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Lai Y, Dong Y, Tian L, Li H, Ye X, Che G. The Optimal Time of High-Intensity Pre-rehabilitation for Surgical Lung Cancer Patients: A Retrospective Cohort Study with 4452 Patients. Ann Surg Oncol 2024:10.1245/s10434-024-16054-6. [PMID: 39298020 DOI: 10.1245/s10434-024-16054-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 08/05/2024] [Indexed: 09/21/2024]
Abstract
BACKGROUND The aim of this study was to investigate the influence of the time of pre-rehabilitation (PR) combined with respiratory training and aerobic exercise on surgical patients with lung cancer. PATIENTS AND METHODS A retrospective study from a 5-year database of a single center, including patients with lung cancer who underwent surgery between 1 January 2016 and 31 December 2020, was conducted. The patients were divided into the PR group, in which they received the PR regimen, and the non-PR group, in which they received routine care. RESULTS A total of 4452 patients were retrospectively included, 684 of whom received PR regimen. A lower postoperative pulmonary complication (PPC) rate was observed in PR group than in non-PR group before or after propensity score matching (PSM) (before: 12.6% vs 18.5%, P < 0.001; after: 12.6% vs 18.7%, P < 0.001). For the PR group, a restricted cubic spline model revealed a significant nonlinear dose‒response association between PR time and the occurrence of PPCs (P for nonlinearity = 0.002). The PR time associated with the lowest occurrence of PPCs was 7 days, and the odds ratio (OR) of PPCs decreased steeply, with an OR of 0.8 [95% confidence interval (CI) 0.66-0.97] per day until 7 days, and then remained stable with a slight increase afterward with an OR of 1.11 (95% CI 0.99-1.25) per day. CONCLUSION The study validated the effectiveness of a pre-rehabilitation regimen for decreasing the occurrence of PPCs. A U-shaped nonlinear relationship was found between pre-rehabilitation time and the PPC rate, indicating that both excessive and insufficient pre-rehabilitation time may increase the incidence of PPCs. Registry Number: ChiCTR1800020097.
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Affiliation(s)
- Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yingxian Dong
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Long Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Hongjun Li
- West China Hospital of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Xinyi Ye
- Department of Endoscopy Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Bertolaccini L, Prisciandaro E, Uslenghi C, Chiari M, Cara A, Mazzella A, Casiraghi M, Spaggiari L. The role of the surgical volume for clinical outcomes in VATS lobectomy for lung cancer: a national large database multicenter analysis. Updates Surg 2024; 76:1475-1482. [PMID: 38103167 DOI: 10.1007/s13304-023-01723-0] [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: 11/05/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
Improving the quality of lung cancer care at a cost that can be sustained is a hotly debated issue. High-risk, low-volume procedures (such as lung resections) are believed to improve significantly when centralised in high-volume centres. However, limited evidence exists to support volume requirements in lung cancer surgery. On the other hand, there was no evidence that the number of lung resections affected either the short-term perioperative results or the long-term cost. Using data from an extensive nationwide registry, this study investigated the correlations between surgical volumes and selected perioperative outcomes. A retrospective analysis of a prospectively filled national registry that follows stringent quality assurance and security procedures was conducted to ensure data accuracy and security. Patients who underwent VATS lobectomy from 2014 to 2019 at the participating centres were included. Selected perioperative outcomes were reported. Total direct hospital cost is measured at discharge for hospitalisations with a primary diagnosis of lung cancer, hospital stay costs, and postoperative length of hospital stay after lobectomy. After the propensity score matched, centres were divided into three groups according to the surgical volume of the unit where VATS lobectomies were performed (high-volume centre: > 500 lobectomies; medium-volume centre: 200-500 lobectomies; low-volume centre: < 200 lobectomies). 11,347 patients were included and matched (low-volume center = 2890; medium-volume center = 3147; high-volume center = 2907). The mean operative time density plot (Fig. 1A) showed no statistically significant difference (p = 0.67). In contrast, the density plot of the harvested lymph nodes (Fig. 1B) showed significantly higher values in the high-volume centres (p = 0.045), albeit without being clinically significant. The adjusted rates of any and significant complications were higher in the low-volume centre (p = 0.034) without significantly affecting the length of hospital stay (p = 0.57). VATS lobectomies for lung cancer in higher-volume centres seem associated with a statistically significantly higher number of harvested lymph nodes and lower perioperative complications, yet without any significant impact in terms of costs and resource consumption. These findings may advise the investigation of the learning curve effect in a complete economic evaluation of VATS lobectomy in lung cancer. Fig. 1 The mean operative time density plot showed no statistically significant difference (p = 0.67).
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - Elena Prisciandaro
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Clarissa Uslenghi
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Matteo Chiari
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Andrea Cara
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Antonio Mazzella
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Motono N, Mizoguchi T, Ishikawa M, Iwai S, Iijima Y, Uramoto H. Analysis of risk factors of postoperative complication for non-small cell lung cancer. BMC Pulm Med 2024; 24:333. [PMID: 38987733 PMCID: PMC11238410 DOI: 10.1186/s12890-024-03054-1] [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: 02/27/2024] [Accepted: 05/07/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND The relationship between risk factors of common postoperative complications after pulmonary resection, such as air leakage, atelectasis, and arrhythmia, and patient characteristics, including nutritional status or perioperative factors, has not been sufficiently elucidated. METHODS One thousand one hundred thirty-nine non-small cell lung cancer patients who underwent pulmonary resection were retrospectively analyzed for risk factors of common postoperative complications. RESULTS In a multivariate analysis, male sex (P = 0.01), age ≥ 65 years (P < 0.01), coexistence of chronic obstructive pulmonary disease (COPD) (P < 0.01), upper lobe (P < 0.01), surgery time ≥ 155 min (P < 0.01), and presence of lymphatic invasion (P = 0.01) were significant factors for postoperative complication. Male sex (P < 0.01), age ≥ 65 years (P = 0.02), body mass index (BMI) < 21.68 (P < 0.01), coexistence of COPD (P = 0.02), and surgery time ≥ 155 min (P = 0.01) were significant factors for severe postoperative complication. Male sex (P = 0.01), BMI < 21.68 (P < 0.01), thoracoscopic surgery (P < 0.01), and surgery time ≥ 155 min (P < 0.01) were significant risk factors for postoperative air leakage. Coexistence of COPD (P = 0.01) and coexistence of asthma (P < 0.01) were significant risk factors for postoperative atelectasis. Prognostic nutrition index (PNI) < 45.52 (P < 0.01), lobectomy or extended resection more than lobectomy (P = 0.01), and surgery time ≥ 155 min (P < 0.01) were significant risk factors for postoperative arrhythmia. CONCLUSION Low BMI, thoracoscopic surgery, and longer surgery time were significant risk factors for postoperative air leakage. Coexistence of COPD and coexistence of asthma were significant risk factors for postoperative atelectasis. PNI, surgery time, and surgical procedure were revealed as risk factors of postoperative arrhythmia. Patients with these factors should be monitored for postoperative complication. TRIAL REGISTRATION The Institutional Review Board of Kanazawa Medical University approved the protocol of this retrospective study (approval number: I392), and written informed consent was obtained from all patients.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
| | - Takaki Mizoguchi
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
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Kang D, Lei C, Zhang Y, Wei X, Dai W, Xu W, Zhang J, Yu Q, Su X, Huang Y, Shi Q. Shortness of breath on the day of discharge: an early alert for post-discharge complications in patients undergoing lung cancer surgery. J Cardiothorac Surg 2024; 19:398. [PMID: 38937786 PMCID: PMC11210099 DOI: 10.1186/s13019-024-02845-1] [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: 01/30/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE Symptom assessment based on patient-reported outcome (PRO) can correlate with disease severity, making it a potential tool for threshold alerts of postoperative complications. This study aimed to determine whether shortness of breath (SOB) scores on the day of discharge could predict the development of post-discharge complications in patients who underwent lung cancer surgery. METHODS Patients were from a study of a dynamic perioperative rehabilitation cohort of lung cancer patients focusing on patient-reported outcomes. Patients were assessed using the Perioperative Symptom Assessment Scale for Lung surgery (PSA-Lung). Logistic regression model was used to examine the potential association between SOB on the day of discharge and complications within 3 months after discharge. The post-discharge complications were taken as the anchor variable to determine the optimal cutpoint for SOB on the day of discharge. RESULTS Complications within 3 months post-discharge occurred in 71 (10.84%) of 655 patients. Logistic regression analysis revealed that being female (OR 1.764, 95% CI 1.006-3.092, P < 0.05) and having two chest tubes (OR 2.026, 95% CI 1.107-3.710, P < 0.05) were significantly associated with post-discharge complications. Additionally, the SOB score on the day of discharge (OR 1.125, 95% CI 1.012-1.250, P < 0.05) was a significant predictor. The optimal SOB cutpoint was 5 (on a scale of 0-10). Patients with an SOB score ≥ 5 at discharge experienced a lower quality of life 1 month later compared to those with SOB score<5 at discharge (73 [50-86] vs. 81 [65-91], P < 0.05). CONCLUSION SOB on the day of discharge may serve as an early warning sign for the timely detection of 3 month post-discharge complications.
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Affiliation(s)
- Dan Kang
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Cheng Lei
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yong Zhang
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Xu
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Jingyu Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
| | - Qingsong Yu
- Chengdu Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, China
| | - Xueyao Su
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yanyan Huang
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China.
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China.
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China.
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Yoo GY, Yoon SK, Moon MH, Moon SW, Hwang W, Kim KS. Development of a Risk Scoring Model to Predict Unexpected Conversion to Thoracotomy during Video-Assisted Thoracoscopic Surgery for Lung Cancer. J Chest Surg 2024; 57:302-311. [PMID: 38472121 PMCID: PMC11089052 DOI: 10.5090/jcs.23.140] [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: 10/06/2023] [Revised: 12/17/2023] [Accepted: 01/15/2024] [Indexed: 03/14/2024] Open
Abstract
Background Unexpected conversion to thoracotomy during planned video-assisted thoracoscopic surgery (VATS) can lead to poor outcomes and comparatively high morbidity. This study was conducted to assess preoperative risk factors associated with unexpected thoracotomy conversion and to develop a risk scoring model for preoperative use, aimed at identifying patients with an elevated risk of conversion. Methods A retrospective analysis was conducted of 1,506 patients who underwent surgical resection for non-small cell lung cancer. To evaluate the risk factors, univariate analysis and logistic regression were performed. A risk scoring model was established to predict unexpected thoracotomy conversion during VATS of the lung, based on preoperative factors. To validate the model, an additional cohort of 878 patients was analyzed. Results Among the potentially significant clinical variables, male sex, previous ipsilateral lung surgery, preoperative detection of calcified lymph nodes, and clinical T stage were identified as independent risk factors for unplanned conversion to thoracotomy. A 6-point risk scoring model was developed to predict conversion based on the assessed risk, with patients categorized into 4 groups. The results indicated an area under the receiver operating characteristic curve of 0.747, with a sensitivity of 80.5%, specificity of 56.4%, positive predictive value of 1.8%, and negative predictive value of 91.0%. When applied to the validation cohort, the model exhibited good predictive accuracy. Conclusion We successfully developed and validated a risk scoring model for preoperative use that can predict the likelihood of unplanned conversion to thoracotomy during VATS of the lung.
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Affiliation(s)
- Ga Young Yoo
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Keun Yoon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wonjung Hwang
- Department of Anesthesiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim AT, Ding L, Lee HB, Ashbrook MJ, Ashrafi A, Wightman SC, Atay SM, David EA, Harano T, Kim AW. Longer hospitalizations, more complications, and greater readmissions for patients with comorbid psychiatric disorders undergoing pulmonary lobectomy. J Thorac Cardiovasc Surg 2024; 167:1502-1511.e11. [PMID: 37245626 DOI: 10.1016/j.jtcvs.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To examine the influence of comorbid psychiatric disorders (PSYD) on postoperative outcomes in patients undergoing pulmonary lobectomy. METHODS A retrospective analysis of the Healthcare Cost and Utilization Project Nationwide Readmissions Database from 2016 to 2018 was performed. Patients with lung cancer with and without psychiatric comorbidities who underwent pulmonary lobectomy were collated and analyzed (International Classification of Diseases, 10th Revision, Clinical Modification Mental, Behavioral and Neurodevelopmental disorders [F01-99]). The association of PSYD with complications, length of stay, and readmissions was assessed using a multivariable regression analysis. Additional subgroup analyses were performed. RESULTS A total of 41,691 patients met inclusion criteria. Of these, 27.84% (11,605) of the patients had at least 1 PSYD. PSYD was associated with a significantly increased risk of postoperative complications (relative risk, 1.041; 95% CI, 1.015-1.068; P = .0018), pulmonary complications (relative risk, 1.125; 95% CI, 1.08-1.171; P < .0001), longer length of stay (PSYD mean, 6.79 days and non-PSYD mean, 5.68 days; P < .0001), higher 30-day readmission rate (9.2% vs 7.9%; P < .0001), and 90-day readmission rate (15.4% vs 12.9%; P < .007). Among patients with PSYD, those with cognitive disorders and psychotic disorders (eg, schizophrenia) appear to have the highest rates and risks of postoperative morbidity and in-hospital mortality. CONCLUSIONS Patients with lung cancer with comorbid psychiatric disorders undergoing lobectomy experience worse postoperative outcomes with longer hospitalization, increased rates of overall and pulmonary complications, and greater readmissions suggesting potential opportunities for improved psychiatric care during the perioperative period.
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Affiliation(s)
- Alexander T Kim
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Li Ding
- Division of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Hochang B Lee
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Matthew J Ashbrook
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Arman Ashrafi
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Sean C Wightman
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Scott M Atay
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Elizabeth A David
- Division of Thoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Takashi Harano
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Anthony W Kim
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
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Nogueira LM, Boffa DJ, Jemal A, Han X, Yabroff KR. Medicaid Expansion Under the Affordable Care Act and Early Mortality Following Lung Cancer Surgery. JAMA Netw Open 2024; 7:e2351529. [PMID: 38214932 PMCID: PMC10787311 DOI: 10.1001/jamanetworkopen.2023.51529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
Importance Medicaid expansion under the Patient Protection and Affordable Care Act is associated with gains in health insurance coverage, earlier stage diagnosis, and improved survival among patients with cancer. Objective To examine the association of Medicaid expansion with changes in early mortality among adults undergoing surgical resection of non-small cell lung cancer (NSCLC), a setting in which access to care is a major determinant of survival. Design, Setting, and Participants This cohort study used the National Cancer Database to identify 14 984 adults 45 to 64 years of age who underwent surgical resection of NSCLC between 2008 and 2019. Analysis was conducted between March 28, 2021, and September 1, 2023. Exposure State of residence Medicaid expansion status. Main Outcomes and Measures Descriptive statistics were used to compare study population characteristics by Medicaid expansion status of patients' state of residence. Difference-in-differences analyses were used to evaluate the association between Medicaid expansion and postoperative mortality before implementation of the ACA (2008-2013) vs after (2014-2019). Results Among 14 984 adults included, the mean (SD) age was 56.3 (5.1) years, 54.6% were women, and 62.1% lived in Medicaid expansion states. Both 30-day (from 0.97% to 0.26%) and 90-day (from 2.63% to 1.32%) postoperative mortality decreased from before the ACA to after among patients residing in Medicaid expansion states (both P < .001) but not in nonexpansion states (30-day mortality before the ACA, 0.75% vs after the ACA, 0.68%; P = .74; and 90-day mortality before the ACA, 2.43% vs after the ACA, 2.20%; P = .57), leading to a difference-in-differences of -0.64 percentage points (95% CI, -1.19 to -0.08; P = .03) for 30-day mortality and -1.08 percentage points (95% CI, -2.08 to -0.08; P = .03) for 90-day mortality. The difference-in-differences for in-hospital mortality was not significant (P = .34) between expansion states (1.41% before the ACA to 0.77% after the ACA; 0.63 percentage point decrease; P = .004) and nonexpansion states (1.49% before the ACA to 1.20% after the ACA; 0.30 percentage point decrease; P = .29). Conclusions and Relevance In this cohort study of patients with NSCLC, Medicaid expansion was associated with declines in 30- and 90-day postoperative mortality following hospital discharge. These findings suggest that Medicaid expansion may be an effective strategy for improving access to care and cancer outcomes in this population.
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Affiliation(s)
- Leticia M. Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Daniel J. Boffa
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K. Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Wang Y, Kapula N, Yang CFJ, Manapat P, Elliott IA, Guenthart BA, Lui NS, Backhus LM, Berry MF, Shrager JB, Liou DZ. Comparison of failure to rescue in younger versus elderly patients following lung cancer resection. JTCVS OPEN 2023; 16:855-872. [PMID: 38204720 PMCID: PMC10774945 DOI: 10.1016/j.xjon.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/14/2023] [Accepted: 08/02/2023] [Indexed: 01/12/2024]
Abstract
Objective Failure to rescue (FTR), defined as in-hospital death following a major complication, has been increasingly studied in patients who undergo cardiothoracic surgery. This study tested the hypothesis that elderly patients undergoing lung cancer resection have greater rates of FTR compared with younger patients. Methods Patients who underwent surgery for primary lung cancer between 2011 and 2020 and had at least 1 major postoperative complication were identified using the National Surgical Quality Improvement Program database. Patients who died following complications (FTR) were compared with those who survived in an elderly (80+ years) and younger (<80 years) cohort. Results Of the 2823 study patients, the younger cohort comprised 2497 patients (FTR: n = 139 [5.6%]), whereas the elderly cohort comprised 326 patients (FTR: n = 39 [12.0%]). Pneumonia was the most common complication in younger (877/2497, 35.1%) and elderly patients (118/326, 36.2%) but was not associated with FTR on adjusted analysis. Increasing age was associated with FTR (adjusted odds ratio [AOR], 1.55 per decade, P < .001), whereas unplanned reoperation was associated with reduced risk (AOR, 0.55, P = .01). Within the elderly cohort, surgery conducted by a thoracic surgeon was associated with lower FTR risk (AOR, 0.29, P = .028). Conclusions FTR following lung cancer resection was more frequent with increasing age. Pneumonia was the most common complication but not a predictor of FTR. Unplanned reoperation was associated with reduced FTR, as was treatment by a thoracic surgeon for elderly patients. Surgical therapy for complications after lung cancer resection and elderly patients managed by a thoracic specialist may mitigate the risk of death following an adverse postoperative event.
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Affiliation(s)
- Yoyo Wang
- University of Michigan Medical School, Ann Arbor, Mich
| | - Ntemena Kapula
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Chi-Fu J. Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Pooja Manapat
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Irmina A. Elliott
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Brandon A. Guenthart
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Natalie S. Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Leah M. Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Mark F. Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Joseph B. Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Douglas Z. Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
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Wong MSH, Pons A, De Sousa P, Proli C, Jordan S, Begum S, Buderi S, Anikin V, Finch J, Asadi N, Beddow E, Lim E. Determining the optimal time to report mortality after lobectomy for lung cancer: An analysis of the time-varying risk of death. JTCVS OPEN 2023; 16:931-937. [PMID: 38204618 PMCID: PMC10774977 DOI: 10.1016/j.xjon.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/10/2023] [Accepted: 07/31/2023] [Indexed: 01/12/2024]
Abstract
Objective Surgical mortality has traditionally been assessed at arbitrary intervals out to 1 year, without an agreed optimum time point. The aim of our study was to investigate the time-varying risk of death after lobectomy to determine the optimum period to evaluate surgical mortality rate after lobectomy for lung cancer. Methods We performed a retrospective study of patients undergoing lobectomy for lung cancer at our institution from 2015 to 2022. Parametric survival models were assessed and compared with a nonparametric kernel estimate. The hazard function was plotted over time according to the best-fit statistical distribution. The time points at which instantaneous hazard rate peaked and stabilized in the 1-year period after surgery were then determined. Results During the study period, 2284 patients underwent lobectomy for lung cancer. Cumulative mortality at 30, 90, and 180 days was 1.3%, 2.9%, and 4.9%, respectively. Log-logistic distribution showed the best fit compared with other statistical distribution, indicated by the lowest Akaike information criteria value. The instantaneous hazard rate was greatest during the immediate postoperative period (0.129; 95% confidence interval, 0.087-0.183) and diminishes rapidly within the first 30 days after surgery. Instantaneous hazard rate continued to decrease past 90 days and stabilized only at approximately 180 days. Conclusions In-hospital mortality is the optimal follow-up period that captures the early-phase hazard during the immediate postoperative period after lobectomy. Thirty-day mortality is not synonymous to "early mortality," as instantaneous hazard rate remains elevated well past the 90-day time point and only stabilizes at approximately 180 days after lobectomy.
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Affiliation(s)
- Matthew Shiu Hang Wong
- Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Aina Pons
- Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Paulo De Sousa
- Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Chiara Proli
- Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Simon Jordan
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Sofina Begum
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Silviu Buderi
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Vladimir Anikin
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Jonathan Finch
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Nizar Asadi
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Emma Beddow
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Eric Lim
- Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom
- National Heart and Lung Institution, Imperial College London, London, United Kingdom
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10
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Piccioni F, Langiano N, Bignami E, Guarnieri M, Proto P, D'Andrea R, Mazzoli CA, Riccardi I, Bacuzzi A, Guzzetti L, Rossi I, Scolletta S, Comi D, Benigni A, Pierconti F, Coccia C, Biscari M, Murzilli A, Umari M, Peratoner C, Serra E, Baldinelli F, Accardo R, Diana F, Fasciolo A, Amodio R, Ball L, Greco M, Pelosi P, Della Rocca G. One-Lung Ventilation and Postoperative Pulmonary Complications After Major Lung Resection Surgery. A Multicenter Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2023; 37:2561-2571. [PMID: 37730455 PMCID: PMC10133024 DOI: 10.1053/j.jvca.2023.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES The effect of one-lung ventilation (OLV) strategy based on low tidal volume (TV), application of positive end-expiratory pressure (PEEP), and alveolar recruitment maneuvers (ARM) to reduce postoperative acute respiratory distress syndrome (ARDS) and pulmonary complications (PPCs) compared with higher TV without PEEP and ARM strategy in adult patients undergoing lobectomy or pneumonectomy has not been well established. DESIGN Multicenter, randomized, single-blind, controlled trial. SETTING Sixteen Italian hospitals. PARTICIPANTS A total of 880 patients undergoing elective major lung resection. INTERVENTIONS Patients were randomized to receive lower tidal volume (LTV group: 4 mL/kg predicted body weight, PEEP of 5 cmH2O, and ARMs) or higher tidal volume (HTL group: 6 mL/kg predicted body weight, no PEEP, and no ARMs). After OLV, until extubation, both groups were ventilated using a tidal volume of 8 mL/kg and a PEEP value of 5 cmH2O. The primary outcome was the incidence of in-hospital ARDS. Secondary outcomes were the in-hospital rate of PPCs, major cardiovascular events, unplanned intensive care unit (ICU) admission, in-hospital mortality, ICU length of stay, and in-hospital length of stay. MEASUREMENTS AND MAIN RESULTS ARDS occurred in 3 of 438 patients (0.7%, 95% CI 0.1-2.0) and in 1 of 442 patients (0.2%, 95% CI 0-1.4) in the LTV and HTV group, respectively (Risk ratio: 3.03 95% CI 0.32-29, p = 0.372). Pulmonary complications occurred in 125 of 438 patients (28.5%, 95% CI 24.5-32.9) and in 136 of 442 patients (30.8%, 95% CI 26.6-35.2) in the LTV and HTV group, respectively (risk ratio: 0.93, 95% CI 0.76-1.14, p = 0.507). The incidence of major complications, in-hospital mortality, and unplanned ICU admission, ICU and in-hospital length of stay were comparable in both groups. CONCLUSIONS In conclusion, among adult patients undergoing elective lung resection, an OLV with lower tidal volume, PEEP 5 cmH2O, and ARMs and a higher tidal volume strategy resulted in low ARDS incidence and comparable postoperative complications, in-hospital length of stay, and mortality.
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Affiliation(s)
- Federico Piccioni
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Nicola Langiano
- SOC Anesthesia and Intensive Care Medicine Clinic - Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Guarnieri
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Paolo Proto
- Department of Critical and Supportive Therapy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Rocco D'Andrea
- Department of Anesthesia, Intensive Care Medicine and Emergency, IRRCS Policlinico di Sant' Orsola, Bologna Academic Hospital, Bologna, Italy
| | - Carlo A Mazzoli
- Department of Anesthesia, Intensive Care Medicine and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Ilaria Riccardi
- SOC Anesthesia and Intensive Care Medicine Clinic - Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Luca Guzzetti
- ASST Settelaghi Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Irene Rossi
- Cardio-thoracic and vascular Department, UOC Cardio-thoracic and vascular Anesthesia and ICM, Azienda ospedaliero-universitaria Senese, Siena, Italy
| | - Sabino Scolletta
- Cardio-thoracic and vascular Department, UOC Cardio-thoracic and vascular Anesthesia and ICM, Azienda ospedaliero-universitaria Senese, Siena, Italy
| | - Daniela Comi
- Anesthesia and Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alberto Benigni
- Anesthesia and Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Pierconti
- IRCCS-IFO National Institute of Oncology - Regina Elena, DPT of Oncologic Clinic and Research, UOC Anesthesia and ICM, Rome, Italy
| | - Cecilia Coccia
- IRCCS-IFO National Institute of Oncology - Regina Elena, DPT of Oncologic Clinic and Research, UOC Anesthesia and ICM, Rome, Italy
| | - Matteo Biscari
- Arcispedale Santa Maria Nuova, IRCCS AUSL di Reggio Emilia, Italy
| | - Alice Murzilli
- Arcispedale Santa Maria Nuova, IRCCS AUSL di Reggio Emilia, Italy
| | - Marzia Umari
- SOC Anesthesia and Intensive Care Medicine - Azienda Sanitaria Universitaria Giuliana, Cattinara Hospital, Trieste, Italy
| | - Caterina Peratoner
- SOC Anesthesia and Intensive Care Medicine - Azienda Sanitaria Universitaria Giuliana, Cattinara Hospital, Trieste, Italy
| | - Eugenio Serra
- Anesthesia and Intensive Care Medicine Institute - Azienda Ospedaliera-Università of Padua, Padua, Italy
| | | | - Rosanna Accardo
- Division of Anesthesia, Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori Fondazione G. Pascale - IRCCS, Naples, Italy
| | - Fernanda Diana
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera Brotzu - Ospedale Oncologico Businco, Cagliari, Italy
| | | | - Riccardo Amodio
- Department of Anesthesia, Intensive Care and Pain Medicine, IRCCS Centro di Riferimento Oncologico della Basilicata/OECI Clinical Cancer Center - Rionero in Vulture, Potenza, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
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11
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Suleiman A, Azizi BA, Munoz-Acuna R, Ahrens E, Tartler TM, Wachtendorf LJ, Linhardt FC, Santer P, Chen G, Wilson JL, Gangadharan SP, Schaefer MS. Intensity of one-lung ventilation and postoperative respiratory failure: A hospital registry study. Anaesth Crit Care Pain Med 2023; 42:101250. [PMID: 37236317 DOI: 10.1016/j.accpm.2023.101250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Studies linked a high intensity of mechanical ventilation, measured as high mechanical power (MP) to postoperative respiratory failure (PRF) in the setting of two-lung ventilation. We investigated whether a higher MP during one-lung ventilation (OLV) is associated with PRF. METHODS In this registry-based study, adult patients who underwent general anesthesia with OLV for thoracic surgeries between 2006 and 2020 at a New England tertiary healthcare network were included. The association between MP during OLV and PRF (emergency non-invasive ventilation or reintubation within seven days) was assessed in a cohort weighted through a generalized propensity score conditional on a priori defined preoperative and intraoperative factors. Dominance of components of MP and intensity of OLV versus two-lung ventilation in predicting PRF was investigated. RESULTS Out of 878 included patients, 106 (12.1%) developed PRF. The median (IQR) MP during OLV was 9.8 J/min (7.5-11.8) and 8.3 J/min (6.6-10.2) in patients with and without PRF respectively. A higher MP during OLV was associated with PRF (ORadj 1.22 per 1 J/min increase; 95%CI 1.13-1.31; p < 0.001) and characterized by a U-shaped dose-response curve, with the lowest probability of PRF (7.5%) at 6.4 J/min. Dominance analysis of PRF predictors showed a stronger contribution of driving pressure over respiratory rate and tidal volume, the dynamic over the static component of MP, and MP during OLV over two-lung ventilation (contribution to Pseudo-R2: 0.017, 0.021, and 0.036, respectively). CONCLUSION A higher intensity of OLV, mainly driven by driving pressure, is dose-dependently associated with PRF and might constitute a target for mechanical ventilation.
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Affiliation(s)
- Aiman Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Basit A Azizi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ricardo Munoz-Acuna
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elena Ahrens
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim M Tartler
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Luca J Wachtendorf
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Felix C Linhardt
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter Santer
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Guanqing Chen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jennifer L Wilson
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sidhu P Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany.
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12
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DE Cosmo G, Levantesi L. Lung collapse: which strategy? Minerva Anestesiol 2023; 89:730-732. [PMID: 37676174 DOI: 10.23736/s0375-9393.23.17465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Germano DE Cosmo
- Department of Anesthesiology and Intensive Care Medicine, Sacred Heart Catholic University, Rome, Italy -
| | - Laura Levantesi
- Department of Anesthesiology and Intensive Care Medicine, Sacred Heart Catholic University, Rome, Italy
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13
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Chuang JH, Chen PH, Lu TP, Hung WT, Liao HC, Tsai TM, Lin MW, Chen KC, Hsu HH, Chen JS. Uniportal versus multiportal nonintubated thoracoscopic anatomical resection for lung cancer: A propensity-matched analysis. J Formos Med Assoc 2023; 122:947-954. [PMID: 37169655 DOI: 10.1016/j.jfma.2023.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/22/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND/PURPOSE No studies have compared between uniportal and multiportal nonintubated thoracoscopic anatomical resection for non-small cell lung cancer (NSCLC). We aimed to compare short- and long-term postoperative outcomes concerning these two methods. METHODS Our retrospective dataset comprised patients with NSCLC who underwent uniportal or multiportal nonintubated thoracoscopic anatomical resection between January 2011 and December 2019. The primary outcome was recurrence-free survival. Propensity scores were matched according to age, sex, body mass index, pulmonary function, tumor size, cancer stage, and surgical method. RESULTS In total, 1130 such patients underwent nonintubated video-assisted thoracoscopic surgery (VATS), and 490 consecutive patients with stage I-III NSCLC underwent nonintubated anatomical resection, including lobectomy and segmentectomy (uniportal, n = 158 [32.3%]; multiportal, n = 331 [67.7%]). The uniportal group had fewer dissected lymph nodes and lymph node stations. In paired group analysis, the uniportal group had shorter operation durations (99.8 vs. 138.2 min; P < 0.001), lower intensive care unit (ICU) admission rates and ICU admission intervals (7.0% vs. 27.8%; P < 0.001), and shorter postoperative hospital stays (4.1 days vs. 5.2 days; P < 0.001). The most common postoperative complication was prolonged air leaks. No surgical mortality was observed. The multiportal group had higher complication rates for grades ≥ II NSCLC; however, this difference was not significant (4.4% vs. 1.3%, respectively; P = 0.09). CONCLUSION Nonintubated uniportal VATS for anatomical resection had better results for some perioperative outcomes than multiportal VATS. Oncological outcomes such as recurrence-free and overall survival remained uncompromised, despite fewer dissected lymph nodes.
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Affiliation(s)
- Jen-Hao Chuang
- Department of Surgical Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Pei-Hsing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, HsinChu County, Taiwan; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Wan-Ting Hung
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan; Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Chi Liao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Traumatology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tung-Ming Tsai
- Department of Surgical Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Mong-Wei Lin
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Ke-Cheng Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Jin-Shing Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei City, Taiwan; Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan; Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
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14
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Zhang D, Xi Y, Boffa DJ, Liu Y, Nogueira LM. Association of Wildfire Exposure While Recovering From Lung Cancer Surgery With Overall Survival. JAMA Oncol 2023; 9:1214-1220. [PMID: 37498574 PMCID: PMC10375383 DOI: 10.1001/jamaoncol.2023.2144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/26/2023] [Indexed: 07/28/2023]
Abstract
Importance With a changing climate, wildfire activity in the US has increased dramatically, presenting multifaceted and compounding health hazards. Individuals discharged from the hospital following surgical resection of non-small cell lung cancer (NSCLC) are potentially at higher risk from wildfires' health hazards. Objective To assess the association between wildfire exposure and postoperative long-term overall survival among patients with lung cancer in the US. Design, Setting, and Participants In this cohort study, individuals who underwent curative-intent NSCLC resection between January 1, 2004, and December 31, 2019, were selected from the National Cancer Database. Daily wildfire information was aggregated at the zip code level from the National Aeronautics and Space Administration Fire Information for Resource Management System. The data analysis was performed between July 19, 2022, and April 14, 2023. Exposure An active wildfire detected at the zip code of residence between 0 and 3, 4 and 6, or 7 and 12 months after NSCLC surgery. Main Outcome Overall survival was defined as the interval between age at hospital discharge and age at death, last contact, or study end, whichever came first. Cox proportional hazards were used for estimating hazard ratios (HRs) adjusted for sex, region, metropolitan category, health insurance type, comorbidities, tumor size, lymph node involvement, era, and facility type. Results A total of 466 912 individuals included in the study (249 303 female and [53.4] and 217 609 male [46.6%]; mean [SD] age at diagnosis, 67.3 [9.9] years), with 48 582 (10.4%) first exposed to a wildfire between 0 and 3 months, 48 328 (10.6%) between 4 and 6 months, and 71 735 (15.3%) between 7 and 12 months following NSCLC surgery. Individuals exposed to a wildfire within 3 months (adjusted HR [AHR], 1.43; 95% CI, 1.41-1.45), between 4 and 6 months (AHR, 1.39; 95% CI, 1.37-1.41), and between 7 and 12 months (AHR, 1.17; 95% CI, 1.15-1.19) after discharge from the hospital following stage I to III NSCLC resection had worse overall survival than unexposed individuals. Conclusions In this cohort study, wildfire exposure was associated with worse overall survival following NSCLC surgical resection, suggesting that patients with lung cancer are at greater risk from the health hazards of wildfires and need to be prioritized in climate adaptation efforts.
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Affiliation(s)
- Danlu Zhang
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yuzhi Xi
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Yang Liu
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Leticia M. Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, Georgia
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15
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Ray MA, Akinbobola O, Fehnel C, Saulsberry A, Dortch K, Wolf B, Valaulikar G, Patel HD, Ng T, Robbins T, Smeltzer MP, Faris NR, Osarogiagbon RU. Surgeon Quality and Patient Survival After Resection for Non-Small-Cell Lung Cancer. J Clin Oncol 2023; 41:3616-3628. [PMID: 37267506 PMCID: PMC10325770 DOI: 10.1200/jco.22.01971] [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] [Received: 08/30/2022] [Revised: 03/06/2023] [Accepted: 04/12/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE The quality and outcomes of curative-intent lung cancer surgery vary in populations. Surgeons are key drivers of surgical quality. We examined the association between surgeon-level intermediate outcomes differences, patient survival differences, and potential mitigation by processes of care. PATIENTS AND METHODS Using a baseline population-based surgical resection cohort, we derived surgeon-level cut points for rates of positive margins, nonexamination of lymph nodes, nonexamination of mediastinal lymph nodes, and wedge resections. Applying the baseline cut points to a subsequent cohort from the same population-based data set, we assign surgeons into three performance categories in reference to each metric: 1 (<25th percentile), 2 (25th-75th percentile), and 3 (>75th percentile). The sum of performance scores created three surgeon quality tiers: 1 (4-6, low), 2 (7-9, intermediate), and 3 (10-12, high). We used chi-squared, Wilcoxon-Mann-Whitney, and Kruskal-Wallis tests to compare patient characteristics between the baseline and subsequent cohorts and across surgeon tiers. We applied Cox proportional hazards models to examine the association between patient survival and surgeon performance tier, sequentially adjusting for clinical stage, patient characteristics, and four specific processes. RESULTS From 2009 to 2021, 39 surgeons performed 4,082 resections across the baseline and subsequent cohorts. Among 31 subsequent cohort surgeons, five were tier 1, five were tier 2, and 21 were tier 3. Tier 1 and 2 surgeons had significantly worse outcomes than tier 3 surgeons (hazard ratio [HR], 1.37; 95% CI, 1.10 to 1.72 and 1.19; 95% CI, 1.00 to 1.43, respectively). Adjustment for specific processes mitigated the surgeon-tiered survival differences, with adjusted HRs of 1.02 (95% CI, 0.8 to 1.3) and 0.93 (95% CI, 0.7 to 1.25), respectively. CONCLUSION Readily accessible intermediate outcomes metrics can be used to stratify surgeon performance for targeted process improvement, potentially reducing patient survival disparities.
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Affiliation(s)
| | | | - Carrie Fehnel
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, TN
| | - Andrea Saulsberry
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, TN
| | - Kourtney Dortch
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, TN
| | | | | | | | - Thomas Ng
- Methodist University Hospital, Memphis, TN
| | - Todd Robbins
- Baptist Memorial Hospital—Memphis, Memphis TN
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | | | - Nicholas R. Faris
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, TN
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Raymond U. Osarogiagbon
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, TN
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
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16
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Marie MM, Jaber SN, Ahmed OF, Kakamad FH, Amin BJH, Tahir SH, Salih AM, Abdalla SH, Ali RK, Rashid RJ, Mohammed SH, Mustafa SM, Ali RA, Rahim HM. Resectability in bronchogenic carcinoma: A single‑center experience. Oncol Lett 2023; 25:219. [PMID: 37153056 PMCID: PMC10157354 DOI: 10.3892/ol.2023.13805] [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: 09/28/2022] [Accepted: 02/09/2023] [Indexed: 05/09/2023] Open
Abstract
Bronchogenic carcinoma comprises >90% of primary lung tumors. The present study aimed to estimate the profile of patients with bronchogenic carcinoma and assess the cancer resectability in newly diagnosed patients. This is a single-center retrospective review conducted over a period of 5 years. A total of 800 patients with bronchogenic carcinoma were included. The diagnoses were mostly proven with either cytological examination or histopathological diagnosis. Sputum analysis, cytological examination of pleural effusion and bronchoscopic examination were performed. Lymph node biopsy, minimally invasive procedures (mediastinoscopy and video-assisted thoracoscopic surgery), tru-cut biopsy or fine-needle aspiration was used to obtain the samples for diagnosis. The masses were removed by lobectomy and pneumonectomy. The age range was between 22 and 87 years, with a mean age of 62.95 years. Males represented the predominant sex. Most of the patients were smokers or ex-smokers. The most common symptom was a cough, followed by dyspnea. Chest radiography revealed abnormal findings in 699 patients. A bronchoscopic evaluation was performed for the majority of patients (n=633). Endobronchial masses and other suggestive malignancy findings were present in 473 patients (83.1%) of the 569 who underwent fiberoptic bronchoscopy. Cytological and/or histopathological samples of 581 patients (91.8%) were positive. Small cell lung cancer (SCLC) occurred in 38 patients (4.75%) and non-SCLC was detected in 762 patients (95.25%). Lobectomy was the main surgical procedure, followed by pneumonectomy. A total of 5 patients developed postoperative complications without any mortality. In conclusion, bronchogenic carcinoma is rapidly increasing without a predilection for sex in the Iraqi population. Advanced preoperative staging and investigation tools are required to determine the rate of resectability.
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Affiliation(s)
| | - Sabah N. Jaber
- Department of Surgery, Medical City, Baghdad 10011, Republic of Iraq
| | - Okba F. Ahmed
- Department of Surgery, Mousl Cardiac Center, Mousl 41001, Republic of Iraq
| | - Fahmi H. Kakamad
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- College of Medicine, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Correspondence to: Dr Fahmi H. Kakamad, College of Medicine, University of Sulaimani, Doctor City, Building 11, Apartment 50, Madam Mitterrand Street, Sulaimani 46000, Republic of Iraq, E-mail:
| | - Bnar J. Hama Amin
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
| | - Soran H. Tahir
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- College of Medicine, University of Sulaimani, Sulaimani 46000, Republic of Iraq
| | - Abdulwahid M. Salih
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- College of Medicine, University of Sulaimani, Sulaimani 46000, Republic of Iraq
| | - Shalaw H. Abdalla
- Department of Oncology, Hiwa Cancer Hospital, Sulaimani 46000, Republic of Iraq
| | - Razhan K. Ali
- Department of Cardiothoracic and Vascular Surgery, Shar Hospital, Sulaimani 46000, Republic of Iraq
| | - Rezheen J. Rashid
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Department of Oncology, Hiwa Cancer Hospital, Sulaimani 46000, Republic of Iraq
| | - Shvan H. Mohammed
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
| | - Shevan M. Mustafa
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Department of Medical Laboratory Technology, Al Qalam University College, Kirkuk 36001, Republic of Iraq
| | - Rebwar A. Ali
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
| | - Hawbash M. Rahim
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Department of Medical Laboratory Science, Komar University of Science and Technology, Sulaimani 46000, Republic of Iraq
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Lee BE, Altorki N. Sub-Lobar Resection: The New Standard of Care for Early-Stage Lung Cancer. Cancers (Basel) 2023; 15:2914. [PMID: 37296877 PMCID: PMC10251869 DOI: 10.3390/cancers15112914] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
The Lung Cancer Study Group previously established lobectomy as the standard of care for treatment of clinical T1N0 NSCLC. Advances in imaging technology and refinements in staging have prompted a re-investigation to determine the non-inferiority of sub-lobar resections to lobectomies. Two recent randomized studies, JCOG 0802 and CALGB 140503, are reviewed here in the context of LCSG 0821. The studies confirm non-inferiority for sub-lobar resection (wedge or segmentectomy) compared to lobectomy for peripheral T1N0 NSCLC less than or equal to 2 cm. Sub-lobar resection should therefore be considered the new standard of care in this sub-set of patients with NSCLC.
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Affiliation(s)
| | - Nasser Altorki
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Suite M404, Weill Cornell Medicine of Cornell University, 525 East 68th Street, New York, NY 10065, USA
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Bertolaccini L, Spaggiari L. Is It Time to Cross the Pillars of Evidence in Favor of Segmentectomies in Early-Stage Non-Small Cell Lung Cancer? Cancers (Basel) 2023; 15:cancers15071993. [PMID: 37046654 PMCID: PMC10093217 DOI: 10.3390/cancers15071993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
In the debate on lobectomy versus segmentectomy for the treatment of early-stage non-small cell lung cancer (NSCLC), currently, we have reached two pillars of knowledge, like Jachim and Boaz, which have encompassed the actual boundary of the literature published up until now [...]
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Altorki N, Wang X, Kozono D, Watt C, Landrenau R, Wigle D, Port J, Jones DR, Conti M, Ashrafi AS, Liberman M, Yasufuku K, Yang S, Mitchell JD, Pass H, Keenan R, Bauer T, Miller D, Kohman LJ, Stinchcombe TE, Vokes E. Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med 2023; 388:489-498. [PMID: 36780674 PMCID: PMC10036605 DOI: 10.1056/nejmoa2212083] [Citation(s) in RCA: 372] [Impact Index Per Article: 372.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The increased detection of small-sized peripheral non-small-cell lung cancer (NSCLC) has renewed interest in sublobar resection in lieu of lobectomy. METHODS We conducted a multicenter, noninferiority, phase 3 trial in which patients with NSCLC clinically staged as T1aN0 (tumor size, ≤2 cm) were randomly assigned to undergo sublobar resection or lobar resection after intraoperative confirmation of node-negative disease. The primary end point was disease-free survival, defined as the time between randomization and disease recurrence or death from any cause. Secondary end points were overall survival, locoregional and systemic recurrence, and pulmonary functions. RESULTS From June 2007 through March 2017, a total of 697 patients were assigned to undergo sublobar resection (340 patients) or lobar resection (357 patients). After a median follow-up of 7 years, sublobar resection was noninferior to lobar resection for disease-free survival (hazard ratio for disease recurrence or death, 1.01; 90% confidence interval [CI], 0.83 to 1.24). In addition, overall survival after sublobar resection was similar to that after lobar resection (hazard ratio for death, 0.95; 95% CI, 0.72 to 1.26). The 5-year disease-free survival was 63.6% (95% CI, 57.9 to 68.8) after sublobar resection and 64.1% (95% CI, 58.5 to 69.0) after lobar resection. The 5-year overall survival was 80.3% (95% CI, 75.5 to 84.3) after sublobar resection and 78.9% (95% CI, 74.1 to 82.9) after lobar resection. No substantial difference was seen between the two groups in the incidence of locoregional or distant recurrence. At 6 months postoperatively, a between-group difference of 2 percentage points was measured in the median percentage of predicted forced expiratory volume in 1 second, favoring the sublobar-resection group. CONCLUSIONS In patients with peripheral NSCLC with a tumor size of 2 cm or less and pathologically confirmed node-negative disease in the hilar and mediastinal lymph nodes, sublobar resection was not inferior to lobectomy with respect to disease-free survival. Overall survival was similar with the two procedures. (Funded by the National Cancer Institute and others; CALGB 140503 ClinicalTrials.gov number, NCT00499330.).
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Affiliation(s)
- Nasser Altorki
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Xiaofei Wang
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - David Kozono
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Colleen Watt
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Rodney Landrenau
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Dennis Wigle
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Jeffrey Port
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - David R Jones
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Massimo Conti
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Ahmad S Ashrafi
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Moishe Liberman
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Kazuhiro Yasufuku
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Stephen Yang
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - John D Mitchell
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Harvey Pass
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Robert Keenan
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Thomas Bauer
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Daniel Miller
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Leslie J Kohman
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Thomas E Stinchcombe
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Everett Vokes
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
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20
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Di Tommaso L, Di Tommaso E, Giordano R, Mileo E, Santini M, Pilato E, Iannelli G. Endovascular Surgery of Descending Thoracic Aorta Involved in T4 Lung Tumor. J Endovasc Ther 2023; 30:84-90. [PMID: 35114844 DOI: 10.1177/15266028221075551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Surgical treatment of primary lung T4 tumors is controversial especially when the cancer invades the mediastinal structures or the descending thoracic aorta. Conventional surgical treatment is associated with a high perioperative mortality and morbidity rate. Thoracic EndoVascular Aortic Repair has emerged as a valid off-label alternative to conventional surgery. We aimed to assess perioperative and midterm aortic-related outcome of patients who have undergone aortic stent-graft implantation, followed by en bloc surgical treatment of the involved aorta and lung cancer resection. MATERIALS AND METHODS From July 2017 to May 2020, we treated 5 patients diagnosed with a T4 lung cancer by the involvement of the descending thoracic aorta. When only the descending thoracic aorta is involved, a 2-stage procedure was considered, with aortic stent-graft implantation performed before tumor resection. One-stage strategy, with stent-graft implantation carried out before thoracotomy, was preferred for patients with the involvement of cardiac and/or other vascular mediastinal structures. RESULTS The mean age was 58.4 ± 6.2 years. All patients were affected by non-small cell lung cancer. All 5 patients required a single stent-graft to completely cover the involved segment of aorta. Four patients underwent a 2-stage procedure. One patient, with the involvement of the left inferior pulmonary vein, required a 1-stage en bloc resection of the left lower lobe, aortic wall adventitia, left inferior pulmonary vein, and reconstruction of the left atrial wall. Primary procedural success was achieved in all. At follow-up, no patient developed aortic-related complications. One patient died 2 years after surgery, due to local recurrence of the tumor. CONCLUSION T4 lung resection combined with aortic stent-graft implantation can be safely performed. Endovascular surgery, by avoiding the use of cardiopulmonary bypass, aortic cross-clamping, and graft replacement, can reduce significant morbidity and mortality rate. Postoperative and long-term outcome of these patients treated with endovascular surgery is mainly related to pulmonary disease, not to aortic treatment.
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Affiliation(s)
- Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Ettorino Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Raffaele Giordano
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Emilio Mileo
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Emanuele Pilato
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
| | - Gabriele Iannelli
- Department of Cardiac Surgery, School of Medicine, University "Federico II," Naples, Italy
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21
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Moreno C, Ureña A, Macia I, Rivas F, Déniz C, Muñoz A, Serratosa I, Poltorak V, Moya-Guerola M, Masuet-Aumatell C, Escobar I, Ramos R. The Influence of Preoperative Nutritional and Systemic Inflammatory Status on Perioperative Outcomes following Da Vinci Robot-Assisted Thoracic Lung Cancer Surgery. J Clin Med 2023; 12:jcm12020554. [PMID: 36675482 PMCID: PMC9863584 DOI: 10.3390/jcm12020554] [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: 12/03/2022] [Revised: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Background: Nutrition is an important factor in the outcome of any disease process. We evaluated the relationship of nutritional status and inflammatory status of non-small cell lung cancer (NSCLC) patients undergoing robotic-assisted thoracic surgery (RATS) with postoperative complications. Methods: This prospective cohort study included 107 NSCLC patients undergoing surgical treatment, between 2019 and 2021. Nutritional status and inflammatory status were assessed before pulmonary resection using anthropometric assessment, blood tests, and body mass index (BMI). Results: The BMI was 27.5 ± 4.4. Based on BMI, 29% (n = 31) were classified as normal weight, 43% (n = 46) as overweight, and 28% (n = 30) as obese. The mean neutrophil/lymphocyte ratio (NLR) was 2.16 ± 0.85, the platelet/lymphocyte ratio (PLR) was 121.59 ± 44.21, and the lymphocyte/monocyte ratio (LMR) was 3.52 ± 1.17. There was no increase in the number of intraoperative complications or bleeding (p = 0.696), postoperative complications (p = 0.569), mean hospital stay (p = 0.258) or duration of chest drain (p = 0.369). Higher inflammatory status, with an NLR > 1.84, was associated with more overall postoperative complications (p = 0.028), only in univariate analysis, but this significance was not maintained on multivariate analysis. Conclusions: BMI was not a predictor of increased postoperative risk in this cohort; therefore, weight should not deter surgeons from using RATS for pulmonary resection.
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Affiliation(s)
- Camilo Moreno
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Anna Ureña
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ivan Macia
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Francisco Rivas
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carlos Déniz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Anna Muñoz
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ines Serratosa
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Violeta Poltorak
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Miguel Moya-Guerola
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Cristina Masuet-Aumatell
- Department of Preventive Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Ricard Ramos
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- Unit of Human Anatomy, Department of Pathology and Experimental Therapeutics, Medical School, University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-933-357-011
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22
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Serce Unat D, Ulusan Bagci O, Unat OS, Kose S, Caner A. The Spectrum of Infections in Patients with Lung Cancer. Cancer Invest 2023; 41:25-42. [PMID: 36445108 DOI: 10.1080/07357907.2022.2153860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Although diagnostic and therapeutic advances in lung cancer (LC) have increased the survival of patients, infection and its complications are still among the most important causes of mortality. The disruption of tissue caused by tumor mass, management of cancer therapy and alteration in the humoral/cellular immune systems due to both cancer itself and therapy considerably increase susceptibility to infection in cancer patients. Particularly, opportunistic microorganisms should be considered, then applying rapid and sensitive diagnostic methods for them. Thus, cancer patients who are already exposed to difficult, long-term and expensive treatments can be prevented from dying from complications related to infections.
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Affiliation(s)
- Damla Serce Unat
- Department of Chest Disease, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ozlem Ulusan Bagci
- Department of Microbiology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey.,Department of Basic Oncology, Institute of Health Sciences, Ege University, Izmir, Turkey
| | - Omer Selim Unat
- Department of Chest Disease, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ayse Caner
- Department of Basic Oncology, Institute of Health Sciences, Ege University, Izmir, Turkey.,Translational Pulmonary Research Group (EGESAM), Ege University, Izmir, Turkey.,Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey.,Cancer Research Center, Ege University, Izmir, Turkey
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23
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Wang Q, Stone K, Kern JA, Slatore CG, Swanson S, Blackstock W, Khan RS, Smith CB, Veluswamy RR, Chidel M, Wisnivesky JP. Adverse Events Following Limited Resection versus Stereotactic Body Radiation Therapy for Early Stage Lung Cancer. Ann Am Thorac Soc 2022; 19:2053-2061. [PMID: 35816617 PMCID: PMC9743482 DOI: 10.1513/annalsats.202203-275oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/05/2022] [Indexed: 12/15/2022] Open
Abstract
Rationale: Approximately a quarter of patients with early stage lung cancer are not medically fit for lobectomy. Limited resection and stereotactic body radiation therapy (SBRT) have emerged as alternatives for these patients. Given the equipoise on the effectiveness of the two treatments, treatment-related adverse events (AEs) could have a significant impact on patients' decision-making and treatment outcomes. Objectives: To compare the AE profile between SBRT versus limited resection. Methods: Data were derived from a prospective cohort of patients with stage I-IIA non-small cell lung cancer who were deemed as high-risk for lobectomy recruited from five centers across the United States. Propensity scores and inverse probability weighting were used to compare the rates of 30- and 90-day AEs among patients treated with limited resection versus SBRT. Results: Overall, 65% of 252 patients underwent SBRT. After adjusting for propensity scores, there was no significant difference in developing at least one AE comparing SBRT to limited resection (odds ratio [OR]: 1.00; 95% confidence interval [CI]: 0.65-1.55 and OR: 1.27; 95% CI: 0.84-1.91 at 30 and 90 days, respectively). SBRT was associated with lower risk of infectious AEs than limited resection at 30 days (OR: 0.05; 95% CI: 0.01-0.39) and 90 days posttreatment (OR: 0.41; 95% CI: 0.17-0.98). Additionally, SBRT was associated with persistently elevated risk of fatigue (OR: 2.47; 95% CI: 1.34-4.54 at 30 days and OR: 2.69; 95% CI: 1.52-4.77 at 90 days, respectively), but significantly lower risks of respiratory AEs (OR: 0.36; 95% CI: 0.20-0.65 and OR: 0.51; 95% CI: 0.31-0.86 at 30 and 90 days, respectively). Conclusions: Though equivalent in developing at least one AE, we found that SBRT is associated with less toxicity than limited resection in terms of infectious and respiratory AEs but higher rates of fatigue that persisted up to 3 months posttreatment. This information, combined with data about oncologic effectiveness, can help patients' decision-making regarding these alternative therapies.
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Affiliation(s)
| | | | - Jeffrey A. Kern
- Division of Oncology, National Jewish Health, Denver, Colorado
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care and
- Section of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, Oregon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Scott Swanson
- Department of Thoracic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - William Blackstock
- Department of Radiology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina; and
| | | | | | | | - Mark Chidel
- Department of Radiation Oncology, Colorado Permanente Medical Group, Denver, Colorado
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, and
- Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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24
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Alban J, Kennedy K, Hulbert A, Lighter M, Pasquinelli M, Rubinstein I, Ghelani S, Clayburn A, Feldman LE. Surgery for early-stage lung cancer with video-assisted thoracoscopic surgery versus open thoracotomy: A narrative review. Semin Oncol 2022; 49:261-264. [PMID: 36088130 DOI: 10.1053/j.seminoncol.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
Abstract
Recommending video-assisted thoracic surgery (VATS) over open thoracotomy to patients with early-stage non-small-cell lung cancer (NSCLC) is controversial. Accordingly, we reviewed randomized comparative studies to determine the risks and benefits of VATS lobectomy. Electronic searches on PubMed with standard search terms revealed 97 comparative studies published between 1990 and 2022. Of those, only 5 were randomized controlled clinical trials (RCT) and 1 is still ongoing although initial data has been published as an abstract form. A total of 918 patients were evaluated in 5 RCT's. All studies included patients with known or suspected primary lung cancer randomized in a 1:1 ratio to VATS or thoracotomy. Between 2 studies, reports of 1-year, 3-year and 5-year overall survival were found to be similar across surgical modalities. Additionally, no differences were found in the rates of locoregional and distant recurrence. Three studies reported no statistical differences in the number of hilar and mediastinal lymph nodes sampled. Two studies found decreased length of stay following VATS (4 days v 5 days, P = 0.027 and P = 0.008), while 2 found no difference. Increased in-hospital complications were seen in 2 studies (P = 0.008 and P = 0.039). VATS was associated with decreased pain scores, better self-reported QOL at 52 weeks (P = 0.014). Few randomized clinical trials comparing VATS lobectomy to open thoracotomy and lobectomy in early stage NSCLC have been reported. These studies suggest that VATS lobectomy offers similar outcomes with decreased in-hospital complications, pain, length of stay, and improved physical functioning when compared to thoracotomy.
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Affiliation(s)
- Juan Alban
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Kathleen Kennedy
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Alicia Hulbert
- Department of Surgery, University of Illinois at Chicago, College of Medicine, Chicago, Illinois; Section of Hematology/Oncology, Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois
| | - Melani Lighter
- Department of Surgery, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Mary Pasquinelli
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Israel Rubinstein
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Section of Pulmonary, Critical Care, and Sleep Medicine, Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois
| | - Seema Ghelani
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Lawrence E Feldman
- Division of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Section of Hematology/Oncology, Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois.
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25
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Motono N, Ishikawa M, Iwai S, Yamagata A, Iijima Y, Uramoto H. Analysis of risk factors for postoperative complications in non-small cell lung cancer: comparison with the Japanese National Clinical Database risk calculator. BMC Surg 2022; 22:180. [PMID: 35568860 PMCID: PMC9107161 DOI: 10.1186/s12893-022-01628-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although the risk calculator of the National Clinical Database (RC-NCD) has been widely used to predict the occurrence of mortality and major morbidity in Japan, it has not been demonstrated whether a correlation between the calculated RC-NCD risk score and the actual occurrence of mortality and severe morbidity exists. Methods The clinical data of 585 patients who underwent pulmonary resection for non-small cell lung cancer were collected, and the risk factors for postoperative morbidity were analyzed to verify the validity of the RC-NCD. Results The coexistence of asthma (p = 0.02), nutrition lymphocyte ratio (p = 0.04), and pulmonary lobe (p < 0.01) were significant risk factors for postoperative morbidity in the present study, and the percent-predicted vital capacity (p < 0.01), pulmonary lobe (p = 0.03), and type of operative procedure (p = 0.01) were significant risk factors for severe postoperative morbidity. Furthermore, in patients received lobectomy, coexistence of asthma (p = 0.01) and pulmonary lobe (p < 0.01) were identified as significant risk factors for postoperative morbidity. Meanwhile, male sex (p = 0.01), high BMI (p < 0.01), low vital capacity (p = 0.04), and pulmonary lobe (p = 0.03) were identified as significant risk factors for severe postoperative morbidity. Conclusions Given that the pulmonary lobe was a significant risk factor for postoperative morbidity in patients received pulmonary resection and for severe postoperative morbidity in patients received lobectomy, the RC-NCD for postoperative morbidity needs to be modified according to high-risk lobes. Trial registration: The Institutional Review Board of Kanazawa Medical University approved the protocol of this retrospective study (approval number: I392), and written informed consent was obtained from all patients.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Aika Yamagata
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
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26
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Niedmers H, Defosse JM, Wappler F, Lopez A, Schieren M. [Current approaches to anesthetic management in thoracic surgery-An evaluation from the German Thoracic Registry]. Anaesthesist 2022; 71:608-617. [PMID: 35507027 DOI: 10.1007/s00101-022-01093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/18/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND While many hospitals in Germany perform thoracic surgery, anesthetic techniques and methods that are actually used are usually only known for individual departments. This study describes the general anesthetic management of three typical thoracic surgical procedures across multiple institutions. MATERIAL AND METHODS The German Thoracic Registry recorded 4614 patients in 5 institutions between 2016 and 2019. Hospitals with a minimum number of more than 50 thoracic procedures per year are eligible for inclusion in the registry. To analyze the anesthetic management, a matching process yielded three comparable patient groups (n = 1506) that differed solely in the surgical procedure. Three surgical procedures with varying degrees of invasiveness were selected: Group A = video-assisted thoracoscopic surgery (VATS) with wedge resection, group B = VATS with lobectomy, group C = open thoracotomy. Statistical analysis was performed descriptively using relative and absolute frequencies. Dichotomous variables were compared using the χ2-test. RESULTS The study enrolled patients with a median age of 65.6 years. The mean value of the American Society of Anesthesiologists (ASA) classification was 2.8. One lung ventilation was most commonly performed (group A = 98.2%, group B = 99.4%, group C = 98.0%) with double lumen tubes (DLT). Bronchial blockers (group A = 0.2%, group B = 0.4%, group C = 0%) were rarely used. Primary bronchoscopy was used to control double lumen tubes after insertion in the majority of cases (group A = 77.5%, group B = 73.1%, group C= 79.7%). Continuous positive airway pressure (CPAP, group A = 1.2%, group B = 1.4%, group C = 5.1%) and jet ventilation (group A = 1.6%, group B = 1.6%, group C = 1.4%) were rarely used intraoperatively. In group C, the administration of a vasopressor was also more frequently required (group A = 59.9%, group B = 77.8%, group C = 86%). A central venous catheter was established in 30.1% of all patients in group A, 39.8% in group B and 73.3% in group C. Patients in group A received an arterial catheter less frequently (71.7%) when compared to groups B (96.4%) and C (95.2%). Total intravenous anesthesia with propofol was used in most patients (group A = 67.7%, group B 61.6%, group C 75.7%). Propofol supplemented by volatile anesthetics was used less frequently (group A = 28.5%, group B = 35.5%, group C = 23.7%). With increasing invasiveness of the surgical procedure, placement of an epidural catheter was preferred (group A = 18.9%, group B = 29.5%, group C = 64.1%). Paravertebral catheters (group A = 7.6%, group B = 4.4%, group C = 4.8%) or a single infiltration of the paravertebral space were performed less frequently (group A = 7.8%, group B = 17.7%, group C = 11.6%). Postoperatively, some patients (3.4-25.7%) were transferred to the general ward. The largest proportion of patients transferred to a general ward underwent less invasive thoracic procedures (group A). When the extent of resection was greater (group B and group C) patients were mostly transferred to an intermediate care unit (IMC) or an intensive care unit (ICU). The insertion of invasive catheters was neither associated with the patients' ASA classification nor preoperative pathologic pulmonary function. CONCLUSION Our data indicate that less invasive thoracic operations are associated with a reduction of invasive anesthetic procedures. As the presented data are descriptive, further studies are required to determine the impact of invasive anesthetic procedures on patient-related outcomes. This evaluation of the anesthetic management in experienced thoracic anesthesiology departments represents the next step towards establishing national quality standards and promoting structural quality in thoracic anesthesia.
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Affiliation(s)
- H Niedmers
- Klinik für Anästhesiologie und operative Intensivmedizin, Krankenhaus Köln-Merheim, Kliniken der Stadt Köln gGmbH, Klinikum der Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland.
| | - J M Defosse
- Klinik für Anästhesiologie und operative Intensivmedizin, Krankenhaus Köln-Merheim, Kliniken der Stadt Köln gGmbH, Klinikum der Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - F Wappler
- Klinik für Anästhesiologie und operative Intensivmedizin, Krankenhaus Köln-Merheim, Kliniken der Stadt Köln gGmbH, Klinikum der Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - A Lopez
- Lungenklinik - Thoraxchirurgie, Krankenhaus Köln-Merheim, Kliniken der Stadt Köln gGmbH, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - M Schieren
- Klinik für Anästhesiologie und operative Intensivmedizin, Krankenhaus Köln-Merheim, Kliniken der Stadt Köln gGmbH, Klinikum der Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
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27
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Gómez-Hernández MT, Fuentes MG, Novoa NM, Rodríguez I, Varela G, Jiménez MF. "Obesity paradox" has not an impact on minimally invasive anatomical lung resection. Cir Esp 2022; 100:288-294. [PMID: 35598956 DOI: 10.1016/j.cireng.2022.05.010] [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: 09/16/2020] [Accepted: 01/18/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The paradoxical benefit of obesity, the 'obesity paradox', has been analyzed in lung surgical populations with contradictory results. Our goal was assessing the relationship of body mass index (BMI) to acute outcomes after minimally invasive major pulmonary resections. METHODS Retrospective review of consecutive patients who underwent pulmonary anatomical resection through a minimally invasive approach for the period 2014-2019. Patients were grouped as underweight, normal, overweight and obese type I, II and III. Adjusted odds ratios regarding postoperative complications (overall, respiratory, cardiovascular and surgical morbidity) were produced with their exact 95% confidence intervals. All tests were considered statistically significant at p<0.05. RESULTS Among 722 patients included in the study, 37.7% had a normal BMI and 61.8% were overweight or obese patients. When compared with that of normal BMI patients, adjusted pulmonary complications were significantly higher in obese type I patients (2.6% vs 10.6%, OR: 4.53 [95%CI: 1.86-12.11]) and obese type II-III (2.6% vs 10%, OR: 6.09 [95%CI: 1.38-26.89]). No significant differences were found regarding overall, cardiovascular or surgical complications among groups. CONCLUSIONS Obesity has not favourable effects on early outcomes in patients undergoing minimally invasive anatomical lung resections, since the risk of respiratory complications in patients with BMI≥30kg/m2 and BMI≥35kg/m2 is 4.5 and 6 times higher than that of patients with normal BMI.
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Affiliation(s)
| | - Marta G Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria M Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Israel Rodríguez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research (IBSAL), Spain
| | - Marcelo F Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research (IBSAL), Spain
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Allehebi A, Kattan KA, Rujaib MA, Dayel FA, Black E, Mahrous M, AlNassar M, Hussaini HA, Twairgi AA, Abdelhafeiz N, Omair AA, Shehri SA, Al-Shamsi HO, Jazieh AR. Management of Early-Stage Resected Non-Small Cell Lung Cancer: Consensus Statement of the Lung cancer Consortium. Cancer Treat Res Commun 2022; 31:100538. [PMID: 35220069 DOI: 10.1016/j.ctarc.2022.100538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Management of early-stage non-small cell lung cancer (ES-NSCLC) has evolved over the last few years especially in terms of work-up and the use of systemic therapy. This consensus statement was developed to present updated guidelines for the management of this disease. METHODS Multidisciplinary team (MDT) of lung cancer experts convened to discuss a set of pertinent questions with importance relevance to the management of ES-NSCLC. ES-NSCLC includes stages I, II and resected stage III. The experts included consultants in chest imaging, thoracic surgery, radiation oncology, and medical oncology. Questions were discussed in virtual meetings and then a written manuscript with supporting evidence was drafted, reviewed, and approved by the team members. RESULTS The Consensus Statement included 9 questions addressing work-up and management of ES-NSCLC. Background information and literature review were presented for each question followed by specific recommendations to address the questions by oncology providers. The Statement was endorsed by various oncology societies in the Gulf region. CONCLUSION The Consensus Statement serves as a guide for thoracic MDT members in the management of ES-NSCLC. Adaptation of these to the local setting is dictated usually by available resources and expertise, however, all efforts should be excreted to provide the optimal care to all patients whenever possible.
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Affiliation(s)
- Ahmed Allehebi
- Oncology Department King Faisal Specialist Hospital & Research Center - Jeddah, Saudi Arabia.
| | - Khaled Al Kattan
- Dean College of Medicine, Al Faisal University, King Faisal Specialist Hospital & Research Center - Riyadh, Saudi Arabia.
| | - Mashael Al Rujaib
- Radiology Department, King Faisal Specialist Hospital & Research Center - Riyadh, Saudi Arabia.
| | - Fouad Al Dayel
- Pathology Department, King Faisal Specialist Hospital & Research Center - Riyadh, Saudi Arabia.
| | - Edward Black
- Thoracic surgery, SSMC-Mayo Partnership, Khalifa University, UAE.
| | - Mervat Mahrous
- Oncology Department, Prince Sultan Military Medical City, Riyadh.
| | | | - Hamed Al Hussaini
- Oncology Department King Faisal Specialist Hospital & Research Center - Riyadh, Saudi Arabia.
| | | | - Nafisa Abdelhafeiz
- Oncology Department, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Ameen Al Omair
- Radiation oncology, King Faisal Specialist Hospital & Research Center - Riyadh, Saudi Arabia.
| | - Salem Al Shehri
- Radiation Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Humaid O Al-Shamsi
- Department of Oncology and Innovation and Research Center, Burjeel cancer institute Abu Dhabi, College of Oncology Society - Dubai, College of Medicine, University of Sharjah, UAE.
| | - Abdul Rahman Jazieh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia, Cincinnati Cancer Advisors, Cincinnati, OH, USA.
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Fiorelli A, Cascone R, Carlucci A, Natale G, Noro A, Bove M, Santini M. Bleeding during Learning Curve of Thoracoscopic Lobectomy: CUSUM Analysis Results. Thorac Cardiovasc Surg 2022; 71:317-326. [PMID: 35135026 DOI: 10.1055/s-0042-1742362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The management of intraoperative bleeding during thoracoscopic lobectomy is challenging, especially for non-experienced surgeons. We evaluated intraoperative bleeding in relation to learning curve of thoracoscopic lobectomy, the strategies to face it, the outcomes, and the target case number for gaining the technical proficiency. METHODS This was a retrospective single center study including consecutive patients undergoing thoracoscopic lobectomy for lung cancer. Based on cumulative sum analysis, patients were divided into early and late experience groups, and the differences on surgical outcomes, with particular focus on vascular injury, were statistically compared. RESULTS Eight-three patients were evaluated. Cumulative sum charts showed a decreasing of operative time, blood loss, and hospital stay after the 49th, the 43th, and the 39th case, respectively. Early (n = 49) compared with late experience group (n = 34) was associated with higher conversion rate (p = 0.08), longer operative time (p <0.0001), greater blood loss (p <0.0001), higher transfusion rate (p = 0.01), higher postoperative air leak rate (p = 0.02), longer chest tube stay (p <0.0001), and hospitalization (p <0.0001). Six patients (7%) had intraoperative bleeding during early phase of learning curve, successfully treated by thoracoscopy in four cases. Patients with vascular injury (n = 6) compared with control group (n = 77) presented a longer operative time (p = 0.003), greater blood loss (p = 0.0001), and higher transfusion rate (p = 0.001); no significant differences were found regarding postoperative morbidity (p = 0.57), length of chest tube stay (p = 0.07), and hospitalization (p = 0.07). CONCLUSION Technical proficiency was achieved after 50 procedures. All vascular injuries occurred in the early phase of learning curve; they were safely managed, without affecting surgical outcomes.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Cascone
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Annalisa Carlucci
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Noro
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mary Bove
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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Tahara M, Ishimaru T, Fujino Y, Fushimi K, Matsuda S, Mukae H, Yatera K. A new scoring system for predicting in‐hospital death after lung cancer surgery (the
SABCIP
score) using a Japanese nationwide administrative database. Thorac Cancer 2022; 13:870-875. [PMID: 35128811 PMCID: PMC8930457 DOI: 10.1111/1759-7714.14343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background We aimed to develop and validate a new risk scoring tool for predicting in‐hospital mortality after lung cancer surgery. Methods We retrospectively identified patients admitted for lung cancer surgery from a nationwide administrative database in Japan and randomly divided them into derivation and validation cohorts. In the derivation cohort, we performed logistic regression analysis to determine predictive variables and developed a risk scoring tool by proportionally weighting the regression coefficients and assigning points to each variable. In both cohorts, we evaluated the predictive performance of the score using the c‐index and showed the in‐hospital mortality at each risk score. Results In total, 64 175 patients (32 170 and 32 005 patients in the derivation and validation cohort, respectively) were enrolled, including 115 (0.4%) and 119 (0.4%) in‐hospital patient deaths in the derivation and validation cohorts, respectively. Following the multivariate regression analysis, we selected six variables to create the SABCIP score, a risk scoring tool named after the parameters on which it is based, namely male sex, age ≥ 75 years, body mass index <18.5, clinical stage ≥3, interstitial lung disease, and procedure type (sleeve resection, chest wall resection, or pneumonectomy). The c‐index of the score was 0.82 and 0.80 in the derivation and validation cohorts, respectively, which represents a better or equal discrimination performance compared with previous scoring tools. In‐hospital mortality increased as the score increased in both cohorts. Conclusion The SABCIP score is a simple and useful predictor of in‐hospital mortality in patients after lung cancer surgery.
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Affiliation(s)
- Masahiro Tahara
- Department of Respiratory Medicine University of Occupational and Environmental Health Kitakyushu Japan
| | - Tomohiro Ishimaru
- Department of Environmental Epidemiology Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health Kitakyushu Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health Kitakyushu Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School of Medicine Tokyo Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health University of Occupational and Environmental Health Kitakyushu Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine University of Occupational and Environmental Health Kitakyushu Japan
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Starke H, von Dossow V, Karsten J. Preoperative evaluation in thoracic surgery: limits of the patient's functional operability and consequence for perioperative anaesthesiologic management. Curr Opin Anaesthesiol 2022; 35:61-68. [PMID: 34860702 DOI: 10.1097/aco.0000000000001086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Preoperative evaluation of older and more morbid patients in thoracic surgery is getting more advanced. In this context, early risk stratification has a crucial role for adequate informed decision-making, and thus for generating favourable effects of clinical outcome. RECENT FINDINGS Recent findings confirm that many risk factors impair mortality and morbidity beyond classical medical findings like results of lung function tests and values of the revised cardiac risk index. Especially results from holistic views on patients' functional status like frailty assessments are linked with long-term survival after lung resection. SUMMARY A comprehensive risk stratification by anaesthesiologists generates valuable guidance for the best strategy of clinical treatment. This includes preoperative, peri-operative and postoperative interventions, provided by interdisciplinary healthcare providers, resulting in an Early Risk Stratification and Strategy ('ERSAS') pathway.
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Affiliation(s)
- Henning Starke
- Institute of Anaesthesiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum
| | - Vera von Dossow
- Institute of Anaesthesiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum
| | - Jan Karsten
- Institute of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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Dezube AR, Hirji S, Shah R, Axtell A, Rodriguez M, Swanson S, Jaklitsch MT, Mody GN. Pre-COVID19 National Mortality Trends in Open and Video-Assisted Lobectomy for Non-Small Cell Lung Cancer. J Surg Res 2022; 274:213-223. [DOI: 10.1016/j.jss.2021.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/04/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
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Facktor MA, Odell DD, Wood DE, Feinglass J, Winchester DP. Initial Assessment of the Effect of ProvenCare on Lung Cancer Surgical Quality. Ann Thorac Surg 2021; 114:898-904. [PMID: 34461073 DOI: 10.1016/j.athoracsur.2021.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND ProvenCare is a joint initiative of the American College of Surgeons Commission on Cancer, Geisinger, and Society of Thoracic Surgeons (STS) to standardize evidence-based practices in the delivery of surgical lung cancer care. We compare outcomes of ProvenCare patients to the STS Database. METHODS Best practice elements were agreed upon through expert consensus meetings. ProvenCare elements were utilized to direct care. Compliance was monitored while clinical outcomes were collected within the STS General Thoracic Surgery Database (GTSD). ProvenCare patient outcomes were compared to all other STS GTSD patients. Univariable and multivariable logistic regression models compared morbidity and mortality. RESULTS A total of 2,026 patients at 23 ProvenCare hospitals were compared to 71,565 controls at 311 hospitals from 2010-2016. ProvenCare patients were more likely to receive guideline recommended staging evaluations and more likely to have mediastinal staging performed during resection (63.4% vs. 49.4%; p<0.001). There was no difference in 30-day mortality (1.4% vs. 1.3% lobectomy, p=0.84; 3.4% vs 2.0% all other resections, p=0.054) or STS indicator complications (10.8% vs. 9.9% lobectomy, p=0.21; 9.2 vs 9.4% all other resections, p=0.92). When controlling for patient-level clinical and demographic risk factors, the likelihood of perioperative morbidity and mortality was not significantly different [OR 1.07 (0.77-1.47) lobectomy; OR 0.97 (0.62-1.50) all other resections]. CONCLUSIONS Variability in pre-operative evaluation of lung cancer patients represents an opportunity to improve quality of care. ProvenCare increased utilization of guideline recommended pre-operative processes, which may improve cancer outcomes and survival, without resulting in differences in short term surgical outcomes.
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Affiliation(s)
- Matthew A Facktor
- Department of Thoracic Surgery, Geisinger Heart Institute, Danville, PA.
| | - David D Odell
- Department of Thoracic Surgery, Northwestern University, Chicago, IL; Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, IL
| | - Douglas E Wood
- Department of Thoracic Surgery, University of Washington, Seattle, WA
| | - Joseph Feinglass
- Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, IL
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Motono N, Ishikawa M, Iwai S, Iijima Y, Usuda K, Uramoto H. Individualization of risk factors for postoperative complication after lung cancer surgery: a retrospective study. BMC Surg 2021; 21:311. [PMID: 34261455 PMCID: PMC8278712 DOI: 10.1186/s12893-021-01305-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The risk factors for postoperative complications after pulmonary resection in patients with non-small cell lung cancer (NSCLC) have not been elucidated. METHODS Clinical data of 956 patients with NSCLC were analyzed. Patient factors such as sex, age, comorbidities, smoking history, respiratory function, and the lobe involved in lung cancer and operative factors such as operative approach and operative procedures were collected and analyzed. RESULTS Male sex (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.09-2.75, p = 0.01), coexistence of asthma (OR 2.68, 95% CI 1.19-6.02, p = 0.01), low percentage of forced expiratory volume in 1 s (FEV1) (OR 1.41, 95% CI 1.02-1.95, p = 0.03), and lobectomy or greater resection (OR 2.47, 95% CI 1.66-3.68, p < 0.01) were identified as significant risk factors for postoperative complications. Male sex (OR 1.98; 95% CI 1.03-3.81, p = 0.03) and complete video-assisted thoracic surgery and robot-assisted thoracic surgery (OR 1.64; 95% CI 1.09-2.45; p = 0.01) were identified as significant risk factors for postoperative air leakage. Coexistence of asthma (OR 9.97; 95% CI 3.66-27.38; p < 0.01) was identified as a significant risk factor for postoperative atelectasis or pneumonia. Lobectomy or greater resection (OR 19.71; 95% CI 2.70-143.57; p < 0.01) was identified as a significant risk factor for postoperative arrhythmia. CONCLUSION Male sex, coexistence of asthma, low percentage of FEV1, and operative procedure were significant risk factors for postoperative complications. Furthermore, risk factors varied according to postoperative complications.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
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Aeschbacher P, Nguyen TL, Dorn P, Kocher GJ, Lutz JA. Surgical Site Infections Are Associated With Higher Blood Loss and Open Access in General Thoracic Practice. Front Surg 2021; 8:656249. [PMID: 34250005 PMCID: PMC8267000 DOI: 10.3389/fsurg.2021.656249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Surgical site infections (SSIs) are the most costly and second most frequent healthcare-associated infections in the Western world. They are responsible for higher postoperative mortality and morbidity rates and longer hospital stays. The aim of this study is to analyze which factors are associated with SSI in a modern general thoracic practice. Methods: Data were collected from our department's quality database. Consecutive patients operated between January 2014 and December 2018 were included in this retrospective study. Results: A total of 2430 procedures were included. SSIs were reported in 37 cases (1.5%). The majority of operations were video-assisted (64.6%). We observed a shift toward video-assisted thoracic surgery in the subgroup of anatomical resections during the study period (2014: 26.7%, 2018: 69.3%). The multivariate regression analysis showed that blood loss >100 ml (p = 0.029, HR 2.70) and open surgery (p = 0.032, HR 2.37) are independent risk factors for SSI. The latter was higher in open surgery than in video-assisted thoracic procedures (p < 0.001). In the subgroup of anatomical resection, we found the same correlation (p = 0.043). SSIs are also associated with significantly longer mean hospital stays (17.7 vs. 7.8 days, p < 0.001). Conclusion: As SSIs represent higher postoperative morbidity and costs, efforts should be made to maintain their rate as low as possible. In terms of prevention of SSIs, video-assisted thoracic surgery should be favored over open surgery whenever possible.
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Affiliation(s)
- Pauline Aeschbacher
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thanh-Long Nguyen
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Jan Kocher
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jon Andri Lutz
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Fukui M, Takamochi K, Suzuki K, Ando K, Matsunaga T, Hattori A, Oh S, Suzuki K. Outcomes of lung cancer surgery for patients with interstitial pneumonia and coronary disease. Surg Today 2021; 52:137-143. [PMID: 34136963 DOI: 10.1007/s00595-021-02319-0] [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: 01/14/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the surgical outcomes of lung cancer patients with idiopathic interstitial pneumonia (IIP) and/or coronary artery disease (CAD). METHODS The subjects of this retrospective study were 2830 patients who underwent surgical resection for lung cancer between 2009 and 2018. Seventy-one patients (2.6%) had both IIP and CAD (FC group). The remaining patients were divided into those with IIP only (group F), those with CAD only (group C), and those without IIP or CAD (group N). We compared mortality and overall survival (OS) among the groups. RESULTS The 90-day mortality and OS were poorer in group FC than in groups C and N, but equivalent to those in group F. Multivariate analyses revealed that IIP (odds ratio [OR] 3.163; p = 0.001) and emphysema (2.588; p = 0.009) were predictors of 90-day mortality. IIP (OR 2.991, p < 0.001), diabetes (OR 1.241, p = 0.043), and a history of other cancers (OR 1.347, p = 0.011) were all predictors of OS. CONCLUSIONS Short-term and long-term mortality after lung cancer surgery were not dependent on coexistent CAD but were related to IIP. Thus, computed tomography (CT) should be done preoperatively to check for IIP, which is a risk factor for surgical mortality.
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Affiliation(s)
- Mariko Fukui
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Kazuya Takamochi
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kazuhiro Suzuki
- Departments of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsutoshi Ando
- Departments of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Aritoshi Hattori
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Shiaki Oh
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kenji Suzuki
- Departments of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
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Moreault O, Couture EJ, Provencher S, Somma J, Lohser J, Ugalde PA, Lemieux J, Lellouche F, Bussières JS. Double-lumen endotracheal tubes and bronchial blockers exhibit similar lung collapse physiology during lung isolation. Can J Anaesth 2021; 68:791-800. [PMID: 33594596 DOI: 10.1007/s12630-021-01938-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Double-lumen endotracheal tubes (DL-ETT) and bronchial blockers (BB) are frequently used to allow one-lung ventilation (OLV) during video-assisted thoracic surgery (VATS). Recently, faster lung collapse has been documented with a BB than with a DL-ETT. The physiologic mechanisms behind this faster collapse remained unknown. We aimed to measure ambient air absorption (Vresorb) and intra-bronchial pressure (Pairway) into the non-ventilated lung during OLV using DL-ETT and BB. METHODS Patients undergoing VATS and OLV for lung resection were randomly assigned to have measurements made of Vresorb or Pairway within the non-ventilated lung using either a DL-ETT or BB. RESULTS Thirty-nine patients were included in the analyses. The mean (standard error of the mean [SEM]) Vresorb was similar in the DL-ETT and BB groups [504 (85) vs 630 (86) mL, respectively; mean difference, 126; 95% confidence interval [CI], -128 to 380; P = 0.31]. The mean (SEM) Pairway became progressively negative in the non-ventilated lung in both the DL-ETT and the BB groups reaching [-20 (5) and -31 (10) cmH2O, respectively; mean difference, -11; 95% CI, -34 to 12; P = 0.44] at the time of the pleural opening. CONCLUSIONS During OLV before pleural opening, entrainment of ambient air into the non-ventilated lung occurs when the lumen of the lung isolation device is kept open. This phenomenon is prevented by occluding the lumen of the isolation device before pleural opening, resulting in a progressive build-up of negative pressure in the non-ventilated lung. Future clinical studies are needed to confirm these physiologic results and their impact on lung collapse and operative outcomes. TRIAL REGISTRATION www.clinicaltrials.gov (NCT02919267); registered 28 September 2016.
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Affiliation(s)
- Olivier Moreault
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Etienne J Couture
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Steeve Provencher
- Department of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
| | - Jacques Somma
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - Jens Lohser
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Paula A Ugalde
- Department of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
| | - Jérôme Lemieux
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
| | - François Lellouche
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
| | - Jean S Bussières
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC, Canada.
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, 2725, Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada.
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Abstract
The increasing use of low-dose CT for screening for lung cancer will inevitably identify many small, asymptomatic lung nodules and ground-glass opacities (GGOs). Current guidelines for the management of screening-detected lesions tend to advise a conservative approach based on serial imaging and intervention only if ‘suspicious’ features emerge. However, more recent developments in thoracic surgery and in the understanding of the screening-detected lesions themselves prompt some pertinent questions over this conservatism. Is CT surveillance sufficiently reliable to exclude malignancy? Is it really necessary to hold back on operative biopsy and resection given modern surgical safety and efficacy? Is the option for early surgical therapy a viable one—especially with the availability of sublobar resection today? Modern data suggests that the risk of inaction for some screening-detected lesions may be higher than expected, whereas the potential harm of surgical intervention may be substantially reduced by sublobar resection and the latest minimally invasive surgical techniques. A more pro-active approach towards offering surgery for screening-detected lesions should now be considered.
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Affiliation(s)
- Alan D L Sihoe
- Gleneagles Hong Kong Hospital, Hong Kong, China.,International Medical Centre, Hong Kong, China
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Zhang J, Zhang Z, Liu D, Shao W, Feng H. A randomized trial of who is better at treating the incomplete pulmonary fissure between stapler and thulium laser. Minerva Surg 2021; 76:436-443. [PMID: 33829717 DOI: 10.23736/s2724-5691.21.08386-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The role of thulium laser in the treatment of interlobar fissures in lobectomy is not clear. We aim to evaluate the safety, effectiveness and economy of thulium laser in the treatment of incomplete interlobar fissure during lobectomy. METHODS A total of 76 patients were randomly divided into two groups: laser group and stapler group. The laser group was treated with thulium laser and the stapler group was treated with stapler. RESULTS Compared with stapler group, the laser group had a longer operation time, more postoperative drainage and lower operation cost while there was no significant difference in hospitalization time, postoperative air leakage time and chest tube duration. CONCLUSIONS Thulium laser is safe and effective in the treatment of incomplete interlobar fissure during lobectomy and can reduce the cost.
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Affiliation(s)
- Jun Zhang
- Department of General Thoracic Surgery, Peking University China-Japan Friendship, School of Clinical Medicine and China-Japan Friendship Hospital, Yinghua, Beijing, China
| | - Zhenrong Zhang
- Department of General Thoracic Surgery, Peking University China-Japan Friendship, School of Clinical Medicine and China-Japan Friendship Hospital, Yinghua, Beijing, China
| | - Deruo Liu
- Department of General Thoracic Surgery, Peking University China-Japan Friendship, School of Clinical Medicine and China-Japan Friendship Hospital, Yinghua, Beijing, China -
| | - Weipeng Shao
- Department of General Thoracic Surgery, Peking University China-Japan Friendship, School of Clinical Medicine and China-Japan Friendship Hospital, Yinghua, Beijing, China
| | - Hongxiang Feng
- Department of General Thoracic Surgery, Peking University China-Japan Friendship, School of Clinical Medicine and China-Japan Friendship Hospital, Yinghua, Beijing, China
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Verhoeven DC, Chollette V, Lazzara EH, Shuffler ML, Osarogiagbon RU, Weaver SJ. The Anatomy and Physiology of Teaming in Cancer Care Delivery: A Conceptual Framework. J Natl Cancer Inst 2021; 113:360-370. [PMID: 33107915 PMCID: PMC8599835 DOI: 10.1093/jnci/djaa166] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/22/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022] Open
Abstract
Care coordination challenges for patients with cancer continue to grow as expanding treatment options, multimodality treatment regimens, and an aging population with comorbid conditions intensify demands for multidisciplinary cancer care. Effective teamwork is a critical yet understudied cornerstone of coordinated cancer care delivery. For example, comprehensive lung cancer care involves a clinical "team of teams"-or clinical multiteam system (MTS)-coordinating decisions and care across specialties, providers, and settings. The teamwork processes within and between these teams lay the foundation for coordinated care. Although the need to work as a team and coordinate across disciplinary, organizational, and geographic boundaries increases, evidence identifying and improving the teamwork processes underlying care coordination and delivery among the multiple teams involved remains sparse. This commentary synthesizes MTS structure characteristics and teamwork processes into a conceptual framework called the cancer MTS framework to advance future cancer care delivery research addressing evidence gaps in care coordination. Included constructs were identified from published frameworks, discussions at the 2016 National Cancer Institute-American Society of Clinical Oncology Teams in Cancer Care Workshop, and expert input. A case example in lung cancer provided practical grounding for framework refinement. The cancer MTS framework identifies team structure variables and teamwork processes affecting cancer care delivery, related outcomes, and contextual variables hypothesized to influence coordination within and between the multiple clinical teams involved. We discuss how the framework might be used to identify care delivery research gaps, develop hypothesis-driven research examining clinical team functioning, and support conceptual coherence across studies examining teamwork and care coordination and their impact on cancer outcomes.
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Affiliation(s)
- Dana C Verhoeven
- Affiliations of authors: Division of Cancer Control and Population Sciences, Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD, USA
| | - Veronica Chollette
- Affiliations of authors: Division of Cancer Control and Population Sciences, Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD, USA
| | - Elizabeth H Lazzara
- Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, Daytona Beach, FL, USA
| | - Marissa L Shuffler
- Department of Psychology, College of Behavioral, Social, & Health Sciences, Clemson University, Clemson, SC, USA
| | | | - Sallie J Weaver
- Affiliations of authors: Division of Cancer Control and Population Sciences, Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Rockville, MD, USA
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Sato S, Nagatani Y, Hashimoto M, Nitta N, Hanaoka J, Ushio N, Tsukagoshi S, Uranishi A, Kimoto T, Oshio Y, Mayumi M, Sonoda A, Otani H, Yamashiro T, Moriya H, Murata K, Watanabe Y. Usability of the lateral decubitus position on four-dimensional ultra-low-dose computed tomography for the detection of localized pleural adhesion in the pulmonary apical region. Acta Radiol 2021; 62:462-473. [PMID: 32611196 DOI: 10.1177/0284185120930611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Localized pleural adhesion (LPA) evaluation in the apical region is difficult even with four-dimensional ultra-low-dose computed tomography (4D-ULDCT) in the supine position due to smaller pleural movements. PURPOSE To assess usability of 4D-ULDCT in the lateral decubitus (LD) position for LPA detection in the apical region. MATERIAL AND METHODS Forty-seven patients underwent 4D-ULDCT of a single respiration cycle with 16-cm coverage of body axis in supine and LD positions with the affected lung uppermost. Intraoperative thoracoscopic findings confirmed LPA presence. A pleural point and a corresponding point on costal outer edge were placed in identical axial planes at end-inspiration. Pleuro-chest wall distance between two points (PCD) was calculated at each respiratory phase. In the affected lung, average change in amount of PCD (PCDACA) was compared between patients with and without LPA in total and two sub-groups (non-COPD and COPD, non-emphysematous and emphysematous patients) in supine and non-dependent (ND) LD positions. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal thresholds in PCDACA for differentiating patients with LPA from those without. RESULTS In COPD/emphysematous patients and total population, PCDACA with LPA was smaller than in those without in the supine and NDLD positions for overall, lateral, and dorsal regions. For the lateral region in COPD patients, area under ROC curve (AUC) increased from supine (0.64) to NDLD position (0.81). For the dorsal region in emphysematous patients, AUC increased from supine (0.76) to NDLD position (0.96). CONCLUSION 4D-ULDCT in LD position may be useful for LPA detection in apical regions for COPD and/or emphysematous patients.
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Affiliation(s)
- Shigetaka Sato
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masayuki Hashimoto
- Department of Respiratory Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Jun Hanaoka
- Department of Respiratory Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Noritoshi Ushio
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | | | - Ayumi Uranishi
- CT System Division, Canon Medical Systems, Otawara, Tochigi, Japan
| | - Tatsuya Kimoto
- Center for Medical Research and Development, Canon Medical Systems, Otawara, Tochigi, Japan
| | - Yasuhiko Oshio
- Department of Respiratory Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masayuki Mayumi
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hideji Otani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima, Fukushima, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Wang C, Lai Y, Li P, Su J, Che G. Influence of enhanced recovery after surgery (ERAS) on patients receiving lung resection: a retrospective study of 1749 cases. BMC Surg 2021; 21:115. [PMID: 33676488 PMCID: PMC7936477 DOI: 10.1186/s12893-020-00960-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/12/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The study aimed to evaluate the outcomes following the implementation of enhanced recovery after surgery (ERAS) for patients undergoing lung cancer surgery. METHOD A retrospective cohort study involving 1749 patients with lung cancer undergoing pulmonary resection was conducted. The patients were divided into two time period groups for analysis (routine pathway and ERAS pathway). Logistic regression analysis was performed to assess the risks of developing postoperative pulmonary complications. RESULTS Among the 1749 patients, 691 were stratified into the ERAS group, and 1058 in to the routine group. The ERAS group presented with shorter postoperative in-hospital length of stay (LOS) (4.0 vs 6.0, P < 0.001), total LOS (10.0 vs. 13.0 days, P < 0.001), and lower total in-hospital costs (P < 0.001), including material (P < 0.001) and drug expenses (P < 0.001). Furthermore, the ERAS group also presented with a lower occurrence of postoperative pulmonary complications (PPCs) than the routine group (15.2% vs. 19.5%, P = 0.022). Likewise, a significantly lower occurrence of pneumonia (8.4% vs. 14.2%, P < 0.001) and atelectasis (5.9% vs. 9.8%, P = 0.004) was found in the ERAS group. Regarding the binary logistic regression, the ERAS intervention was the sole independent factor for the occurrence of PPCs (OR: 0.601, 95% CI 0.434-0.824, P = 0.002). In addition, age (OR: 1.032, 95% CI 1.018-1.046), COPD (OR: 1.792, 95% CI 1.196-2.686), and FEV1 (OR: 0.205, 95% CI 0.125-0.339) were also independent predictors of PPCs. CONCLUSION Implementation of an ERAS pathway shows improved postoperative outcomes, including shortened LOS, lower in-hospital costs, and reduced occurrence of PPCs, providing benefits to the postoperative recovery of patients with lung cancer undergoing surgical treatment.
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Affiliation(s)
- Chunmei Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yutian Lai
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jianhuan Su
- Rehabilitation Department, 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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Khoury AL, Kolarczyk LM, Strassle PD, Feltner C, Hance LM, Teeter EG, Haithcock BE, Long JM. Thoracic Enhanced Recovery After Surgery: Single Academic Center Observations After Implementation. Ann Thorac Surg 2021; 111:1036-1043. [DOI: 10.1016/j.athoracsur.2020.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/23/2020] [Accepted: 06/03/2020] [Indexed: 01/01/2023]
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Gómez-Hernández MT, Fuentes MG, Novoa NM, Rodríguez I, Varela G, Jiménez MF. "Obesity paradox" has not an impact on minimally invasive anatomical lung resection. Cir Esp 2021; 100:S0009-739X(21)00040-3. [PMID: 33637296 DOI: 10.1016/j.ciresp.2021.01.018] [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: 09/16/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The paradoxical benefit of obesity, the 'obesity paradox', has been analyzed in lung surgical populations with contradictory results. Our goal was assessing the relationship of body mass index (BMI) to acute outcomes after minimally invasive major pulmonary resections. METHODS Retrospective review of consecutive patients who underwent pulmonary anatomical resection through a minimally invasive approach for the period 2014-2019. Patients were grouped as underweight, normal, overweight and obese type I, II and III. Adjusted odds ratios regarding postoperative complications (overall, respiratory, cardiovascular and surgical morbidity) were produced with their exact 95% confidence intervals. All tests were considered statistically significant at p<0.05. RESULTS Among 722 patients included in the study, 37.7% had a normal BMI and 61.8% were overweight or obese patients. When compared with that of normal BMI patients, adjusted pulmonary complications were significantly higher in obese type I patients (2.6% vs 10.6%, OR: 4.53 [95%CI: 1.86-12.11]) and obese type II-III (2.6% vs 10%, OR: 6.09 [95%CI: 1.38-26.89]). No significant differences were found regarding overall, cardiovascular or surgical complications among groups. CONCLUSIONS Obesity has not favourable effects on early outcomes in patients undergoing minimally invasive anatomical lung resections, since the risk of respiratory complications in patients with BMI≥30kg/m2 and BMI≥35kg/m2 is 4.5 and 6 times higher than that of patients with normal BMI.
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Affiliation(s)
| | - Marta G Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria M Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Israel Rodríguez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research (IBSAL), Spain
| | - Marcelo F Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research (IBSAL), Spain
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Fiorelli A, Forte S, Caronia FP, Ferrigno F, Santini M, Petersen RH, Fang W. Is video-assisted thoracoscopic lobectomy associated with higher overall costs compared with open surgery? Results of best evidence topic analysis. Thorac Cancer 2021; 12:567-579. [PMID: 33544445 PMCID: PMC7919127 DOI: 10.1111/1759-7714.13708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022] Open
Abstract
Thoracoscopic lobectomy has become the preferred approach for surgical management of early stage lung cancer, but the potential higher operative costs limit its widespread use. Theoretically, higher direct costs may be significantly counterbalanced by lower indirect costs, resulting in lower overall costs for thoracoscopic than for open lobectomy. To support this hypothesis, we reviewed the literature until May 2020, analyzing all papers comparing the cost of thoracoscopic versus open lobectomy.A total of 20 studies provided the most applicable evidence to evaluate this issue. In all the studies apart from one, thoracoscopic lobectomy was associated with higher operative costs due to the increased use of disposable instruments, and prolonged operative time. By contrast, in 17 studies the increased operative costs were significantly offset by indirect costs which were lower in thoracoscopic than in open lobectomy due to fewer postoperative complications, faster recovery, and lower readmission rates. It translated into lower overall costs for thoracoscopic than for open lobectomy in 10 studies, similar costs in seven, and higher in three, despite the lower hospitalization costs. The low bed fees and high prices of disposable instruments in these three studies may explain the discordance. The careful use of disposable instruments, and the minimizing hospitalization costs can reduce the total costs of thoracoscopic lobectomy to levels similar or to below those of open lobectomy. The worry that video‐assisted thoracoscopic surgery lobectomy (VATSL) might be associated with an increased overal cost is thus not warranted, and should not be used as an excuse against the use of VATS in surgery for early stage lung cancers.
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Affiliation(s)
- Alfonso Fiorelli
- Department of Translation Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Forte
- Istituto Oncologico del Mediterraneo (IOM), Catania, Italy
| | | | | | - Mario Santini
- Department of Translation Medicine, Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University Medical School, Shanghai, China
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Dezube AR, Mazzola E, Bravo-Iñiguez CE, De León LE, Rochefort MM, Bueno R, Wiener DC, Jaklitsch MT. Analysis of Lymph Node Sampling Minimums in Early Stage Non-Small-Cell Lung Cancer. Semin Thorac Cardiovasc Surg 2021; 33:834-845. [DOI: 10.1053/j.semtcvs.2020.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022]
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47
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Abstract
Anatomic staging is a critical step in evaluation of patients with lung cancer. Accurate identification of stage based on features of primary tumor (T), regional nodes (N), and metastatic disease (M) is fundamental to determining appropriate care. In this article, the TNM components of the anatomic staging system and a framework for description of lung cancer with multiple pulmonary sites of involvement are discussed. TNM combinations are grouped according to prognosis, with patient-level, tumor-level, and environment-level factors also influencing survival outcomes. Although the staging system does not include molecular and immunologic information, anatomic staging remains the common language for communicating extent of disease.
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Affiliation(s)
- Lynn T Tanoue
- Yale School of Medicine, 333 Cedar Street, PO Box 208057, New Haven, CT 06520, USA.
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48
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Zhou K, Lai Y, Wang Y, Sun X, Mo C, Wang J, Wu Y, Li J, Chang S, Che G. Comprehensive Pulmonary Rehabilitation is an Effective Way for Better Postoperative Outcomes in Surgical Lung Cancer Patients with Risk Factors: A Propensity Score-Matched Retrospective Cohort Study. Cancer Manag Res 2020; 12:8903-8912. [PMID: 33061586 PMCID: PMC7520117 DOI: 10.2147/cmar.s267322] [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] [Received: 06/12/2020] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
Background To investigate the effectiveness and cost minimization of comprehensive pulmonary rehabilitation (CPR) in lung cancer patients who underwent surgery. Patients and Methods A retrospective observational study based on medical records was conducted, with 2410 lung cancer patients who underwent an operation with/without CPR during the peri-operative period. Variables including clinical characteristics, length of stay (LOS), postoperative pulmonary complications (PPCs), and hospitalization expenses were compared between the intervention group (IG) and control group (CG). The CPR regimen consists of inspiratory muscle training (IMT), aerobic endurance training, and pharmacotherapy. Results Propensity score matching analysis was performed between two groups, and the ratio of matched patients was 1:4. Finally, 205 cases of IG and 820 cases of CG in the matched cohort of our study were identified. The length of postoperative hospital stay [median: 5 interquartile (4–7) vs 7 (4–8) days, P < 0.001] and drug expenses [7146 (5411–8987) vs 8253 (6048–11,483) ¥, P < 0.001] in the IG were lower compared with the CG. Additionally, the overall incidence of PPCs in the IG was reduced compared with the CG (26.8% vs 36.7%, P = 0.008), including pneumonia (10.7% vs 16.8%, P = 0.035) and atelectasis (8.8% vs 14.0%, P = 0.046). Multivariable analysis showed that CPR intervention (OR = 0.655, 95% CI: 0.430–0.865, P = 0.006), age ≥70 yr (OR = 1.919, 95% CI: 1.342–2.744, P < 0.001), smoking (OR = 2.048, 95% CI: 1.552–2.704, P < 0.001) and COPD (OR = 1.158, 95% CI: 1.160–2.152, P = 0.004) were related to PPCs. Conclusion The retrospective cohort study revealed a lower PPC rate and the shorter postoperative length of stay in the patients receiving CPR, demonstrating the clinical value of CRP as an effective strategy for surgical lung cancer patients with risk factors.
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Affiliation(s)
- Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China.,Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Chunmei Mo
- Medical Record Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Jiao Wang
- Rehabilitation Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yanming Wu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Shuai Chang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
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Walter J, Tufman A, Holle R, Schwarzkopf L. Differences in therapy and survival between lung cancer patients treated in hospitals with high and low patient case volume. Health Policy 2020; 124:1217-1225. [PMID: 32928583 DOI: 10.1016/j.healthpol.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 05/26/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND In light of political discussions about minimum case volumes and certified lung cancer centers, this observational study investigates differences in therapy and survival between high vs. low patient volume hospitals (HPVH vs. LPVH). METHODS We identified 12,374 lung cancer patients treated in HPVH (>67 patients) and LPVH in 2013 from German health insurance claims. Stratified by metastasis status (no metastases, nodal metastases, systemic metastases), we compared HPVHs and LPVHs regarding likelihood of resection and systemic therapy, type of systemic therapy, and surgical outcomes, using multivariate logistic models. Three-year survival was modeled using Cox regression. We adjusted all regression models for age, gender, comorbidity, and residence area, and included a cluster variable for the hospital. RESULTS Around 24 % of patients were treated in HPVHs. Irrespective of stratum and subgroup, three-year survival was significantly better in HPVHs. In patients with systemic metastases (OR = 1.84, CI=[1.22,2.76]) and without metastases (OR = 3.28, CI=[2.13, 5.04]), resection was more likely in HPVHs. Among patients with systemic therapy, the odds of receiving pemetrexed was higher in HPVHs, in patients with nodal metastases (OR = 1.57, CI=[1.01,2.45]). In resected patients without metastases the odds ratio of receiving a thoracoscopic lobectomy was 2.28 (CI=[1.04,4.99]) in HPVHs. CONCLUSION Our data suggests that case volume is clinically relevant in resected and non-resected lung cancer patients, but optimal minimum case volumes may differ for subgroups.
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Affiliation(s)
- Julia Walter
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management (IGM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Ludwig-Maximilians-University Hospital (LMU) Munich, Medical Clinic V - Pneumology, Ziemssenstr. 1, 80336 München, Germany; Ludwig-Maximilians-University Hospital (LMU) Munich, Department of Thoracic Surgery, Marchioninistraße 15, 81377 München, Germany; German Center for Lung Research (DZL), Aulweg 130, 35392 Gießen, Germany.
| | - Amanda Tufman
- Ludwig-Maximilians-University Hospital (LMU) Munich, Medical Clinic V - Pneumology, Ziemssenstr. 1, 80336 München, Germany; German Center for Lung Research (DZL), Aulweg 130, 35392 Gießen, Germany.
| | - Rolf Holle
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management (IGM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
| | - Larissa Schwarzkopf
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management (IGM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; German Center for Lung Research (DZL), Aulweg 130, 35392 Gießen, Germany; IFT Institut für Therapieforschung, Leopoldstraße 175, 80804 Munich, Germany.
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Influence of postoperative complications on long-term outcome after oncologic lung resection surgery. Substudy of a randomized control trial. J Clin Monit Comput 2020; 35:1183-1192. [PMID: 32797324 DOI: 10.1007/s10877-020-00580-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Lung resection surgery (LRS) causes an intense local and systemic inflammatory response. There is a relationship between inflammation and postoperative complications (POCs). Also, it has been proposed that the inflammation and complications related with the surgery may promote the recurrence of cancer and therefore deterioration of survival. We investigated the association between inflammatory biomarkers, severity of POCs and long-term outcome in patients who were discharged after LRS. This is a prospective substudy of a randomized control trial. We established three groups based in the presence of POCs evaluated by Clavien-Dindo (C-D) classification: Patients with no postoperative complications (No-POCs group) (C-D = 0), patients who developed light POCs (L-POCs group) (C-D = I-II), and major POCs (M-POCs group) (C-D = III, IV, or V). Kaplan-Meier curves and Cox regression model were created to compare survival and oncologic recurrence in those groups. Patients who developed POCs (light or major) had an increase in some inflammatory biomarkers (TNF-α, IL-6, IL-7, IL-8) compared with No-POCs group. This pro-inflammatory status plays a fundamental role in the appearance of POCs and therefore in a shorter life expectancy. Individuals in the M-POCs group had a higher risk of death (HR = 3.59, 95% CI 1.69 to 7.63) compared to individuals in the No-POCs group (p = 0.001). Patients of L-POCs group showed better survival than M-POCs group (HR = 2.16, 95% CI 1.00 to 4.65, p = 0.049). Besides, M-POCs patients had higher risk of recurrence in the first 2 years, when compared with L-POCs (p = 0,008) or with No-POCs (p = 0.002). In patients who are discharged after undergoing oncologic LRS, there is an association between POCs occurrence and long term outcome. Oncologist should pay special attention in patients who develop POCs after LRS.
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