic surgery. This study analyzed the risk factors for thoracoscopic postoperative complications of non-small cell lung cancer (NSCLC) and established a nomogram prediction model in order to provide help for clinical decision-making. Methods Patients with NSCLC who underwent thoracoscopic surgery from January 2017 to December 2021 were selected as study subjects. The relationship between patient characteristics, surgical factors, and postoperative complications was collected and analyzed. Based on the results of the statistical regression analysis, a nomogram model was constructed, and the predictive performance of the nomogram model was evaluated. Results A total of 872 patients who met the study criteria were included in the study. A total of 171 patients had complications after thoracoscopic surgery, accounting for 19.6% of the study population. Logistic regression analysis showed that thoracic adhesion, history of respiratory disease, and lymphocyte-monocyte ratio (LMR) were independent risk factors for complications after thoracoscopic surgery (P<0.05). Variables with P<0.1 in logistic regression analysis were included in the nomogram model. The verification results showed that the area under curve (AUC) of the model was 0.734 [95% confidence interval (CI): 0.693-0.775], and the calibration curve showed that the model had good differentiation. The decision curve analysis (DCA) curve showed that this model has good clinical application value. In subgroup analysis of complications, gender, history of respiratory disease, body mass index (BMI), type of surgical procedure, thoracic adhesion, and Time of operation were identified as significant risk factors for prolonged air leak (PAL) after surgery. Tumor location and forced expiratory volume in the first second (FEV1) were identified as important risk factors for postoperative pulmonary infection. N stage and thoracic adhesion were identified as significant risk factors for postoperative pleural effusion. The AUC for PAL was 0.823 (95% CI: 0.768-0.879). The AUC of postoperative pulmonary infection was 0.714 (95% CI: 0.627-0.801). The AUC of postoperative pleural effusion was 0.757 (95% CI: 0.650-0.864). The calibration curve and DCA curve indicated that the model had good predictive performance and clinical application value. Conclusions This study analyzed the risk factors affecting the postoperative complications of NSCLC through thoracoscopic surgery, and the nomogram model built based on the influencing factors has certain significance for the identification and reduction of postoperative complications.
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Affiliation(s)
- Shixin Ma
- Dalian Medical University Graduate School, Dalian, China
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Fei Li
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Jian Li
- Department of Thoracic Surgery, Peking University First Hospital, Beijing, China
| | - Lunqing Wang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Haiping Song
- Department of Oncology, Qingdao Central Hospital, Qingdao, China
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Yang Y, Jiang C, Liu Z, Zhu K, Yu B, Yuan C, Qi C, Li Z. Impact of operative time on textbook outcome after minimally invasive esophagectomy, a risk-adjusted analysis from a high-volume center. Surg Endosc 2024; 38:3195-3203. [PMID: 38632118 DOI: 10.1007/s00464-024-10834-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND We aimed to study the impact of operative time on textbook outcome (TO), especially postoperative complications and length of postoperative stay in minimally invasive esophagectomy. METHODS Patients undergoing esophagectomy for curative intent within a prospectively maintained database from 2016 to 2022 were retrieved. Relationships between operative time and outcomes were quantified using multivariable mixed-effects models with medical teams random effects. A restricted cubic spline (RCS) plotting was used to characterize correlation between operative time and the odds for achieving TO. RESULTS Data of 2210 patients were examined. Median operative time was 270 mins (interquartile range, 233-313) for all cases. Overall, 902 patients (40.8%) achieved TO. Among non-TO patients, 226 patients (10.2%) had a major complication (grade ≥ III), 433 patients (19.6%) stayed postoperatively longer than 14 days. Multivariable analysis revealed operative time was associated with higher odds of major complications (odds ratio 1.005, P < 0.001) and prolonged postoperative stay (≥ 14 days) (odds ratio 1.003, P = 0.006). The relationship between operative time and TO exhibited an inverse-U shape, with 298 mins identified as the tipping point for the highest odds of achieving TO. CONCLUSIONS Longer operative time displayed an adverse influence on postoperative morbidity and increased lengths of postoperative stay. In the present study, the TO displayed an inverse U-shaped correlation with operative time, with a significant peak at 298 mins. Potential factors contributing to prolonged operative time may potentiate targets for quality metrics and risk-adjustment process.
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Affiliation(s)
- Yuxin Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Chao Jiang
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Zhichao Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Kaiyuan Zhu
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Boyao Yu
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Chang Yuan
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Cong Qi
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, No.241 Huaihai West Rd, Shanghai, 200030, China.
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Zhang G, Liu X, Hu Y, Luo Q, Ruan L, Xie H, Zeng Y. Development and comparison of machine-learning models for predicting prolonged postoperative length of stay in lung cancer patients following video-assisted thoracoscopic surgery. Asia Pac J Oncol Nurs 2024; 11:100493. [PMID: 38808011 PMCID: PMC11130994 DOI: 10.1016/j.apjon.2024.100493] [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: 03/19/2024] [Accepted: 04/18/2024] [Indexed: 05/30/2024] Open
Abstract
Objective This study aimed to develop models for predicting prolonged postoperative length of stay (PPOLOS) in lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS) by utilizing machine-learning techniques. These models aim to offer valuable insights for clinical decision-making. Methods This retrospective cohort study analyzed a dataset of lung cancer patients who underwent VATS, identifying 25 numerical features and 45 textual features. Three classification machine-learning models were developed: XGBoost, random forest, and neural network. The performance of these models was evaluated based on accuracy (ACC) and area under the receiver operating characteristic curve, whereas the importance of variables was assessed using the feature importance parameter from the random forest model. Results Of the 6767 lung cancer patients, 1481 patients (21.9%) experienced a postoperative length of stay of > 4 days. The majority were male (4111, 60.8%), married (6246, 92.3%), and diagnosed with adenocarcinoma (4145, 61.3%). The Random Forest classifier exhibited superior prediction performance with an area under the curve (AUC) of 0.792 and ACC of 0.804. The calibration plot revealed that all three classifiers were in close alignment with the ideal calibration line, indicating high calibration reliability. The five most critical features identified were the following: surgical duration (0.116), age (0.066), creatinine (0.062), hemoglobin (0.058), and total protein (0.054). Conclusions This study developed and evaluated three machine-learning models for predicting PPOLOS in lung cancer patients undergoing VATS. The findings revealed that the Random Forest model is most accurately predicting the PPOLOS. Findings of this study enable the identification of crucial determinants and the formulation of targeted interventions to shorten the length of stay among lung cancer patients after VATS, which contribute to optimize the allocation of healthcare resources.
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Affiliation(s)
- Guolong Zhang
- Respiratory Intervention Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuanhui Liu
- Department of Industrial Design, Hangzhou City University, Hangzhou, China
| | - Yuning Hu
- School of Computing Sciences, Hangzhou City University, Hangzhou, China
| | - Qinchi Luo
- School of Computing Sciences, Hangzhou City University, Hangzhou, China
| | - Liang Ruan
- Respiratory Intervention Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongxia Xie
- School of Computing Sciences, Hangzhou City University, Hangzhou, China
| | - Yingchun Zeng
- School of Medicine, Hangzhou City University, Hangzhou, China
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Tupper HI, Lawson BL, Kipnis P, Patel AR, Ashiku SK, Roubinian NH, Myers LC, Liu VX, Velotta JB. Video-Assisted vs Robotic-Assisted Lung Lobectomies for Operating Room Resource Utilization and Patient Outcomes. JAMA Netw Open 2024; 7:e248881. [PMID: 38700865 PMCID: PMC11069083 DOI: 10.1001/jamanetworkopen.2024.8881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/09/2024] [Indexed: 05/06/2024] Open
Abstract
Importance With increased use of robots, there is an inadequate understanding of minimally invasive modalities' time costs. This study evaluates the operative durations of robotic-assisted vs video-assisted lung lobectomies. Objective To compare resource utilization, specifically operative time, between video-assisted and robotic-assisted thoracoscopic lung lobectomies. Design, Setting, and Participants This retrospective cohort study evaluated patients aged 18 to 90 years who underwent minimally invasive (robotic-assisted or video-assisted) lung lobectomy from January 1, 2020, to December 31, 2022, with 90 days' follow-up after surgery. The study included multicenter electronic health record data from 21 hospitals within an integrated health care system in Northern California. Thoracic surgery was regionalized to 4 centers with 14 board-certified general thoracic surgeons. Exposures Robotic-assisted or video-assisted lung lobectomy. Main Outcomes and Measures The primary outcome was operative duration (cut to close) in minutes. Secondary outcomes were length of stay, 30-day readmission, and 90-day mortality. Comparisons between video-assisted and robotic-assisted lobectomies were generated using the Wilcoxon rank sum test for continuous variables and the χ2 test for categorical variables. The average treatment effects were estimated with augmented inverse probability treatment weighting (AIPTW). Patient and surgeon covariates were adjusted for and included patient demographics, comorbidities, and case complexity (age, sex, race and ethnicity, neighborhood deprivation index, body mass index, Charlson Comorbidity Index score, nonelective hospitalizations, emergency department visits, a validated laboratory derangement score, a validated institutional comorbidity score, a surgeon-designated complexity indicator, and a procedural code count), and a primary surgeon-specific indicator. Results The study included 1088 patients (median age, 70.1 years [IQR, 63.3-75.8 years]; 704 [64.7%] female), of whom 446 (41.0%) underwent robotic-assisted and 642 (59.0%) underwent video-assisted lobectomy. The median unadjusted operative duration was 172.0 minutes (IQR, 128.0-226.0 minutes). After AIPTW, there was less than a 10% difference in all covariates between groups, and operative duration was a median 20.6 minutes (95% CI, 12.9-28.2 minutes; P < .001) longer for robotic-assisted compared with video-assisted lobectomies. There was no difference in adjusted secondary patient outcomes, specifically for length of stay (0.3 days; 95% CI, -0.3 to 0.8 days; P = .11) or risk of 30-day readmission (adjusted odds ratio, 1.29; 95% CI, 0.84-1.98; P = .13). The unadjusted 90-day mortality rate (1.3% [n = 14]) was too low for the AIPTW modeling process. Conclusions and Relevance In this cohort study, there was no difference in patient outcomes between modalities, but operative duration was longer in robotic-assisted compared with video-assisted lung lobectomy. Given that this elevated operative duration is additive when applied systematically, increased consideration of appropriate patient selection for robotic-assisted lung lobectomy is needed to improve resource utilization.
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Affiliation(s)
- Haley I. Tupper
- Division of General Surgery, Department of Surgery, University of California, Los Angeles
| | - Brian L. Lawson
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Patricia Kipnis
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Ashish R. Patel
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Oakland, Oakland, California
| | - Simon K. Ashiku
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Oakland, Oakland, California
| | - Nareg H. Roubinian
- Division of Research, Kaiser Permanente Northern California, Oakland
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Laura C. Myers
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Vincent X. Liu
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jeffrey B. Velotta
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Oakland, Oakland, California
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
- Department of Surgery, University of California San Francisco School of Medicine
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Haruki T, Kubouchi Y, Kidokoro Y, Matsui S, Ohno T, Kojima S, Nakamura H. A comparative study of robot-assisted thoracoscopic surgery and conventional approaches for short-term outcomes of anatomical segmentectomy. Gen Thorac Cardiovasc Surg 2024; 72:338-345. [PMID: 37934374 PMCID: PMC11018688 DOI: 10.1007/s11748-023-01983-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES Since anatomical segmentectomy requires meticulous dissection of the segmental pulmonary vessels and bronchus, robot-assisted thoracoscopic surgery (RATS) has been widely adopted in recent years. We investigated the usefulness of RATS segmentectomy by comparing perioperative outcomes with conventional approaches including open thoracotomy or video-assisted thoracoscopic surgery (VATS). We compared perioperative outcomes of segmentectomy between RATS and conventional approaches including open thoracotomy or video-assisted thoracoscopic surgery (VATS). METHODS This single-institutional retrospective study comprised 231 patients with primary lung cancer who underwent segmentectomy by RATS or conventional approaches between January 2011 and December 2022. Surgical outcomes and postoperative complications were analyzed among patients whose background factors were adjusted by propensity score matching (PSM). RESULTS Before PSM, there were significant differences in age, smoking status, and types of segmentectomy. After PSM, 126 patients (63 patients in each group) were included in this analysis. The RATS group had significantly shorter operative time (154 vs 210 min; p < 0.01), fewer bleeding amounts (10 vs 40 mL; p < 0.01), and shorter duration of chest drainage (2 vs 2 days; p = 0.04) than the conventional-approach group. There was no significant difference in the incidence of all complications; however, the incidence of postoperative pneumonia was significantly lower than in the conventional-approach group (p = 0.02). CONCLUSIONS RATS segmentectomy is proposed to be useful. It was suggested that RATS segmentectomy may be useful with better perioperative results than the conventional approach. Further studies on oncological long-term outcomes and cost-benefit comparisons are needed.
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Affiliation(s)
- Tomohiro Haruki
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Yasuaki Kubouchi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Yoshiteru Kidokoro
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Shinji Matsui
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Takashi Ohno
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Shunsuke Kojima
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hiroshige Nakamura
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
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Towe CW, Servais EL, Brown LM, Blasberg JD, Mitchell JD, Worrell SG, Seder CW, David EA. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2023 Update on Outcomes and Research. Ann Thorac Surg 2024; 117:489-496. [PMID: 38043852 DOI: 10.1016/j.athoracsur.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
The Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD) continues its trajectory of growth and enhancement, solidifying its stature as a premier global thoracic surgical database. The past year witnessed a notable expansion with the inclusion of 10 additional participating sites, now totaling 287, augmenting the database's repository to more than 800,000 procedures. A significant stride was made in refining the data audit process, thereby elevating the accuracy and completeness metrics, a testament to the relentless pursuit of data integrity. The GTSD further broadened its research apparatus, with 15 scholarly publications, a 50% uptick from the preceding year. These publications underscore the database's instrumental role in advancing thoracic surgical knowledge. In a concerted effort to alleviate data entry exigencies, the GTSD Task Force also instituted streamlined data submission protocols, a move lauded by participant sites. This report delineates the recent advancements, volume trajectories, and outcome metrics and encapsulates the prolific research output emanating from the GTSD, reflecting a year of substantial progress and academic fecundity.
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Affiliation(s)
- Christopher W Towe
- Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Elliot L Servais
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts; Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
| | - Lisa M Brown
- Section of General Thoracic Surgery, UC Davis Health, Sacramento, California
| | - Justin D Blasberg
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - John D Mitchell
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado
| | | | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Elizabeth A David
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado
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Aigner C, Batirel H, Huber RM, Jones DR, Sihoe ADL, Štupnik T, Brunelli A. Resectable non-stage IV nonsmall cell lung cancer: the surgical perspective. Eur Respir Rev 2024; 33:230195. [PMID: 38508666 PMCID: PMC10951859 DOI: 10.1183/16000617.0195-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 03/22/2024] Open
Abstract
Surgery remains an essential element of the multimodality radical treatment of patients with early-stage nonsmall cell lung cancer. In addition, thoracic surgery is one of the key specialties involved in the lung cancer tumour board. The importance of the surgeon in the setting of a multidisciplinary panel is ever-increasing in light of the crucial concept of resectability, which is at the base of patient selection for neoadjuvant/adjuvant treatments within trials and in real-world practice. This review covers some of the topics which are relevant in the daily practice of a thoracic oncological surgeon and should also be known by the nonsurgical members of the tumour board. It covers the following topics: the pre-operative selection of the surgical candidate in terms of fitness in light of the ever-improving nonsurgical treatment alternatives unfit patients may benefit from; the definition of resectability, which is so important to include patients into trials and to select the most appropriate radical treatment; the impact of surgical access and surgical extension with the evolving role of minimally invasive surgery, sublobar resections and parenchymal-sparing sleeve resections to avoid pneumonectomy.
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Affiliation(s)
- Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University, Istanbul, Turkey
| | - Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, and Thoracic Oncology Centre Munich, Ludwig-Maximilians-Universität in Munich, Munich, Germany
| | - David R Jones
- Department of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alan D L Sihoe
- Department of Cardio-Thoracic Surgery, CUHK Medical Centre, Hong Kong, China
| | - Tomaž Štupnik
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
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de Angelis P, Tan KS, Chudgar NP, Dycoco J, Adusumilli PS, Bains MS, Bott MJ, Downey RJ, Huang J, Isbell JM, Molena D, Park BJ, Rusch VW, Sihag S, Jones DR, Rocco G. Operative Time is Associated With Postoperative Complications After Pulmonary Lobectomy. Ann Surg 2023; 278:e1259-e1266. [PMID: 36066195 PMCID: PMC9985664 DOI: 10.1097/sla.0000000000005696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate the association between operative time and postoperative outcomes. BACKGROUND The association between operative time and morbidity after pulmonary lobectomy has not been characterized fully. METHODS Patients who underwent pulmonary lobectomy for primary lung cancer at our institution from 2010 to 2018 were reviewed. Exclusion criteria included clinical stage ≥IIb disease, conversion to thoracotomy, and previous ipsilateral lung treatment. Operative time was measured from incision to closure. Relationships between operative time and outcomes were quantified using multivariable mixed-effects models with surgeon-level random effects. RESULTS In total, 1651 patients were included. The median age was 68 years (interquartile range, 61-74), and 63% of patients were women. Median operative time was 3.2 hours (interquartile range, 2.7-3.8) for all cases, 3.0 hours for open procedures, 3.3 hours for video-assisted thoracoscopies, and 3.3 hours for robotic procedures ( P =0.0002). Overall, 488 patients (30%) experienced a complication; 77 patients (5%) had a major complication (grade ≥3), and 5 patients (0.3%) died within 30 days of discharge. On multivariable analysis, operative time was associated with higher odds of any complication [odds ratio per hour, 1.37; 95% confidence interval (CI), 1.20-1.57; P <0.0001] and major complication (odds ratio per hour, 1.41; 95% CI, 1.21-1.64; P <0.0001). Operative time was also associated with longer hospital length of stay (β, 1.09; 95% CI, 1.04-1.14; P =0.001). CONCLUSIONS Longer operative time was associated with worse outcomes in patients who underwent lobectomy. Operative time is a potential risk factor to consider in the perioperative phase.
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Affiliation(s)
- Paolo de Angelis
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neel P. Chudgar
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph Dycoco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Prasad S. Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit S. Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew J. Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J. Downey
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James M. Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J. Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie W. Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R. Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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10
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Tong C, Shen Y, Zhu H, Zheng J, Xu Y, Wu J. Continuous Relationship of Operative Duration with Risk of Adverse Perioperative Outcomes and Early Discharge Undergoing Thoracoscopic Lung Cancer Surgery. Cancers (Basel) 2023; 15:cancers15020371. [PMID: 36672321 PMCID: PMC9856387 DOI: 10.3390/cancers15020371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background: For thoracoscopic lung cancer surgery, the continuous relationship and the trigger point of operative duration with a risk of adverse perioperative outcomes (APOs) and early discharge remain unknown. Methods: This study enrolled 12,392 patients who underwent this surgical treatment. Five groups were stratified by operative duration: <60 min, 60−120 min, 120−180 min, 180−240 min, and ≥240 min. APOs included intraoperative hypoxemia, delayed extubation, postoperative pulmonary complications (PPCs), prolonged air leakage (PAL), postoperative atrial fibrillation (POAF), and transfusion. A restricted cubic spline (RCS) plot was used to characterize the continuous relationship of operative duration with the risk of APOs and early discharge. Results: The risks of the aforementioned APOs increased with each additional hour after the first hour. A J-shaped association with APOs was observed, with a higher risk in those with prolonged operative duration compared with those with shorter values. However, the probability of early discharge decreased from 0.465 to 0.350, 0.217, and 0.227 for each additional hour of operative duration compared with counterparts (<60 min), showing an inverse J-shaped association. The 90 min procedure appears to be a tipping point for a sharp increase in APOs and a significant reduction in early discharge. Conclusions: Our findings have important and meaningful implications for risk predictions and clinical interventions, and early rehabilitation, for APOs.
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Affiliation(s)
- Chaoyang Tong
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200052, China
- Department of Anesthesiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yaofeng Shen
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200052, China
| | - Hongwei Zhu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200052, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
- Correspondence: (J.Z.); (J.W.)
| | - Yuanyuan Xu
- Department of Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jingxiang Wu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200052, China
- Correspondence: (J.Z.); (J.W.)
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11
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Servais EL, Blasberg JD, Brown LM, Towe CW, Seder CW, Onaitis MW, Block MI, David EA. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2022 Update on Outcomes and Research. Ann Thorac Surg 2023; 115:43-49. [PMID: 36404445 DOI: 10.1016/j.athoracsur.2022.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 12/31/2022]
Abstract
The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) remains the largest and most robust thoracic surgical database in the world. Participating sites receive risk-adjusted performance reports for benchmarking and quality improvement initiatives. The GTSD also provides several mechanisms for high-quality clinical research using data from 274 participant sites and 781,000 procedures since its inception in 2002. Participant sites are audited at random annually for completeness and accuracy. Over the last year and a half, the GTSD Task Force continued to refine the data collection process, implementing an updated data collection form in July 2021, ensuring high data fidelity while minimizing data entry burden. In addition, the STS Workforce on National Databases has supported a robust GTSD-based research program, which led to eight scholarly publications in 2021. This report provides an update on volume trends, outcomes, and database initiatives as well as a summary of research productivity resulting from the GTSD over the preceding year.
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Affiliation(s)
- Elliot L Servais
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, and Tufts University School of Medicine, Boston, Massachusetts.
| | - Justin D Blasberg
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Lisa M Brown
- Section of General Thoracic Surgery, UC Davis Health, Sacramento, California
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mark W Onaitis
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Diego, California
| | - Mark I Block
- Division of Thoracic Surgery, Memorial Healthcare System, Hollywood, Florida
| | - Elizabeth A David
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado
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12
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Brunelli A. Surgical Speed as a Quality Metric? All That Glitters Is Not Gold. Ann Thorac Surg 2022; 114:948. [PMID: 35196524 DOI: 10.1016/j.athoracsur.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Alessandro Brunelli
- Department of Thoracic Surgery, St. James's University Hospital Bexley Wing, Beckett St, Leeds, LS9 7TF, United Kingdom.
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13
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Forster C, Hasenauer A, Perentes JY, Abdelnour-Berchtold E, Zellweger M, Krueger T, Gonzalez M. Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection. J Thorac Dis 2022; 14:1980-1989. [PMID: 35813729 PMCID: PMC9264101 DOI: 10.21037/jtd-21-1774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/21/2022] [Indexed: 12/03/2022]
Abstract
Background Video-assisted thoracic surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. This study evaluates the impact of operative time (OT) on post-operative outcomes after VATS anatomical pulmonary resection for non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed all consecutive patients undergoing VATS lobectomy or segmentectomy for NSCLC between November 2010 and December 2019. Postoperative outcomes were compared between short (<150 minutes) and long (≥150 minutes) OT groups. A multivariable analysis was performed to identify predictors of long OT and overall post-operative complications. Results A total of 670 patients underwent lobectomy (n=496, 74%) or segmentectomy (n=174, 26%) for NSCLC. Mediastinal lymph node dissection was performed in 621 patients (92.7%). The median OT was 141 minutes (SD: 47 minutes) and 387 patients (57.8%) were operated within 150 minutes. Neoadjuvant chemotherapy was given in 25 patients (3.7%). Conversion thoracotomy was realized in 40 patients (6%). Shorter OT was significantly associated with decreased post-operative overall complication rate (30% vs. 41%; P=0.003), shorter median length of drainage (3 vs. 4 days; P<0.001) and shorter median length of hospital stay (6 vs. 7 days; P<0.001). On multivariable analysis, long OT (≥150 minutes) (OR 1.64, P=0.006), ASA score >2 (OR 1.87, P=0.001), FEV1 <80% (OR 1.47, P=0.046) and DLCO <80% (OR 1.5, P=0.045) were significantly associated with postoperative complications. Two predictors of long OT were identified: neoadjuvant chemotherapy (OR 3.11, P=0.01) and lobectomy (OR 1.5, P=0.032). Conclusions A prolonged OT is significantly associated with postoperative complications in our collective of patients undergoing VATS anatomical pulmonary resection.
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Affiliation(s)
- Céline Forster
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Arpad Hasenauer
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jean Yannis Perentes
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Matthieu Zellweger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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