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Song L, Chen X, Zhu L, Qian G, Xu Y, Song Z, Li J, Chen T, Huang J, Luo Q, Cheng X, Yang Y. Perioperative outcomes of bi-pigtail catheter drainage strategy versus conventional chest tube after uniportal video-assisted thoracic lung surgery. Eur J Cardiothorac Surg 2023; 64:ezad411. [PMID: 38078822 DOI: 10.1093/ejcts/ezad411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/22/2023] [Accepted: 12/09/2023] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES Chest tube (CT) drainage is a main cause of postoperative pain in lung surgery. Here, we introduced a novel drainage strategy with bi-pigtail catheters (PCs) and conducted a randomized controlled trial to compare with conventional CT drainage after uniportal video-assisted thoracic surgery lung surgery. METHODS A single-centre, prospective, open-labelled, randomized controlled trial (ChiCTR2000035337) was conducted with a preplanned sample size of 396. The primary outcome was the numerical pain rating scale (NPRS) on the first postoperative day. Secondary outcomes included other indicators of postoperative pain, drainage volume, duration of drainage, postoperative hospital stay, incidence of postoperative complications, CT reinsertion and medical costs. RESULTS A total number of 396 patients were randomized between August 2020 and January 2021, 387 of whom were included in the final analysis. The baseline and clinical characteristics of the patients were well balanced between 2 groups. The NPRS on the first postoperative day was significantly lower in the PC group than in the CT group (2.40 ± 1.27 vs 3.02 ± 1.39, p < 0.001), as well as the second/third-day NPRS, the incidence of sudden severe pain (9/192, 4.7% vs 34/195, 17.4%, P < 0.001) and pain requiring intervention (19/192, 9.9% vs 46/195, 23.6%, P < 0.001). In addition, the medical cost in the PC group was lower (US$7809 ± 1646 vs US$8205 ± 1815, P = 0.025). Univariable and multivariable analyses revealed that the drainage strategy was the only factor influencing the incidence of pain requiring intervention. CONCLUSIONS The drainage strategy with bi-PCs in patients undergoing uniportal video-assisted thoracic surgery lung surgery alleviates postoperative pain with adequate safety and efficacy.
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Affiliation(s)
- Liwei Song
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xingshi Chen
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Zhu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Gang Qian
- Department of Thoracic Surgery, Zhangjiagang Third People's Hospital, Suzhou, China
| | - Yanhui Xu
- Department of Thoracic Surgery, Zhejiang Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, China
| | - Zuodong Song
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiantao Li
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tianxiang Chen
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia Huang
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qingquan Luo
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xinghua Cheng
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yunhai Yang
- Department of Oncological Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Wang L, Dong Y, Ji Y, Song W, Cheng C, Yang M, Che G. Clinical outcome and risk factors for subcutaneous emphysema in patients with lung cancer after video-assisted thorascopic surgery. Front Surg 2022; 9:956431. [PMID: 36117818 PMCID: PMC9478373 DOI: 10.3389/fsurg.2022.956431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background and purpose With the clinical application of minimally invasive surgery and concept of enhanced recovery after surgery, the incidence of postoperative complications in lung cancer patients has been significantly reduced. However, postoperative subcutaneous emphysema (SE) becomes the main factor affecting the early discharge of patients. The aim of this study was to analyze the clinical outcome and risk factors for postoperative SE in lung cancer patients. Methods The clinical data of 414 lung cancer patients who were admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University from September 2021 to December 2021 were prospectively collected. The incidence, severity and treatment of patients who had SE, surgery approach, application of drainage tube and clinical information were analyzed. Results The incidence rate of postoperative SE in patients with lung cancer was 33.09% (137/414) and mild cases accounted for the vast majority (30.19%, 125/414). Multivariate analysis indicated that male [odds ratio (OR) = 2.247, P = .014] and advanced age (OR = 1.021, P = .043) were main risk factors for postoperative SE in patients with lung cancer. Conservative treatment was the main treatment option for SE (98.5%, 135/137). The average hospital stay in the subcutaneous emphysema group (5.49 ± 4.41 days) was significantly longer than that in the non-subcutaneous emphysema group (4.44 ± 3.32 days) (P = .014) and no significant statistical difference in the average total hospital cost between the two groups (7,798.31 ± 1,414.85$ vs. 7,501.14 ± 1,605.18$, P = .072). Conclusion Postoperative SE in patients with minimally invasive lung cancer is mainly mild, and conservative treatment is appropriate for most cases.
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Affiliation(s)
- Lei Wang
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Yingxian Dong
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
| | - Yanli Ji
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenpeng Song
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
| | - Chao Cheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Yang
- Department of Thoracic Surgery, West China School of Nursing, Sichuan University, Chengdu, China
| | - Guowei Che
- Lung Cancer Center, West-China Hospital, Sichuan University, Chengdu, China
- Correspondence: Guowei Che
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Dong Y, Shen C, Wang Y, Zhou K, Li J, Chang S, Ma H, Che G. Safety and Feasibility of Video-Assisted Thoracoscopic Day Surgery and Inpatient Surgery in Patients With Non-small Cell Lung Cancer: A Single-Center Retrospective Cohort Study. Front Surg 2021; 8:779889. [PMID: 34869571 PMCID: PMC8635799 DOI: 10.3389/fsurg.2021.779889] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/15/2021] [Indexed: 02/05/2023] Open
Abstract
Background and Objective: This study was undertaken to evaluate how safe and viable the use of video-assisted thoracoscopic day surgery (VATDS) is for individuals diagnosed with early-stage non-small cell lung cancer (NSCLC). Methods: Data obtained from the selected patients with NSCLC who underwent video-assisted thoracoscopic surgery (VATS) in the same medical group were analyzed and a single-center, propensity-matched cohort study was performed. In total, 353 individuals were included after propensity score matching (PSM) with 136 individuals in the day surgery group (DSG) and 217 individuals in the inpatient surgery group (ISG). Results: The 24-h discharge rate in the DSG was 93.38% (127/136). With respect to the postoperative complications (PPCs), no difference between the two groups was found (DSG vs. ISG: 11.76 vs. 11.52%, p = 0.933). In the DSG, a shorter length of stay (LOS) after surgery (1.47 ± 1.09 vs. 2.72 ± 1.28 days, p < 0.001) and reduced drainage time (8.45 ± 3.35 vs. 24.11 ± 5.23 h, p < 0.001) were found, while the drainage volume per hour (mL/h) was not notably divergent between the relevant groups (p = 0.312). No difference was observed in the cost of equipment and materials between the two groups (p = 0.333). However, the average hospital cost and drug cost of the DSG were significantly lower than those of the ISG (p < 0.001). Conclusion: The study indicated that the implementation of VATDS showed no difference in PPCs, but resulted in shorter in-hospital stays, shorter drainage times, and lower hospital costs than inpatient surgery. These results indicate the safety and feasibility of VATDS for a group of highly selected patients with early-stage NSCLC.
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Affiliation(s)
- Yingxian Dong
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Yan Wang
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Kun Zhou
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Jue Li
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Shuai Chang
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Hongsheng Ma
- Day Surgery Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
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Shi W, Chen Y, Zhang MQ, Che GW, Yu H. Effects of methylprednisolone on early postoperative pain and recovery in patients undergoing thoracoscopic lung surgery: A randomized controlled trial. J Clin Anesth 2021; 75:110526. [PMID: 34610541 DOI: 10.1016/j.jclinane.2021.110526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE Evidence from previous studies indicates that glucocorticoids offer effective postoperative analgesia and improve the quality of recovery (QoR). The aim of this study was to evaluate the efficacy of preoperative methylprednisolone on early postoperative pain and QoR following thoracoscopic lung surgery. DESIGN A prospective, single-center, three-arm, double-blinded, randomized trial. SETTING Tertiary university hospital. PATIENTS Adult patients aged ≥18 years undergoing thoracoscopic lung surgery were eligible for participation. INTERVENTIONS Patients enrolled in this study were randomized to receive preoperative methylprednisolone (40 mg or 120 mg) or identical volumes of 0.9% saline. MEASUREMENTS The primary outcome was the proportion of moderate-to-severe pain (numerical rating scale [NRS] ≥ 4 when coughing during pulmonary rehabilitation exercises) on the first day postoperatively. The postoperative pain scores, QoR-15 scores and other secondary outcomes were also recorded. MAIN RESULTS Of the 180 enrolled patients, 173 patients were included in the primary analysis. The results showed that the proportion of moderate-to-severe pain was not significantly different between the combined methylprednisolone group and the placebo group (51.7% vs. 64.9%; absolute difference, 13.2%; 95% CI, -2.1% to 29.3%; P = 0.10). Patients who received methylprednisolone treatment had lower pain scores at rest and coughing on the first day after surgery than those who received placebo treatment, with mean differences of 0.5 and 0.7, respectively (P < 0.01). QoR-15 scores were higher in patients treated with methylprednisolone at day 1 (mean difference, 6.9; P < 0.001) and day 2 (mean difference, 7.2; P < 0.001) than in patients who received placebo treatment. No side-effects associated with methylprednisolone treatment were observed. CONCLUSIONS Our findings suggested that preoperative methylprednisolone (either high or low dose) has limited impact on early postoperative pain and recovery in patients undergoing thoracoscopic lung surgery, with no clinically relevant benefits detected when compared with placebo. TRIAL REGISTRATION Chinese Clinical Trail Register (identifier: ChiCTR1900021020).
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Affiliation(s)
- Wei Shi
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Ying Chen
- Department of Anesthesiology, Hospital of Integrated Traditional Chinese and Western Medicine of Liangshan Prefecture, Liangshan 615000, Sichuan, China
| | - Meng-Qiu Zhang
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Guo-Wei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Hai Yu
- Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
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Jiang L, Lei T, Zhou K, Ma H, Che G. Pivotal role of video-assisted thoracoscopic surgery in improving survival outcome of stage I non-small cell lung cancer in day surgery patients. Thorac Cancer 2021; 12:2865-2872. [PMID: 34558195 PMCID: PMC8563150 DOI: 10.1111/1759-7714.14145] [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: 06/25/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung cancer, the leading cause of cancer-related deaths worldwide, has high morbidity rates. Video-assisted thoracoscopic surgery (VATS) as day surgery makes surgical treatment ideally in time with the same quality of medical care. This study aimed to assess the safety of stage I NSCLC patients who underwent VATS at a day surgery center. METHODS We retrospectively analyzed the clinical characteristics and tumor features of VATS patients at a single center, West China Hospital, from June 1, 2019, to December 31, 2020. Patients fulfilled all inclusion criteria, did not meet any exclusion criteria and underwent wedge resection, segmentectomy, or lobectomy with systematic lymph node dissection. RESULTS The median patient age was 43 (range, 19-67) years. Of the 209 patients, most were women. A total of 108 (51.7%) patients underwent segmentectomy, 87 (41.6%) lobectomy, and 14 (6.7%) wedge resection with systematic lymph node dissection. According to the AJCC/UICC eighth edition of lung cancer stage grouping, stages IA, IA1, IA2, and IA3 were 195 (93.3%), 122 (58.4%), 50 (23.9%), and one (0.5%), respectively. A total of 36 (17.2%) patients were stage 0. Adenocarcinoma was predominantly the postoperative pathological diagnosis, as only 14 (6.7%) were benign. A total of 201 (96.17%) patients were discharged without a chest tube. The most common chief complaints were cough, incisional pain, and shortness of breath. No severe complications or life-threatening emergencies were observed. CONCLUSIONS The day surgery mode of VATS for stage I NSCLC is safe and feasible, which makes surgical treatment ideally in time for stage I NSCLC patients with the same quality of medical care.
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Affiliation(s)
- Lisha Jiang
- Day Surgery Center, Sichuan University West China Hospital, Chengdu, China
| | - Tiantian Lei
- Day Surgery Center, Sichuan University West China Hospital, Chengdu, China
| | - Kun Zhou
- Department of Thoracic Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Hongsheng Ma
- Day Surgery Center, Sichuan University West China Hospital, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, Sichuan University West China Hospital, Chengdu, China
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Dong Y, Li J, Chang J, Song W, Wang Y, Wang Y, Che G. Video-Assisted Thoracoscopic Day Surgery for Patients with Pulmonary Nodules: A Single-Center Clinical Experience of 200 Cases. Cancer Manag Res 2021; 13:6169-6179. [PMID: 34393510 PMCID: PMC8354674 DOI: 10.2147/cmar.s324165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/23/2021] [Indexed: 02/05/2023] Open
Abstract
Background We reviewed our experience with 200 patients who underwent video-assisted thoracoscopic day surgery (VATDS) at the Day Surgery Center at West China Hospital to identify the safety and feasibility of VATDS and assess the value of novel management in patients with pulmonary nodules. Methods Between June 2019 and December 2020, 200 patients with pulmonary nodules underwent VATDS at the Day Surgery Center at West China Hospital. The medical records of these 200 patients were reviewed for age, sex, preoperative history, operative and pathological findings, amount of daily chest tube drainage, procedure method and duration, length of stay (LOS), visual analog scale (VAS), and postoperative pulmonary complications (PPCs). Results There were 45 male and 155 female patients with a median age of 43 years (range 18 to 58 years). A total of 158 (79.00%) patients were diagnosed with lung adenocarcinoma, 35 (17.50%) were diagnosed with chronic inflammation with fibrous hyperplasia, and seven (3.50%) were diagnosed with granulomatous inflammation with necrosis. The mean LOS of the 200 patients was 1.25±0.95 days, and 187 (93.50%) patients were discharged within 24 hours as planned. Thirteen patients were transferred to the thoracic surgery ward for further treatment because of PPCs. The median VAS was 3 points (range 1 to 7 points), and the rate of PPCs was 11.50%. Conclusion Two hundred patients underwent VATDS with an acceptable 24-hour discharge rate. However, selection of patients for VATDS is required, and the implementation of VATDS on a larger scale requires further discussion.
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Affiliation(s)
- Yingxian Dong
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jialong Li
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Junke Chang
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Wenpeng Song
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yu Wang
- Day Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yan Wang
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
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Gustave Roussy Immune Score based on a three-category risk assessment scale serves as a novel and effective prognostic indicator for surgically resectable early-stage non-small-cell lung cancer: A propensity score matching retrospective cohort study. Int J Surg 2020; 84:25-40. [DOI: 10.1016/j.ijsu.2020.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023]
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沈 诚, 常 帅, 周 坤, 车 国. [The Present Situation and Prospect of Day Surgery and Enhanced Recovery
after Surgery in Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:800-805. [PMID: 32752581 PMCID: PMC7519962 DOI: 10.3779/j.issn.1009-3419.2020.102.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 02/05/2023]
Abstract
The good results of enhanced recovery after surgery (ERAS) combined with minimally invasive surgery are reflected in reducing the incidence of perioperative complications and shortening the length of hospitalization (LOS). It has been widely used in surgical fields of different specialties. The implementation of the day surgery mode can shorten the waiting time for patients and reduce the financial burden. Especially in thoracic surgery, the shorter the waiting time in the hospital, the more beneficial for the patient's physical and psychological recovery. With the widespread implementation of minimally invasive technology and accelerated rehabilitation procedures, the application of ERAS in thoracic surgery has made it possible for some thoracic surgery to be completed in the day surgery. This article summarizes the current application of ERAS in the field of thoracic surgery and the development prospects of day surgery models in China.
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Affiliation(s)
- 诚 沈
- />610041 成都,四川大学华西医院胸外科Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 帅 常
- />610041 成都,四川大学华西医院胸外科Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 坤 周
- />610041 成都,四川大学华西医院胸外科Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 国卫 车
- />610041 成都,四川大学华西医院胸外科Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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You J, Zhang H, Li W, Dai N, Zheng Z. Single versus double chest drains after pulmonary lobectomy: a systematic review and meta-analysis. World J Surg Oncol 2020; 18:175. [PMID: 32690055 PMCID: PMC7372892 DOI: 10.1186/s12957-020-01945-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/03/2020] [Indexed: 12/25/2022] Open
Abstract
Background Previous randomized controlled trials have compared the efficacy and safety of single chest drain (SCD) and double chest drains (DCD) in the patients undergone pulmonary lobectomy, yet the results remain inconsistent. Therefore, we aimed to conduct this present systematic review and meta-analysis to evaluate the role of SCD and DCD in the patients undergone pulmonary lobectomy. Methods PubMed, Medline, EMBASE, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang, Weipu, and China Biomedical Literature databases were searched up to February 28, 2020, to identify the potential RCTs on SCD and DCD in the patients undergone pulmonary lobectomy. The main outcomes including verbal pain score, the duration of drainage (days), the length of hospital stay (days), and the incidence of air leak and re-drainage were collected and analyzed. All the data were processed and analyzed with software RevMan 5.3. We calculated and analyzed the odds ratios (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes. Results A total of 11 RCTs with 1214 patients were included, in which 589 patients received SCD treatment and 625 patients DCD treatment. The verbal pain score (MD = − 0.54, 95%CI (− 0.87, − 0.21)), the duration of drainage (MD = − 0.65, 95%CI (− 1.04, − 0.26)), and the length of hospital stay (MD = − 0.55, 95%CI (− 0.80, − 0.29)) in SCD group were significantly less than that of DCD group. There were no significant differences on the incidence of air leak (OR = 1.35, 95%CI (0.86, 2.11)) and re-drainage (OR = 0.88, 95%CI (0.41, 1.90)) among the two groups. Conclusions SCD is a safe option, and it has the advantages of less postoperative pain, shortened duration of drain, and reduced length of hospital stay when compared with DCD in the patients undergone pulmonary lobectomy.
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Affiliation(s)
- Jinzhi You
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Hailing Zhang
- The Suqian Clinical College of Xuzhou Medical University, Suqian, China
| | - Wei Li
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Ninghuang Dai
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Zhongfeng Zheng
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China.
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Che G. [Proper Selection of Enhanced Recovery after Surgery Programs between the Medical Service and Medical Intervence - Is It Time to Do?]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 22:681-686. [PMID: 31771736 PMCID: PMC6885415 DOI: 10.3779/j.issn.1009-3419.2019.11.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
加速康复外科(enhanced recovery after surgery, ERAS)理念诞生与微创外科技术进步密切相关。ERAS发展过程中利用技术,又融入人文因素,使其高于技术,而丰富ERAS的内涵和外延。结合近年ERAS在外科各领域的进展,总结ERAS临床应用的现状与策略:一是微创技术进步使ERAS理念的临床应用成为必然;二是外科学理论与技术的发展,深入与扩大了ERAS的内涵与外延;三是ERAS临床应用需要我们更新观念;四是ERAS的临床实践需要在医疗服务和医疗干预之间合理选择;五是ERAS临床应用加减之间应用的现实问题与策略。从而深入理解ERAS的真正临床意义,更好地指导临床实践。
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Affiliation(s)
- Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Dong Y, Zhu D, Che G, Liu L, Zhou K, Zhu T, Ma H. [Clinical Effect of Day Surgery in Patients with Lung Caner by Optimize Operating Process]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:77-83. [PMID: 32093451 PMCID: PMC7049788 DOI: 10.3779/j.issn.1009-3419.2020.02.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The types and number of day surgery are increasing, what is the result of day surgery of selected patients with lung cancer? To explore the operation process and clinical effect of day surgery in patients with lung cancer by fusing the concept of enhanced recovery after surgery (ERAS) and minimally invasive surgical techniques. METHODS A prospective study was planned with the approval of our institutional review board. 153 lung cancer patients who underwent anatomic resection in a single medical group between June 2019 and Nov 2019 were randomized. 20 patients were applied day surgery and 28 patients by inpatient surgery and the average length of stay, average hospital cost , complications and adverse reactions were analysed. RESULTS The average hospital day in DSG group (1 d) was significantly shorter than in ISG group (7.7±2.8) d (P=0.000). The average hospital cost in DSG group (38,297.3±3,408.7)¥ was significantly lower than in ISG group (47,831.1±7,376.1)¥ (P=0.000). There was no significant difference in the incidence of postoperative complications between the daytime surgery group (5.0%) and the inpatient surgery group (3.6%) (P=0.812). The postoperation adverse reactions in DSG (10.0%) and ISG (17.9%) is no difference (P=0.72). CONCLUSIONS Our study showed that the same clinical effect achieved between DSG and ISG, and recover quickly lung cancer patients after day surgery.
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Affiliation(s)
- Yingxian Dong
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Daojun Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hongsheng Ma
- Day Surgery Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Che G. [Current Situation and Strategy of Day Surgery in Patients with Lung Cancer by Enhanced Recovery after Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:1-4. [PMID: 31948531 PMCID: PMC7007390 DOI: 10.3779/j.issn.1009-3419.2020.01.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
加速康复外科(enhanced recovery after surgery, ERAS)理论、手术器械和治疗病种的变化,均需要重新审视现在的临床治疗观念和操作流程。ERAS理念从兴起到完善,为复杂却风险低的手术日间化提供了理论和技术支持。结合最近的国内外临床实践,以肺癌为例,分析肺癌手术日间化面临的问题与应对策略。从以下几方面论述:一是肺癌患者由住院手术转为日间手术(ambulatory surgery day surgery)的必要性与可行性;二是肺癌手术日间化的团队及平台建设;三是肺癌日间手术操作流程及围手术期管理需要优化;四是利用“分级诊疗-日间手术”模式保障患者安全;五是肺癌日间手术临床应用前景。
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Affiliation(s)
- Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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13
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Shen C, Che G. Tubeless minimally invasive treatment: taking a new step in enhanced recovery after surgery (ERAS). Thorac Cancer 2019; 10:2067-2070. [PMID: 31588634 PMCID: PMC6825901 DOI: 10.1111/1759-7714.13206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
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