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Allen A, Francisco MA, Jatis J, Turner Y, Nordgren R, Rubin D, Huisingh-Scheetz M, Bryan DS, Donington J, Ferguson MK, Gleason LJ, Madariaga ML. Implementing a Frailty-Specific Postoperative Order Set to Improve Postoperative Outcomes in Frail Adults After Elective Thoracic Surgery. J Nurs Care Qual 2024:00001786-990000000-00146. [PMID: 38936412 DOI: 10.1097/ncq.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Frailty is independently associated with adverse patient outcomes after surgery. The current standards of postoperative care rarely consider frailty status. LOCAL PROBLEM There was no standardized protocol to optimize specialized postoperative care for frail patients at an academic medical center. METHODS A quasi-experimental pre-/postimplementation study design, using the Reach, Effectiveness, Adoption, Implementation, Maintenance implementation framework, was utilized. INTERVENTIONS A frailty-specific postoperative order set (FPOS) was developed, including tailored nursing care, activity levels, and nutritional goals. RESULTS There were significant improvements in nurse's self-reported familiarity with frailty (P = .003) and FPOS awareness (P < .001). The number of orders for delirium prevention, elimination, nutrition, sleep promotion, and sensory support increased (P < .001). CONCLUSIONS Implementing an FPOS showed improvements in nurse frailty knowledge, awareness, and order set utilization.
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Affiliation(s)
- Amani Allen
- Author Affiliations: The University of Chicago Pritzker School of Medicine (Dr Allen), Department of Public Health Sciences (Dr Nordgren), Department of Anesthesia and Critical Care (Dr Rubin), Section of Geriatrics and Palliative Medicine, Department of Medicine (Drs Huisingh-Scheetz and Gleason), Section of Thoracic Surgery, Department of Surgery (Drs Bryan, Donington, Ferguson, and Madariaga), University of Chicago, Chicago, Illinois; and Department of Nursing Research and Evidence Based Practice (Mss Francisco, Jatis, and Turner), University of Chicago Medical Center, Chicago, Illinois
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Aigner C, Batirel H, Huber RM, Jones DR, Sihoe ADL, Štupnik T, Brunelli A. Resectable non-stage IV nonsmall cell lung cancer: the surgical perspective. Eur Respir Rev 2024; 33:230195. [PMID: 38508666 PMCID: PMC10951859 DOI: 10.1183/16000617.0195-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 03/22/2024] Open
Abstract
Surgery remains an essential element of the multimodality radical treatment of patients with early-stage nonsmall cell lung cancer. In addition, thoracic surgery is one of the key specialties involved in the lung cancer tumour board. The importance of the surgeon in the setting of a multidisciplinary panel is ever-increasing in light of the crucial concept of resectability, which is at the base of patient selection for neoadjuvant/adjuvant treatments within trials and in real-world practice. This review covers some of the topics which are relevant in the daily practice of a thoracic oncological surgeon and should also be known by the nonsurgical members of the tumour board. It covers the following topics: the pre-operative selection of the surgical candidate in terms of fitness in light of the ever-improving nonsurgical treatment alternatives unfit patients may benefit from; the definition of resectability, which is so important to include patients into trials and to select the most appropriate radical treatment; the impact of surgical access and surgical extension with the evolving role of minimally invasive surgery, sublobar resections and parenchymal-sparing sleeve resections to avoid pneumonectomy.
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Affiliation(s)
- Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University, Istanbul, Turkey
| | - Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, and Thoracic Oncology Centre Munich, Ludwig-Maximilians-Universität in Munich, Munich, Germany
| | - David R Jones
- Department of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Alan D L Sihoe
- Department of Cardio-Thoracic Surgery, CUHK Medical Centre, Hong Kong, China
| | - Tomaž Štupnik
- Department of Thoracic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
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Nakanishi K, Goto H. A New Index for the Quantitative Evaluation of Surgical Invasiveness Based on Perioperative Patients' Behavior Patterns: Machine Learning Approach Using Triaxial Acceleration. JMIR Perioper Med 2023; 6:e50188. [PMID: 37962919 PMCID: PMC10685283 DOI: 10.2196/50188] [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: 06/22/2023] [Revised: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The minimally invasive nature of thoracoscopic surgery is well recognized; however, the absence of a reliable evaluation method remains challenging. We hypothesized that the postoperative recovery speed is closely linked to surgical invasiveness, where recovery signifies the patient's behavior transition back to their preoperative state during the perioperative period. OBJECTIVE This study aims to determine whether machine learning using triaxial acceleration data can effectively capture perioperative behavior changes and establish a quantitative index for quantifying variations in surgical invasiveness. METHODS We trained 7 distinct machine learning models using a publicly available human acceleration data set as supervised data. The 3 top-performing models were selected to predict patient actions, as determined by the Matthews correlation coefficient scores. Two patients who underwent different levels of invasive thoracoscopic surgery were selected as participants. Acceleration data were collected via chest sensors for 8 hours during the preoperative and postoperative hospitalization days. These data were categorized into 4 actions (walking, standing, sitting, and lying down) using the selected models. The actions predicted by the model with intermediate results were adopted as the actions of the participants. The daily appearance probability was calculated for each action. The 2 differences between 2 appearance probabilities (sitting vs standing and lying down vs walking) were calculated using 2 coordinates on the x- and y-axes. A 2D vector composed of coordinate values was defined as the index of behavior pattern (iBP) for the day. All daily iBPs were graphed, and the enclosed area and distance between points were calculated and compared between participants to assess the relationship between changes in the indices and invasiveness. RESULTS Patients 1 and 2 underwent lung lobectomy and incisional tumor biopsy, respectively. The selected predictive model was a light-gradient boosting model (mean Matthews correlation coefficient 0.98, SD 0.0027; accuracy: 0.98). The acceleration data yielded 548,466 points for patient 1 and 466,407 points for patient 2. The iBPs of patient 1 were [(0.32, 0.19), (-0.098, 0.46), (-0.15, 0.13), (-0.049, 0.22)] and those of patient 2 were [(0.55, 0.30), (0.77, 0.21), (0.60, 0.25), (0.61, 0.31)]. The enclosed areas were 0.077 and 0.0036 for patients 1 and 2, respectively. Notably, the distances for patient 1 were greater than those for patient 2 ({0.44, 0.46, 0.37, 0.26} vs {0.23, 0.0065, 0.059}; P=.03 [Mann-Whitney U test]). CONCLUSIONS The selected machine learning model effectively predicted the actions of the surgical patients with high accuracy. The temporal distribution of action times revealed changes in behavior patterns during the perioperative phase. The proposed index may facilitate the recognition and visualization of perioperative changes in patients and differences in surgical invasiveness.
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Affiliation(s)
- Kozo Nakanishi
- Department of General Thoracic Surgery, National Hospital Organization Saitama Hospital, Wako Saitama, Japan
| | - Hidenori Goto
- Department of General Thoracic Surgery, National Hospital Organization Saitama Hospital, Wako Saitama, Japan
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Swanson SJ, White A. Sublobar resections for lung cancer: Finally, some answers and some more questions? J Surg Oncol 2023; 127:269-274. [PMID: 36630096 DOI: 10.1002/jso.27163] [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: 10/19/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 01/12/2023]
Abstract
The Lung Cancer Study Group Trial, published in 1995, set the tone for lobectomy as the standard of care for early-stage nonsmall cell lung cancer. Twenty-seven years and two randomized trials later, does the thoracic oncology community have clarity regarding the choice type of resection, or more questions?
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Affiliation(s)
- Scott J Swanson
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Abby White
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Effects of Smoking, Obesity, and Pulmonary Function on Home Oxygen Use after Curative Lung Cancer Surgery. Ann Am Thorac Soc 2021; 19:442-450. [PMID: 34699344 DOI: 10.1513/annalsats.202103-231oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Lung cancer surgical morbidity has been decreasing, increasing attention to quality-of-life measures. A chronic sequela of lung cancer surgery is use of postoperative oxygen at home after discharge. Prospective studies are needed to identify risk predictors for home oxygen(HO2) use after curative lung cancer surgery. OBJECTIVES To prospectively assess risk factors for postoperative oxygen use and post-surgical morbidity in patients undergoing curative lung cancer surgery. We hypothesized that obesity, poor pre-operative pulmonary function, and smoking status would contribute to the risk of postoperative oxygen use. METHODS Patients undergoing surgery for first primary non-small cell lung cancer at Mount Sinai, from 2016 to 2020. Univariate, multivariable logistic regression analyses and adjusted odds ratio and 95% confidence intervals were assessed. RESULTS Of the 433 patients diagnosed with pathologic stage I non-small cell lung cancer, 63 (14.5%) were discharged with HO2. Using multivariable analyses, body mass index (OR for BMI25-30=4.0, 95% CI:1.6-11.2, p = 0.005 and OR for BMI≥ 30=6.1, 95% CI:2.4-17.5, p<0.001)and pre-operative diffusing capacity for carbon monoxide(DLCO) (OR for DLCO<40=24.9, 95% CI:3.6-234.1, p=0.002 and OR for DLCO 40-59=3.1, 95% CI:1.3-7.2, p=0.008) were significant independent risk factors associated with risk of home oxygen after controlling for other covariates. Although current smoking significantly increased the risk in the univariate analysis, it was no longer significant in the multivariable model. CONCLUSIONS Obesity and diffusing capacity for carbon monoxide were significant as risk factors for oxygen use at home after discharge. These findings allow for identification of patients at risk of being discharged with home oxygen after lung resection surgery.
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Jindal R, Nar AS, Mishra A, Singh RP, Aggarwal A, Bansal N. Video-assisted thoracoscopic surgery versus open thoracotomy in the management of empyema: A comparative study. J Minim Access Surg 2020; 17:470-478. [PMID: 33047681 PMCID: PMC8486060 DOI: 10.4103/jmas.jmas_249_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: With a rise in the incidence of thoracic empyema, surgical interventions also have evolved from the traditional open decortication to the current minimally invasive video-assisted thoracoscopic surgery (VATS). In this study, we determine the feasibility of VATS and also put the superiority of VATS over open thoracotomy (OT) to test. Subjects and Methods: Prospective single-centre comparative analysis of clinical outcome in 60 patients undergoing either VATS or OT for thoracic empyema was done between 1st September, 2014, and 1st November, 2018. Furthermore, another group of patients, who were converted intraoperatively from VATS to OT, was studied descriptively. Results: Nearly 75% of the patients were male with a mean age of 45.16 years. Every second patient had associated tuberculosis (TB), attributed to the endemicity of TB in India. When compared with OT, VATS had a shorter duration of surgery (268.15 vs. 178.33 min), chest tube drainage (11.70 vs. 6.13 days), post-operative hospital stay (13.56 vs. 7.42 days) and time to return to work (26.96 vs. 12.57 days). Post-operative pain and analgesic requirement were also significantly reduced in the VATS group (P < 0.0001). Conversion rate observed was 14.2%, the most common reason being the presence of dense adhesions. Conclusion: We conclude that VATS, a minimally invasive procedure with its substantial advantages over thoracotomy and better functional outcome, should be preferred whenever feasible to do so. Also if needed, conversion of VATS to the conventional open procedure, rather than a failure, is a wise surgical judgement.
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Affiliation(s)
- Rohit Jindal
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Amandeep Singh Nar
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Atul Mishra
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ravinder Pal Singh
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Aayushi Aggarwal
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Namita Bansal
- Research and Development Centre, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Arrieta O, Cardona AF, Lara-Mejía L, Heredia D, Barrón F, Zatarain-Barrón ZL, Lozano F, de Lima VC, Maldonado F, Corona-Cruz F, Ramos M, Cabrera L, Martin C, Corrales L, Cuello M, Arroyo-Hernández M, Aman E, Bacon L, Baez R, Benitez S, Botero A, Burotto M, Caglevic C, Ferraris G, Freitas H, Kaen DL, Lamot S, Lyons G, Mas L, Mata A, Mathias C, Muñoz A, Patane AK, Oblitas G, Pino L, Raez LE, Remon J, Rojas L, Rolfo C, Ruiz-Patiño A, Samtani S, Viola L, Viteri S, Rosell R. Recommendations for detection, prioritization, and treatment of thoracic oncology patients during the COVID-19 pandemic: the THOCOoP cooperative group. Crit Rev Oncol Hematol 2020; 153:103033. [PMID: 32650215 PMCID: PMC7305738 DOI: 10.1016/j.critrevonc.2020.103033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/13/2020] [Indexed: 12/16/2022] Open
Abstract
The world currently faces a pandemic due to SARS-CoV-2. Relevant information has emerged regarding the higher risk of poor outcomes in lung cancer patients. As such, lung cancer patients must be prioritized in terms of prevention, detection and treatment. On May 7th, 45 experts in thoracic cancers from 11 different countries were invited to participate. A core panel of experts regarding thoracic oncology care amidst the pandemic gathered virtually, and a total of 60 initial recommendations were drafted based on available evidence, 2 questions were deleted due to conflicting evidence. By May 16th, 44 experts had agreed to participate, and voted on each of the 58 recommendation using a Delphi panel on a live voting event. Consensus was reached regarding the recommendations (>66 % strongly agree/agree) for 56 questions. Strong consensus (>80 % strongly agree/agree) was reached for 44 questions. Patients with lung cancer represent a particularly vulnerable population during this time. Special care must be taken to maintain treatment while avoiding exposure.
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Affiliation(s)
- Oscar Arrieta
- Instituto Nacional de Cancerología, Mexico City, Mexico.
| | - Andrés F Cardona
- Thoracic Oncology Clinic, Clínica del Country, Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia
| | | | - David Heredia
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | | | | | | | | | - Maritza Ramos
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Luis Cabrera
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Claudio Martin
- Thoracic Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina; Hospital Maria Ferrer, Buenos Aires, Argentina
| | - Luis Corrales
- Oncology Department, Hospital San Juan de Dios, San José Costa Rica, Costa Rica; Oncología Médica, Centro de Investigación y Manejo del Cáncer (CIMCA), San José, Costa Rica
| | - Mauricio Cuello
- Department of Oncology, Hospital de Clínicas, Universidad de la República - UDELAR, Montevideo, Uruguay
| | | | - Enrique Aman
- Clinical Oncology Unit, Swiss Medical Group, Buenos Aires, Argentina
| | - Ludwing Bacon
- Centro de Oncología, Hospital Vivián Pellas, Nicaragua
| | - Renata Baez
- National Institute for Respiratory Diseases, Mexico City, Mexico
| | - Sergio Benitez
- Coordinador de la sección Oncología, asociación Argentina de Medicina Respiratoria, Argentina
| | | | - Mauricio Burotto
- Clínica Universidad de los Andes, Centro de Estudios Clínicos Bradford Hill, Chile
| | - Christian Caglevic
- Departamento de Investigación del Cáncer- Fundación Arturo López Pérez, Santiago, Chile
| | - Gustavo Ferraris
- Centro Médico Dean Funes, Radioterapia Oncológica, Córdoba, Argentina
| | - Helano Freitas
- Departamento de Oncologia Clínica - A C Camargo Cancer Center, São Paulo, Brazil
| | | | - Sebastián Lamot
- CONCIENCIA, Instituto Oncohematológico de la Patagonia, Chile
| | - Gustavo Lyons
- Department of Thoracic Surgery, Hospital Británico, Buenos Aires, Argentina
| | - Luis Mas
- Medical Oncology Department, National Institute for Neoplastic Diseases - INEN, Lima, Peru
| | - Andrea Mata
- Hospital La Católica Goicoechea, San José, Costa Rica
| | | | | | - Ana Karina Patane
- Hospital de Rehabilitacion Respiratoria María Ferrer, Buenos Aires, Argentina
| | | | - Luis Pino
- Medical Oncology Group, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Luis E Raez
- Thoracic Oncology Program Memorial Cancer Institute, Memorial Healthcare System, Pembroke Pines, FL, United States
| | - Jordi Remon
- Medical Oncology Department, Centro Integral Oncología Clara Campal Bacelona, HM-Delfos, Barcelona, Spain
| | - Leonardo Rojas
- Medical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Christian Rolfo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | | | - Suraj Samtani
- Medical Oncology Department, Clínica Bradford Hill, Santiago, Chile
| | - Lucia Viola
- Fundación neumológica colombiana, Bogotá, Colombia
| | - Santiago Viteri
- Instituto Oncológico Dr. Rosell. Centro Médico Teknon. Grupo QuironSalud. Barcelona, España
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Dumitra TC, Molina JC, Mouhanna J, Nicolau I, Renaud S, Aubin L, Siblini A, Mulder D, Ferri L, Spicer J. Feasibility analysis for the development of a video-assisted thoracoscopic (VATS) lobectomy 23-hour recovery pathway. Can J Surg 2020; 63:E349-E358. [PMID: 32735430 DOI: 10.1503/cjs.002219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Video-assisted thoracoscopic (VATS) lobectomy has been demonstrated to offer several benefits over open surgery. The purpose of this study was to assess the feasibility and safety of an ultra-fast-track 23-hour recovery pathway for VATS lobectomy. Methods A prospectively maintained institutional database was queried for patients who underwent VATS lobectomy from 2006 to 2016 at the McGill University Health Centre in Montreal, Quebec, and data were supplemented with focused chart review. Patients discharged with a length of stay (LOS) of 23 hours or less were compared with those with an LOS of 2 days or more. Logistic regression was performed to identify predictors of LOS of 23 hours or less. Results Two hundred and five patients were included in the study. Perioperative 30-day mortality for our cohort was 0% and the major complication rate was 8.3%. The median LOS was 3 days (interquartile range [IQR] 2-4 d). Thirty-four patients were discharged within 23 hours and none of them required readmission; 171 patients were discharged on postoperative day 2 or later and 9 of them (5.3%) required readmission (p = 0.36). The proportion of patients discharged within 23 hours increased in 2016 compared with previous years (25.8% v. 12.0%, p = 0.05). Patients discharged within 23 hours had shorter chest tube duration (odds ratio [OR] 0.20, 95% confidence interval [CI] 0.09-0.46, p < 0.001), lower clinical stage disease (stages II-III v. stage I OR 0.07, 95% CI 0.01-0.52, p = 0.011), lower pathologic stage lesions (stages II-III v. stage I OR 0.26, 95% CI 0.07-0.91, p = 0.035), fewer surgical complications (OR 0.04, 95% CI 0.01-0.30, p = 0.002) and shorter operative time (surgery duration > 120 min OR 0.42, 95% CI 0.18-0.95, p = 0.04). Our exploratory prediction modelling showed that chest tube duration, clinical stage and surgeon were the most influential predictors of discharge within 23 hours. Conclusion The only preoperative factors that predicted shorter LOS in our cohort were clinical stage and surgeon. A significant proportion of patients can be discharged safely by adopting a VATS lobectomy 23-hour enhanced recovery pathway.
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Affiliation(s)
- Teodora-Cristiana Dumitra
- From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - Juan-Carlos Molina
- From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - Jack Mouhanna
- From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - Ioana Nicolau
- From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - Stephane Renaud
- From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - Ludovic Aubin
- From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - Aya Siblini
- From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - David Mulder
- From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - Lorenzo Ferri
- From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montréal, Que
| | - Jonathan Spicer
- From the Division of Thoracic and Upper Gastrointestinal Surgery, Department of Surgery, McGill University Health Centre, Montréal, Que
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Hue JJ, Linden PA, Bachman KC, Worrell SG, Gray KE, Towe CW. Conversion from thoracoscopic to open pneumonectomy is not associated with short- or long-term mortality. Surgery 2020; 168:948-952. [PMID: 32680746 DOI: 10.1016/j.surg.2020.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thoracoscopic pneumonectomy commonly requires conversion to thoracotomy. We hypothesize that conversion would lead to worse short- and long-term outcomes compared with operations completed thoracoscopically. METHODS The National Cancer Database identified patients who underwent a pneumonectomy from 2010 to 2016. Trends in conversion were described using linear regression. Multivariable regression of factors associated with conversion was performed. Short-term outcomes included duration of stay, number of lymph nodes harvested, margin status, readmission, and 90-day mortality. Long-term outcome was evaluated as overall survival. RESULTS A total of 8,037 patients underwent a pneumonectomy. The rate of attempted thoracoscopic pneumonectomies increased from 11% to 22% (P < .001) and the rate of conversion decreased from 39% to 33% (P = .011). On multivariable analysis, a greater patient comorbidity index and pathologic nodal-stage 2 disease were associated with an increased rate of conversion. The mean number of lymph nodes evaluated was greater as was the duration of stay in the conversion group, but conversion to open thoracotomy was not associated with positive surgical margins, readmission rate, 90-day mortality, or survival. CONCLUSION Thoracoscopic pneumonectomy is performed with increasing frequency and decreasing conversion rate. Conversion is associated with a greater duration of stay but other short- and long-term outcomes are similar. This observation suggests minimal harm in conversion from minimally invasive to open pneumonectomy.
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Affiliation(s)
- Jonathan J Hue
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, OH
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, OH
| | - Katelynn C Bachman
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, OH
| | - Stephanie G Worrell
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, OH
| | - Kelsey E Gray
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, OH
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, OH.
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Ely S, Jiang SF, Patel AR, Ashiku SK, Velotta JB. Regionalization of Lung Cancer Surgery Improves Outcomes in an Integrated Health Care System. Ann Thorac Surg 2020; 110:276-283. [DOI: 10.1016/j.athoracsur.2020.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 01/10/2020] [Accepted: 02/06/2020] [Indexed: 11/16/2022]
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Lee EC, Lazzaro RS, Glassman LR, Singh VA, Jurado JE, Hyman KM, Patton BD, Zeltsman D, Scheinerman JS, Hartman AR, Lee PC. Switching from Thoracoscopic to Robotic Platform for Lobectomy: Report of Learning Curve and Outcome. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:235-242. [PMID: 32228219 DOI: 10.1177/1556984520911670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The optimal minimally invasive surgical management for patients with non-small-cell lung cancer (NSCLC) is unclear. For experienced video-assisted thoracoscopic surgery (VATS) surgeons, the increased costs and learning curve are strong barriers for adoption of robotics. We examined the learning curve and outcome of an experienced VATS lobectomy surgeon switching to a robotic platform. METHODS We conducted a retrospective review to identify patients who underwent a robotic or VATS lobectomy for NSCLC from 2016 to 2018. Analysis of patient demographics, perioperative data, pathological upstaging rates, and robotic approach (RA) learning curve was performed. RESULTS This study evaluated 167 lobectomies in total, 118 by RA and 49 by VATS. Patient and tumor characteristics were similar. RA had significantly more lymph node harvested (14 versus 10; P = 0.004), more nodal stations sampled (5 versus 4; P < 0.001), and more N1 nodes (8 versus 6; P = 0.010) and N2 nodes (6 versus 4; P = 0.017) resected. With RA, 22 patients were upstaged (18.6%) compared to 5 patients (10.2%) with VATS (P = 0.26). No differences were found in perioperative outcome. Operative time decreased significantly with a learning curve of 20 cases, along with a steady increase in lymph node yield. CONCLUSIONS RA can be adopted safely by experienced VATS surgeons. Learning curve is 20 cases, with RA resulting in superior lymph node clearance compared to VATS. The potential improvement in upstaging and oncologic resection for NSCLC may justify the associated investments of robotics even for experienced VATS surgeons.
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Affiliation(s)
- Eric C Lee
- 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA
| | - Richard S Lazzaro
- 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA
| | - Lawrence R Glassman
- 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA
| | - Vijay A Singh
- 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA
| | - Julissa E Jurado
- 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA
| | - Kevin M Hyman
- 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA
| | - Byron D Patton
- 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA
| | - David Zeltsman
- 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA
| | - Jacob S Scheinerman
- 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA
| | - Alan R Hartman
- 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA
| | - Paul C Lee
- 232890 Department of Cardiovascular and Thoracic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Lenox Hill Hospital, New Hyde Park, NY, USA
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Kim SS, Bharat A. Commentary: Video-assisted thoracoscopic surgery versus robotic assisted surgery: Are we asking the right question? J Thorac Cardiovasc Surg 2020; 160:1374-1375. [PMID: 32171485 DOI: 10.1016/j.jtcvs.2020.01.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Samuel S Kim
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Ankit Bharat
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Ye B, Wang M. Video-assisted Thoracoscopic Surgery versus Thoracotomy for Non-Small Cell Lung Cancer: A Meta-Analysis. Comb Chem High Throughput Screen 2020; 22:187-193. [PMID: 30987564 DOI: 10.2174/1386207322666190415103030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/20/2018] [Accepted: 12/11/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients undergoing surgery for non-small cell lung cancer (NSCLC) are often elderly and have co-morbidity conditions and decreased performance status. Compared with open thoracotomy, video-assisted thoracoscopic lobectomy is associated with fewer postoperative complications. Despite encouraging results for patients with NSCLC who underwent VATS, the procedure is still not widely accepted, and large retrospective studies have yielded conflicting results. OBJECTIVES In video-assisted lobectomy for NSCLC, it has remained controversial whether mediastinal lymphadenectomy can be performed as effectively as an open procedure via thoracotomy. To deal with inherent biases in any non-randomized comparison, we analyzed propensity-matched studies and randomized controlled trials. The aim of this study was to evaluate the treatment outcomes of VATS and open thoracotomy for NSCLC patients. METHODS We collected publications on comparison of VATS versus open thoracotomy for NSCLC patients from 2007 to 2017. All trials analyzed the summary Hazard Ratios (HRs) of the endpoints of interest, including perioperative mortality and morbidity, and individual postoperative complications. Revman 5.3 software was used to analyze the combined pooled HRs using fixed- or random-effects models according to heterogeneity. RESULTS A systematic literature search was conducted including 15 studies. The results indicated that VATS was associated with lower postoperative morbidity and mortality, and significantly lower rates of prolonged pneumonia, atrial arrhythmias and renal failure. CONCLUSIONS Compared with lobectomy by thoracotomy, thoracoscopic lobectomy is associated with a lower incidence of major complications, including lower rates of prolonged pneumonia, atrial arrhythmias and renal failure. Lobectomy via VATs may be the preferred strategy for appropriately selected NSCLC patients. The determinants of this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.
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Affiliation(s)
- Bo Ye
- Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Ming Wang
- Department of Thoracic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, Zhejiang, China
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Chan JWY, Yu PSY, Yang JH, Yuan EQ, Jia H, Peng J, Lau RWH, Ng CSH. Surgical access trauma following minimally invasive thoracic surgery. Eur J Cardiothorac Surg 2020; 58:i6-i13. [PMID: 32061088 DOI: 10.1093/ejcts/ezaa025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/05/2019] [Accepted: 12/22/2019] [Indexed: 12/11/2022] Open
Abstract
SummarySurgical access trauma has important detrimental implications for immunological status, organ function and clinical recovery. Thoracic surgery has rapidly evolved through the decades, with the advantages of minimally invasive surgery becoming more and more apparent. The clinical benefits of enhanced recovery after video-assisted thoracoscopic surgery (VATS) may be, at least in part, the result of better-preserved cellular immunity and cytokine profile, attenuated stress hormone release and improved preservation of pulmonary and shoulder function. Parameters of postoperative pain, chest drain duration, hospital stay and even long-term survival are also indirect reflections of the advantages of reduced access trauma. With innovations of surgical instruments, optical devices and operative platform, uniportal VATS, robotic thoracic surgery and non-intubated anaesthesia represent the latest frontiers in minimizing trauma from surgical access.
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Affiliation(s)
- Joyce W Y Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jack Hong Yang
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Evan Qize Yuan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hao Jia
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jia Peng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Kaufmann KB, Loop T, Heinrich S. Risk factors for post-operative pulmonary complications in lung cancer patients after video-assisted thoracoscopic lung resection: Results of the German Thorax Registry. Acta Anaesthesiol Scand 2019; 63:1009-1018. [PMID: 31144301 DOI: 10.1111/aas.13388] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/28/2019] [Accepted: 04/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Post-operative pulmonary complications (PPCs) represent the most frequent complications after lung surgery. The aim of this study was to identify the modifiable risk factors for PPCs after video-assisted thoracoscopic surgery (VATS) in lung cancer patients. METHODS Data of this retrospective study were extracted from the German Thorax Registry, an interdisciplinary and multicenter database of the German Society of Anesthesiology and Intensive care medicine and the German Society of Thoracic Surgery. Univariate and multivariate stepwise logistic regression analysis of patient-specific and procedural risk factors for PPCs were conducted. RESULTS We analyzed 376 patients with lung cancer who underwent VATS bilobectomy (n = 2), lobectomy (n = 258) or segmentectomy (n = 116) in 2016 and 2017. One-hundred fourteen patients (114/376; 30%) developed PPCs. Two patients died within 30 days after surgery. In the univariate analysis, patients of the PPC group showed significantly more often a body mass index (BMI) ≤ 19 kg/m2 ; a pre-operative forced expiratory volume in 1 second (FEV1 ) ≤ 60%; a pre-operative arterial oxygen partial pressure (pa O2 ) ≤ 60 mm Hg; a higher rate of prolonged duration of surgery (≥2 hours [h]) and a higher frequency of intraoperative blood loss ≥500 mL. The multivariate stepwise logistic regression analysis revealed 4 independent risk factors: FEV1 ≤ 60% (1.9[1.1-3.4] OR [95% CI], P = 0.029); pa O2 ≤ 60 mm Hg (4.6[1.7-12.8] OR [95% CI], P = 0.003; duration of surgery ≥2 hours (2.7[1.5-4.7] OR [95% CI], P = 0.001) and intraoperative crystalloids ≥6 mL/kg/h (2.9[1.2-7.5] OR [95% CI], P = 0.023). CONCLUSION Intraoperative amount of crystalloid fluids should be kept below 6 mL/kg/h and duration of surgery should be below 2 hours to avoid an increased risk for PPCs.
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Affiliation(s)
- Kai B. Kaufmann
- Faculty of Medicine, Department of Anesthesiology and Critical Care Medicine Medical Center ‐ University of Freiburg Freiburg Germany
| | - Torsten Loop
- Faculty of Medicine, Department of Anesthesiology and Critical Care Medicine Medical Center ‐ University of Freiburg Freiburg Germany
| | - Sebastian Heinrich
- Faculty of Medicine, Department of Anesthesiology and Critical Care Medicine Medical Center ‐ University of Freiburg Freiburg Germany
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Bilgi Z, Swanson SJ. Current indications and outcomes for thoracoscopic segmentectomy for early stage lung cancer. J Thorac Dis 2019; 11:S1662-S1669. [PMID: 31516739 DOI: 10.21037/jtd.2019.07.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Management of early stage non-small cell lung cancer (NSCLC) is evolving as the epidemiology of NSCLC has changed due to decreased rates of smoking in the general population, the development of screening programs and advancements in imaging modalities. Surgical technique is also evolving as a result of changes in instrumentation. Segmentectomy for early stage NSCLC has the advantage of preservation of lung function. Video-assisted thoracic surgery (VATS) segmentectomy is a safe option for surgeons already experienced in VATS lobectomy and offers comparable oncological benefit with better quality of life in selected patients. In this article, we will examine the role of segmentectomy and VATS for early stage NSCLC.
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Affiliation(s)
- Zeynep Bilgi
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott J Swanson
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Phillips JD, Bostock IC, Hasson RM, Goodney PP, Goodman DC, Millington TM, Finley DJ. National practice trends for the surgical management of lung cancer in the CMS population: an atlas of care. J Thorac Dis 2019; 11:S500-S508. [PMID: 31032068 PMCID: PMC6465423 DOI: 10.21037/jtd.2019.01.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/31/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has been established as a safe and effective alternative to an open approach for the treatment of early-stage lung cancer. Despite this, differences in utilization across the nation are present. The aims of this study were to: (I) characterize trends in the use of open surgery and VATS for the management of lung cancer across the United States, and (II) describe if particular regions of the country utilize minimally invasive surgery more frequently. METHODS We studied all Medicare beneficiaries from the ages of 65 to 99 years with full Part A and B coverage and no HMO coverage for the years of 2006 and 2014 (the most recent year available at the time of this analysis). Beneficiaries with a diagnosis of lung cancer (ICD-9 codes: 162.0 162.2 162.3 162.4 162.5 162.8 162.9) were selected. Rates of thoracoscopic surgery (CPT codes: 32663, 32666, 32667, 32668, 32669, 32670, 32671) and open lung resections (32505, 32506, 32507, 32608, 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488) were calculated by year and region. Rates in 2006 and 2014 with descriptive statistics and a univariate analysis were performed using Student's t-test and chi-square, as appropriate. A two-sided P value <0.05 was considered statistically significant. RESULTS A total of 24,368,333 and 23,921,059 beneficiaries for the years of 2006 and 2014 were analyzed. A diagnosis of lung cancer was detected in claims of 167,418 patients (0.7%) in 2006 and 167,506 patients in 2014 (0.7%), which was not significantly different (P=0.7). Among these lung cancer patients, a surgical intervention was performed in 17,249 patients (10.3%) during 2006 and 18,603 patients (11.1%) in 2014 (P=0.01). Among those undergoing surgery, a VATS approach was performed in 2,512 patients (15%) during 2006 and 9,578 patients (54%) during 2014 (P=0.001). In 2006, California, New York, and New Jersey performed the most VATS procedures, in comparison to 2014, when New York, Florida, and California performed the highest number of VATS procedures. CONCLUSIONS While the prevalence of lung cancer in the United States was unchanged between 2006 and 2014, the use of VATS techniques increased five-fold. Further studies to better understand the adoption or availability of new surgical techniques in lung cancer populations across geographic regions and patient populations are necessary.
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Affiliation(s)
- Joseph D. Phillips
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Rian M. Hasson
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Philip P. Goodney
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - David C. Goodman
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Timothy M. Millington
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - David J. Finley
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Mori S, Noda Y, Tsukamoto Y, Shibazaki T, Asano H, Matsudaira H, Yamashita M, Odaka M, Morikawa T. Perioperative outcomes of thoracoscopic lung resection requiring a long operative time. Interact Cardiovasc Thorac Surg 2019; 28:380-386. [PMID: 30212874 DOI: 10.1093/icvts/ivy275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/31/2018] [Accepted: 08/15/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Difficult thoracoscopic surgery sometimes requires a long operative time. It is unclear whether patients benefit from such thoracoscopic surgeries. We investigated whether thoracoscopic surgery for difficult cases contributed to improvements in perioperative outcomes. METHODS We retrospectively reviewed cases of anatomical lung resection with thoracoscopic surgery, including conversion to thoracotomy, between January 2006 and December 2016 and compared patient demographics and perioperative outcomes of the long (≥360 min) and the normal operative time groups (<360 min). RESULTS One hundred and seventy-six patients were in the long operative time group and 655 patients were in the normal operative time group. The long operative time group had more male patients, more progressive clinical stages, bilobectomy or pneumonectomy, conversion to thoracotomy and more blood loss than the normal operative time group. The long operative time group had higher rates of postoperative complications and longer hospital stay (30% vs 16%, P < 0.001 and 9 ± 9 days vs 7 ± 8 days, P < 0.001; respectively). Multivariate analysis showed that in the first half of the operative period, chronic obstructive pulmonary disease and bilobectomy or pneumonectomy were independent predictive factors for postoperative complications. The long operative time as a factor was close to statistical significance (odds ratio 1.689, P = 0.079) unlike the elective conversion to thoracotomy (odds ratio 0.784, P = 0.667) and emergency conversion to thoracotomy (odds ratio 0.938, P = 0.924). CONCLUSIONS In conclusion, when difficult cases are encountered, conversion to thoracotomy should be considered by surgeons if continuation of thoracoscopic surgery increases the operative time.
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Affiliation(s)
- Shohei Mori
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Yuki Noda
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Yo Tsukamoto
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Takamasa Shibazaki
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Hisatoshi Asano
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Hideki Matsudaira
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Makoto Yamashita
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Makoto Odaka
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Toshiaki Morikawa
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan
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Ismail M, Nachira D, Swierzy M, Ferretti GM, Englisch JP, Ossami Saidy RR, Li F, Badakhshi H, Rueckert JC. Lymph node upstaging for non-small cell lung cancer after uniportal video-assisted thoracoscopy. J Thorac Dis 2018; 10:S3648-S3654. [PMID: 30505548 DOI: 10.21037/jtd.2018.06.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Radical lymph node dissection (LND) plays a major role in the treatment of non-small cell lung cancer (NSCLC). This study presents the analysis of the results after uniportal video-assisted thoracoscopy (VATS) lymphadenectomy during anatomical lung resections for NSCLC, focusing on pathological nodal upstaging. Any possible risk factor affecting nodal upstaging was also investigated. Methods The prospectively collected clinical data of 136 patients undergone uniportal VATS anatomical lung resections, from June 2012 to September 2017, were reviewed. In particular, all details inherent the clinical and pathological node stage and any possible risk factor affecting nodal upstaging were analyzed. Results The patient population consisted of 90 males and 46 females; their mean age was 67.42±10.64 years. The mean number of lymph nodes retrieved during uniportal VATS lymphadenectomy was 20.14±10.73 (7.27±5.90 and 12.60±7.96 in N1 and N2 stations, respectively). The incidence of nodal upstaging was 13.3% (18 cases). In particular there was a N0-1 upstaging in 10 cases (7.4%), a N1-2 upstaging in 3 (2.2%) and a N0-2 in 4 (3%). The ROC analysis showed that the resection of 18 lymph nodes was the best predictor of a general upstaging with an AUC-ROC of 0.595, while the resection of 7 hilar lymph nodes was the best predictor of N1 upstaging (AUC-ROC: 0.554) and 11 mediastinal nodes was the best predictor of N2 upstaging (AUC-ROC: 0.671). The number of positive lymph nodes of stations 5-6 (OR: 2.035, 95% CI: 1.082-3.826, P=0.027) and stations 2-3-4 (OR: 6.198, 95% CI: 1.580-24.321, P=0.009) were confirmed to be the only independent risk factors for N2 upstaging by multivariate analysis. Conclusions According to our experience, uniportal VATS allows a safe and effective radical lymphadenectomy, with a satisfactory pathological nodal upstaging, comparable to other minimally invasive techniques.
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Affiliation(s)
- Mahmoud Ismail
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Marc Swierzy
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gian Maria Ferretti
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Julianna Paulina Englisch
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ramin Raul Ossami Saidy
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Feng Li
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Harun Badakhshi
- Department of Clinical Radiation Oncology, Ernst von Bergmann Medical Center, Potsdam, Germany
| | - Jens C Rueckert
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Gonzalez-Rivas D, Kuo YC, Wu CY, Delgado M, Mercedes DLT, Fernandez R, Fieira E, Hsieh MJ, Paradela M, Chao YK, Wu CF. Predictive factors of postoperative complications in single-port video-assisted thoracoscopic anatomical resection: Two center experience. Medicine (Baltimore) 2018; 97:e12664. [PMID: 30290649 PMCID: PMC6200447 DOI: 10.1097/md.0000000000012664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to identify the risk factors for adverse events during single-port video-assisted thoracoscopic (SPVATS) anatomical resections.We retrospectively reviewed patients who had undergone SPVATS anatomic resections between January 2014 and February 2017 in Coruña University Hospital's Minimally Invasive Thoracic Surgery Unit (CHUAC, Spain) and Chang Gung Memorial Hospital (CGMH, Taiwan). Four hundred forty-two patients (male: 306, female: 136) were enrolled in this study. Logistic regression analysis was performed on variables for postoperative complications.Postoperative complications with a 30-day mortality occurred in 94 patients (21.3%) and with a 90-day mortality in 3 patients (0.7%) while the major complication rate was 3.9%. Prolonged air leak (PAL > 5 days) was the most common complication and came by postoperative arrhythmia. Logistic regression indicated that pleural symphysis (odds ratio (OR), 1.91; 95% confidence interval (CI), 1.14-3.18; P = .014), computed tomography (CT) pulmonary emphysema (OR, 2.63; 95% CI, 1.41-4.76; P = .002), well-developed pulmonary CT fissure line (OR, 0.49; 95% CI, 0.29-0.84; P = .009), and tumor size (≥3 cm) (OR, 2.15; 95% CI, 1.30-3.57; P = .003) were predictors of postoperative complications.Our preliminary results revealed that SPVATS anatomic resection achieves acceptable 30- and 90-day surgery related mortality (0.7%) and major complications rate (3.9%). Prolonged Air leak (PAL > 5 days) was the most common postoperative complication. Pleural symphysis, pulmonary emphysema, well-developed pulmonary CT fissure line and tumor size (≥3 cm) were predictors of adverse events during SPVATS anatomic resection.
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Affiliation(s)
- Diego Gonzalez-Rivas
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Yung Chia Kuo
- Chang Gung University, Division of Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching Yang Wu
- Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery
| | - Maria Delgado
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - de la Torre Mercedes
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Ricardo Fernandez
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Eva Fieira
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Ming Ju Hsieh
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Marina Paradela
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
| | - Yin Kai Chao
- Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery
| | - Ching Feng Wu
- Coruña University Hospital; Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, CORUÑA, Spain
- Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery
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Swanson SJ. Good vibrations-better care for lung cancer patients. J Thorac Cardiovasc Surg 2018; 157:378-379. [PMID: 29730113 DOI: 10.1016/j.jtcvs.2018.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/06/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Scott J Swanson
- Brigham and Women's Hospital Dana-Farber Cancer Institute, Boston, Mass.
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22
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Ma D, Song X, Li S, Liu H, Cui Y, Huang C, Zhou X, Qin Y, Li L, Chen Y. Video-Assisted Thoracoscopic Surgery Lobectomy Performed Satisfaction and Complications of Patients During Hands-On Training Courses. J Laparoendosc Adv Surg Tech A 2018; 28:804-810. [PMID: 29658824 DOI: 10.1089/lap.2017.0661] [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: 11/12/2022] Open
Abstract
AIM It was aimed to concern about the satisfaction and procedural complications of patients during the thoracoscopy exist of hands-on training in this present study. PATIENTS AND METHODS The patients with non-small-cell carcinoma underwent video-assisted thoracoscopic surgery (VATS) lobectomy during hands-on training courses at thoracoscopic center in our hospital and collected from January 2009 and December 2014. The rates of satisfaction and complications of patients were compared from hands-on training group and control group. Potential risk factors associated with post-VATS complications of patients and thoracoscopist-related variables were analyzed. There were 54 patients join in six meetings with hands-on thoracoscopy training in our center. RESULTS There was no significant difference between patients for hands-on training group (n = 54) and control group (n = 54), including sex, age, BMI, smoking, PpoFEV1 and comorbidities. The satisfaction rate and the incidence of complication were similar between the two groups. CONCLUSION Univariate analyses showed that elder age, heart disease, chronic obstructive pulmonary disease, long operative time, and first-time mentorship were significantly associated with post-VATS complications of patients in hands-on training group. We should pay more attention to the characteristics of patent and the experience of mentor before VATS hands-on training courses.
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Affiliation(s)
- Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Xiaonan Song
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Yushang Cui
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Xiaoyun Zhou
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Li Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital , CAMS & PUMC, Beijing, China
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Ghee CD, Fortes DL, Liu C, Khandhar SJ. A Randomized Controlled Trial of Continuous Subpleural Bupivacaine After Thoracoscopic Surgery. Semin Thorac Cardiovasc Surg 2017; 30:240-249. [PMID: 29024718 DOI: 10.1053/j.semtcvs.2017.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 12/26/2022]
Abstract
We sought to evaluate the merit of routine placement of a subpleural tunneled pain catheter delivering local anesthetic as measured by narcotic medication usage and subjective pain score analysis. Eighty-six patients were randomized into the subpleural catheter or intraoperative incision site injection groups in a 1:1 fashion, and underwent thoracoscopic surgery using 2 incisions. All patients had standardized anesthetic delivery and postoperative pain control. Patients' use of pain medication and pain scores was tracked for 7 days postoperatively. There was no significant difference in the 2 groups' usage of narcotics (P = 0.23), acetaminophen (P = 0.23), or nonsteroidal antiinflammatory drugs (P = 0.57) over time from linear mixed model analysis. The subpleural catheter group had significantly higher nonsteroidal antiinflammatory drug self-reported usage on postoperative day 4 (P = 0.04), postoperative day 5 (P = 0.05), postoperative day 6 (P = 0.01), and postoperative day 7 (P <0.01). There were no significant differences in average daily pain scores (all P ≥ 0.06). Length of hospital stay and results from 30-day postoperative surveys were not significantly different between the subpleural catheter and the intraoperative incision site injection groups. Our results did not show any objective differences between the subpleural catheter and the intraoperative incision site injection groups to justify routine use of tunneled subpleural catheters. The main limitation of this study is missing self-reported data. The differences noted in daily nonsteroidal antiinflammatory drug use in the pain catheter arm may actually suggest slightly worse pain control in those patients, although the clinical significance seems to be minimal.
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Affiliation(s)
- Charles D Ghee
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia.
| | | | - Chang Liu
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Sandeep J Khandhar
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
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Zhao Y, Li G, Zhang Y, Hu H, Zhang J, Sun Y, Chen H. Comparison of outcomes between muscle-sparing thoracotomy and video-assisted thoracic surgery in patients with cT1 N0 M0 lung cancer. J Thorac Cardiovasc Surg 2017; 154:1420-1429.e1. [DOI: 10.1016/j.jtcvs.2017.04.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 04/02/2017] [Accepted: 04/22/2017] [Indexed: 11/16/2022]
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Gul NH, Hennon M. Advances in video-assisted thoracoscopic surgery. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0590-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Soder SA, Barth F, Perin FA, Felicetti JC, Camargo JDJP, Camargo SM. Anatomic pulmonary resection via video-assisted thoracic surgery: analysis of 117 cases at a referral center in Brazil. J Bras Pneumol 2017; 43:129-133. [PMID: 28538780 PMCID: PMC5474376 DOI: 10.1590/s1806-37562015000000352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 10/31/2016] [Indexed: 12/25/2022] Open
Abstract
Objective: To describe our experience with video-assisted thoracic surgery (VATS) for anatomic pulmonary resection at a referral center for thoracic surgery in Brazil. Methods: All patients who underwent anatomic pulmonary resection by VATS between 2010 and 2015 were included. Clinical and pathological data, as well as postoperative complications, were analyzed. Results: A total of 117 pulmonary resections by VATS were performed, of which 98 were lobectomies and 19 were anatomic segmentectomies. The mean age of the patients was 63.6 years (range, 15-86 years). Females predominated (n = 69; 59%). The mean time to chest tube removal was 2.47 days, and the mean length of ICU stay was 1.88 days. The mean length of hospital stay was 4.48 days. Bleeding ≥ 400 mL occurred in 15 patients. Conversion to thoracotomy was required in 4 patients. Conclusions: Our results are similar to those published in major international studies, indicating that VATS is an important strategy for pulmonary resection. They also show that VATS can be safely performed with adequate training. This technique should be used more often for the treatment of lung diseases in Brazil.
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Affiliation(s)
- Stephan Adamour Soder
- . Serviço de Cirurgia Torácica, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Frederico Barth
- . Serviço de Cirurgia Torácica, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - Fabiola Adelia Perin
- . Serviço de Cirurgia Torácica, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
| | - José Carlos Felicetti
- . Serviço de Cirurgia Torácica, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil.,. Disciplina de Cirurgia Torácica, Universidade de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - José de Jesus Peixoto Camargo
- . Serviço de Cirurgia Torácica, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil.,. Disciplina de Cirurgia Torácica, Universidade de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Spencer Marcantônio Camargo
- . Serviço de Cirurgia Torácica, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre (RS) Brasil
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ElSaegh MMM, Ismail NA, Mydin MI, Nardini M, Dunning J. Subxiphoid uniportal lobectomy. J Vis Surg 2017; 3:24. [PMID: 29078587 PMCID: PMC5638006 DOI: 10.21037/jovs.2016.12.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/10/2016] [Indexed: 11/06/2022]
Abstract
Video-assisted thoracic surgery (VATS) surgery has seen an evolution from multiple ports to uniportal and finally subxiphoid uniportal recently. In traditional VATS surgery, the instruments and the thoracoscope enter the thoracic cavity through two to four operating ports on the lateral chest wall, which can cause chronic pain and chest wall numbness. However single-portal VATS surgery could potentially cause similar problems as the port is placed in between the ribs. In March 2015 Liu et al. reported a VATS bilateral pulmonary metastasectomy and right middle lobectomy via a subxiphoid uniportal technique. The advantage of the uniportal subxiphoid approach is the ability to use different size of instruments and freedom of movement as there is no limitation by the ribs. Post-operative pain typically experienced due to bruising of the intercostal nerves is also avoided in this approach. Shanghai Pulmonary hospital has taken VATS surgery to the next level with subxiphoid uniportal VATS (SVATS) lung resection, whereby this method is performed in large volumes of cases. Here we describe our experience of a uniportal subxiphoid VATS right middle lobectomy using the Shanghai technique, the first in the UK. A uniportal sub-xiphoid lobectomy was performed on a 62-year-old lifelong smoker male patient with a histological diagnosis of right middle lobe adenocarcinoma, measuring 1.5 cm and radiological staging of T1aN0M0. We have been performing microlobectomies in our institution (with the utility port placed in the subxiphoid region) which is technically similar to this approach. This is the first subxiphoid uniportal lobectomy performed in the UK. The operation was done successfully and the patient was discharged home 2 days later without any complications.
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Affiliation(s)
| | - Nur Aziah Ismail
- Department of Cardiothoracic Surgery, National heart institute (IJN), Kuala Lumpur, Malaysia
| | - Mohamed I. Mydin
- Department of Cardiothoracic Surgery, the James Cook University Hospital, Middlesbrough, UK
| | - Marco Nardini
- Department of Cardiothoracic Surgery, the James Cook University Hospital, Middlesbrough, UK
| | - Joel Dunning
- Department of Cardiothoracic Surgery, the James Cook University Hospital, Middlesbrough, UK
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Smith CB, Wolf A, Mhango G, Wisnivesky JP. Impact of Surgeon Volume on Outcomes of Older Stage I Lung Cancer Patients Treated via Video-assisted Thoracoscopic Surgery. Semin Thorac Cardiovasc Surg 2017; 29:223-230. [PMID: 28823334 DOI: 10.1053/j.semtcvs.2017.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 11/11/2022]
Abstract
Surgeon procedure volume influences outcomes of patients undergoing cancer operations. Limited data are available, however, on the volume-outcome relationship for video-assisted thoracoscopic surgery (VATS) in the treatment of non-small cell lung cancer (NSCLC). In this study, we used population-based data to evaluate the extent to which surgeon volume is associated with postoperative and long-term oncological outcomes following VATS resection for older patients with early-stage NSCLC. Stage I NSCLC patients >65 years treated with VATS wedge, segmentectomy, or lobectomy between 2000 and 2010 were identified from the Surveillance, Epidemiology, and End Results registry linked to Medicare. Surgeon volume was grouped into tertiles (low, intermediate, and high). Outcomes included perioperative complications, intensive care unit admission, extended length of stay, perioperative (30-day) mortality, and long-term overall and lung cancer-specific survival. We used propensity score methods to compare adjusted survival of patients by surgical volume group. A total of 2295 study patients were identified. Patients treated by high-volume surgeons had decreased intensive care unit admissions (hazard ratio [HR]: 0.46, 95% CI: 0.41-0.51) and postoperative length of stay (HR: 0.75, 95% CI: 0.61-0.92). Adjusted analyses showed that overall (HR: 0.73, 95% CI: 0.62-0.87) and lung cancer-specific (HR: 0.76, 95% CI: 0.58-0.99) survival was better for patients treated by high-volume surgeons. Elderly stage I NSCLC patients undergoing VATS by high-volume surgeons have reduced postoperative complications and improved survival. Organization of care favoring referrals of VATS candidates to high-volume providers may help improve the outcomes of patients with early-stage lung cancer.
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Affiliation(s)
- Cardinale B Smith
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Andrea Wolf
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Grace Mhango
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Paul S, Lee PC, Mao J, Isaacs AJ, Sedrakyan A. Long term survival with stereotactic ablative radiotherapy (SABR) versus thoracoscopic sublobar lung resection in elderly people: national population based study with propensity matched comparative analysis. BMJ 2016; 354:i3570. [PMID: 27400862 PMCID: PMC4937638 DOI: 10.1136/bmj.i3570] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare cancer specific survival after thoracoscopic sublobar lung resection and stereotactic ablative radiotherapy (SABR) for tumors ≤2 cm in size and thoracoscopic resection (sublobar resection or lobectomy) and SABR for tumors ≤5 cm in size. DESIGN National population based retrospective cohort study with propensity matched comparative analysis. SETTING Surveillance, Epidemiology, and End Results (SEER) registry linked with Medicare database in the United States. PARTICIPANTS Patients aged ≥66 with lung cancer undergoing SABR or thoracoscopic lobectomy or sublobar resection from 1 Oct 2007 to 31 June 2012 and followed up to 31 December 2013. MAIN OUTCOME MEASURES Cancer specific survival after SABR or thoracoscopic surgery for lung cancer. RESULTS 690 (275 (39.9%) SABR and 415 (60.1%) thoracoscopic sublobar lung resection) and 2967 (714 (24.1%) SABR and 2253 (75.9%) thoracoscopic resection) patients were included in primary and secondary analyses. The average age of the entire cohort was 76. Follow-up of the entire cohort ranged from 0 to 6.25 years, with an average of three years. In the primary analysis of patients with tumors sized ≤2 cm, 37 (13.5%) undergoing SABR and 44 (10.6%) undergoing thoracoscopic sublobar resection died from lung cancer, respectively. The cancer specific survival diverged after one year, but in the matched analysis (201 matched patients in each group) there was no significant difference between the groups (SABR v sublobar lung resection mortality: hazard ratio 1.32, 95% confidence interval 0.77 to 2.26; P=0.32). Estimated cancer specific survival at three years after SABR and thoracoscopic sublobar lung resection was 82.6% and 86.4%, respectively. The secondary analysis (643 matched patients in each group) showed that thoracoscopic resection was associated with improved cancer specific survival over SABR in patients with tumors sized ≤5 cm (SABR v resection mortality: hazard ratio 2.10, 1.52 to 2.89; P<0.001). Estimated cancer specific survival at three years was 80.0% and 90.3%, respectively. CONCLUSIONS This propensity matched analysis suggests that patients undergoing thoracoscopic surgical resection, particularly for larger tumors, might have improved cancer specific survival compared with patients undergoing SABR. Despite strategies used in study design and propensity matching analysis, there are inherent limitations to this observational analysis related to confounding, similar to most studies in healthcare of non-surgical technologies compared with surgery. As the adoption of SABR for the treatment of early stage operable lung cancer would be a paradigm shift in lung cancer care, it warrants further thorough evaluation before widespread adoption in practice.
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Affiliation(s)
- Subroto Paul
- Department of Cardiothoracic Surgery, RWJ Barnabas Health System, West Orange, NJ, USA
| | - Paul C Lee
- Department of Thoracic Surgery, New York Presbyterian Hospital/Queens, NY, USA
| | - Jialin Mao
- Department of Healthcare Policy and Research, Weill Cornell Medical College and New York Presbyterian Hospital/New York, 402 E 67th Street, New York, NY, 10065, USA
| | - Abby J Isaacs
- Department of Healthcare Policy and Research, Weill Cornell Medical College and New York Presbyterian Hospital/New York, 402 E 67th Street, New York, NY, 10065, USA
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College and New York Presbyterian Hospital/New York, 402 E 67th Street, New York, NY, 10065, USA
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ElSaegh MM, Ismail NA, Gordon J, Khan I, Jones R, Calvert R, Connelly L, Dunning J. Video-assisted thoracic surgery micro pneumonectomy, a new approach. J Vis Surg 2016; 2:94. [PMID: 29399481 DOI: 10.21037/jovs.2016.03.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 03/30/2016] [Indexed: 11/06/2022]
Abstract
Background Video-assisted thoracic surgery (VATS) pneumonectomy is normally limited due to the difficulty to remove the whole lung via the utility incision. We present our technique of VATS pneumonectomy, this we call micropneumonectomy. Methods A 75-year-old male current smoker with a right hilar mass, invading both upper and lower lobe bronchi to segmental level on CT scan and PET scan, pathology from CT guided biopsy showed squamous cell carcinoma. The patient had a mediastinoscopy just prior to pneumonectomy, primarily to remove station 7 lymph nodes and to mobilize the carina to facilitate the VATS pneumonectomy. Results Smooth postoperative course, and patient was fit for discharge two and half days post operatively. Conclusions Our technique showed an effective way of doing pneumonectomy via VATS technique, which expands the use of VATS technique into pneumonectomies, with three intercostals incisions smaller than 5 mm, in addition to a single sub-xiphoid incision which can take 12 mm instruments.
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Affiliation(s)
- Mohamed Moneer ElSaegh
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, UK
| | - Nur Aziah Ismail
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, UK
| | - Jacqueline Gordon
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, UK
| | - Iqbal Khan
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, UK
| | - Richard Jones
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, UK
| | - Rachel Calvert
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, UK
| | - Leanne Connelly
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, UK
| | - Joel Dunning
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, UK
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Peng J, An S, Wang HP, Chen XL, Ning XG, Liu J, Yu XY, Mao X, Xu TR. Video-assisted thoracoscopic surgery lobectomy for lung cancer versus thoracotomy: a less decrease in sVEGFR2 level after surgery. J Thorac Dis 2016; 8:323-8. [PMID: 27076926 DOI: 10.21037/jtd.2016.02.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Angiogenic and anti-angiogenic factors play an important role in tumor biology and tumor recurrence after surgical resection. Antiangiogenic factors such as vascular endothelial growth factor (VEGF)-receptor 1 (sVEGFR1) and sVEGFR2, two soluble form receptor proteins of VEGF, are critical for angiogenesis. VEGF can be sequestered by soluble forms of these receptors, which result in decreasing VEGF amount available to bind to its receptor on vascular endothelial cell surface. This study aimed to investigate the influences of video-assisted thoracoscopic surgery (VATS) lobectomy and open by thoracotomy for early stage non-small cell lung cancer (NSCLC) on postoperative circulating sVEGFR1 and sVEGFR2 levels. METHODS Forty-eight lung cancer patients underwent lobectomy through either VATS (n=26) or thoracotomy (n=22). Blood samples were collected from all patients preoperatively and postoperatively on days 1, 3 and 7. ELISA analysis was used to determine the plasma levels of sVEGFR1 and sVEGFR2. Data are reported as means and standard deviations, and were assessed with the Wilcoxon signed-Rank test (P<0.05). RESULTS For all patients undergoing lobectomy, postoperative sVEGFR1 levels on days 1 and 3 were markedly increased, while postoperative sVEGFR2 levels on days 1 and 3 were significantly decreased. Moreover, VATS group had significantly higher plasma level of sVEGFR2 postoperative in comparison with open thoracotomy (OT) on day 1 (VATS 6,953±1,535 pg/mL; OT 5,874±1,328 pg/mL, P<0.05). CONCLUSIONS Major pulmonary resection for early stage NSCLC resulted in the increased sVEGFR1 and decreased sVEGFR2 productions. VATS is associated with enhanced anti-angiogenic response with higher circulating sVEGFR2 levels compared with that with OT. Such differences in anti-angiogenic response may have an important effect on cancer biology and recurrence after surgery.
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Affiliation(s)
- Jun Peng
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Su An
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Hui-Ping Wang
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Xin-Long Chen
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Xian-Gu Ning
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Jun Liu
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Xu-Ya Yu
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Xin Mao
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
| | - Tian-Rui Xu
- 1 Department of Thoracic Surgery, The First People's Hospital of Yunnan Province, Kunming University of Science and Technology, Kunming 650032, China ; 2 Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China ; 3 Children's Hospital Affiliated to Kunming Medical University, Kunming 650228, China
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Zhang S, Pan SB, Lyu QH, Wu P, Qin GM, Wang Q, He ZL, He XM, Wu M, Chen G. Postoperative Regulatory T-Cells and Natural Killer Cells in Stage I Nonsmall Cell Lung Cancer Underwent Video-assisted Thoracoscopic Lobectomy or Thoracotomy. Chin Med J (Engl) 2016; 128:1502-9. [PMID: 26021508 PMCID: PMC4733783 DOI: 10.4103/0366-6999.157672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Regulatory T-cells (Treg) play key roles in suppressing cell-mediated immunity in cancer patients. Little is known about perioperative Treg fluctuations in nonsmall cell lung cancer (NSCLC). Video-assisted thoracoscopic (VATS) lobectomy, as a minimal invasive procedure for treating NSCLC, may have relatively less impact on the patient's immune system. This study aimed to observe perioperative dynamics of circulating Treg and natural killer (NK) cell levels in NSCLC patients who underwent major lobectomy by VATS or thoracotomy. METHODS Totally, 98 consecutive patients with stage I NSCLC were recruited and assigned into VATS or thoracotomy groups. Peripheral blood samples were taken on 1-day prior to operation, postoperative days (PODs) 1, 3, 7, 30, and 90. Circulating Treg and NK cell counts were assayed by flow cytometry, defined as CD4 + CD25 + CD127 low cells in CD4 + lymphocytes and CD56 + 16 + CD3- cells within CD45 + leukocytes respectively. With SPSS software version 21.0 (SPSS Inc., USA), differences between VATS and thoracotomy groups were determined by one-way analysis of variance (ANOVA), and differences between preoperative baseline and PODs in each group were evaluated by one-way ANOVA Dunnett t-test. RESULTS In both groups, postoperative Treg percentages were lower than preoperative status. No statistical difference was found between VATS and thoracotomy groups on PODs 1, 3, 7, and 30. On POD 90, Treg percentage in VATS group was significantly lower than in thoracotomy group (5.26 ± 2.75 vs. 6.99 ± 3.60, P = 0.012). However, a higher level of NK was found on all PODs except on POD 90 in VATS group, comparing to thoracotomy group. CONCLUSIONS Lower Treg level on POD 90 and higher NK levels on PODs 1, 3, 7, 30 in VATS group might imply better preserved cell-mediated immune function in NSCLC patients, than those in thoracotomy group.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gang Chen
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang 310009, China
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Medbery RL, Gillespie TW, Liu Y, Nickleach DC, Lipscomb J, Sancheti MS, Pickens A, Force SD, Fernandez FG. Nodal Upstaging Is More Common with Thoracotomy than with VATS During Lobectomy for Early-Stage Lung Cancer: An Analysis from the National Cancer Data Base. J Thorac Oncol 2016; 11:222-33. [PMID: 26792589 DOI: 10.1016/j.jtho.2015.10.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/22/2015] [Accepted: 10/13/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Questions remain regarding differences in nodal evaluation and upstaging between thoracotomy (open) and video-assisted thoracic surgery (VATS) approaches to lobectomy for early-stage lung cancer. Potential differences in nodal staging based on operative approach remain the final significant barrier to widespread adoption of VATS lobectomy. The current study examines differences in nodal staging between open and VATS lobectomy. METHODS The National Cancer Data Base was queried for patients with clinical stage T2N0M0 or lower lung cancer who underwent lobectomy in 2010-2011. Propensity score matching was performed to compare the rate of nodal upstaging in VATS with that in open approaches. Additional subgroup analysis was performed to assess whether rates of upstaging differed by specific clinical setting. RESULTS A total of 16,983 lobectomies were analyzed; 4935 (29.1%) were performed using VATS. Nodal upstaging was more frequent in the open group (12.8% versus 10.3%; p < 0.001). In 4437 matched pairs, nodal upstaging remained more common for open approaches. For a subgroup of patients who had seven lymph or more nodes examined, propensity matching revealed that nodal upstaging remained more common after an open approach than after VATS (14.0% versus 12.1%; p = 0.03). For patients who were treated in an academic/research facility, however, the difference in nodal upstaging between an open and VATS approach was no longer significant (12.2% versus 10.5%, p = 0.08). CONCLUSIONS For early-stage lung cancer, nodal upstaging was observed more frequently with thoracotomy than with VATS. However, nodal upstaging appears to be affected by facility type, which may be a surrogate for expertise in minimally invasive surgical procedures.
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Affiliation(s)
- Rachel L Medbery
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Theresa W Gillespie
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Dana C Nickleach
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Joseph Lipscomb
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA; Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Manu S Sancheti
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Allan Pickens
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Seth D Force
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Felix G Fernandez
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
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Yu WS, Jung HS, Lee JG, Kim DJ, Chung KY, Lee CY. Safety of thoracoscopic surgery for lung cancer without interruption of anti-platelet agents. J Thorac Dis 2015; 7:2024-32. [PMID: 26716042 DOI: 10.3978/j.issn.2072-1439.2015.11.40] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Perioperative bleeding concerns have led to the general recommendation that antiplatelet agents (APAs) be discontinued 7-10 days preoperatively, but this could increase the risk of perioperative cardiovascular events. This retrospective study aimed to evaluate the safety of APA continuation during thoracoscopic surgery for lung cancer. METHODS Between January 2009 and February 2015, 164 patients taking APAs underwent curative resection. Comparisons were conducted between two groups: preoperatively interrupted APA administration (group I, n=106) and continued APA administration (group N, n=58). RESULTS Group N had a significantly higher revised cardiac risk index (rCRI) (P=0.001). Lobectomy was performed in the majority of patients [95 (89.6%) in group I; 52 (89.7%) in group N]. There were no significant differences in intraoperative outcomes, such as the thoracotomy conversion rate, operating time, intraoperative transfusion, and amount of blood loss during the operation, or postoperative outcomes, such as postoperative bleeding and thrombotic complications, postoperative transfusions, and operative mortality. Within group N, the patients taking aspirin + clopidogrel (n=11) had significantly greater postoperative bleeding (P=0.005), and more postoperative transfusions (P=0.003) and chest tube drainage over a 3-day period (P=0.049) compared with other antiplatelet regimens. CONCLUSIONS Continued use of APAs during thoracoscopic surgery for lung cancer could be safely done in patients at high risk of cardiac or thrombotic events. However, in patients administered aspirin + clopidogrel, it may be the best to continue aspirin only because of an increased risk of postoperative bleeding and transfusion requirements.
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Affiliation(s)
- Woo Sik Yu
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Suk Jung
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Lee
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Joon Kim
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Young Chung
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Young Lee
- 1 Department of Thoracic Surgery, Armed Forces Capital Hospital, Seongnam-si, Kyunggi-do, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Tane S, Nishio W, Okuma H, Ogawa H, Hokka D, Tane K, Tanaka Y, Uchino K, Yoshimura M, Maniwa Y. Operative outcomes of thoracoscopic lobectomy for non-small-cell lung cancer. Asian Cardiovasc Thorac Ann 2015. [DOI: 10.1177/0218492315596657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim We examined the advantages of thoracoscopy over thoracotomy in terms of perioperative outcomes and toleration of adjuvant chemotherapy. Methods Between April 2010 and March 2013, 657 patients with non-small-cell lung cancer who underwent lobectomy were classified into thoracoscopy (308 patients) and thoracotomy (349 patients) groups and compared. Results The thoracoscopy group had less blood loss compared to the thoracotomy group ( p < 0.001). When limiting the analysis to pathological stage I patients, the results were similar ( p < 0.001). In addition, the difference in blood loss between the 2 groups was greater in patients with severe pleural adhesions. The postoperative morbidity of the thoracoscopy group was significantly less than that of the thoracotomy group (13.3% vs. 21.2%, p < 0.001), and this result was similar when analyzing the pathological stage I patients (12.6% vs. 20.6%, p = 0.001). A higher percentage of the thoracoscopy group received both the full planned course and dose of adjuvant chemotherapy compared to the thoracotomy group (84.2% vs. 65.8%, p = 0.032). Conclusions These results indicate that totally thoracoscopic lobectomy is the more beneficial surgical approach with regard to the incidence of postoperative complications and toleration of adjuvant chemotherapy.
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Affiliation(s)
- Shinya Tane
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Nishio
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Hiromichi Okuma
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Ogawa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Hokka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenta Tane
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuya Uchino
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan
| | | | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Berry MF. Pulmonary Artery Bleeding During Video-Assisted Thoracoscopic Surgery: Intraoperative Bleeding and Control. Thorac Surg Clin 2015. [PMID: 26210920 DOI: 10.1016/j.thorsurg.2015.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
With appropriate planning and operative technique, the risk of pulmonary artery injury and bleeding during video-assisted thoracoscopic surgery (VATS) lobectomy can be minimized. However, the risk cannot be completely eliminated; surgeons should always ensure that they are prepared to manage this situation if it occurs. Although pulmonary artery bleeding can potentially lead to intraoperative disasters, appropriate judgment, management, and control via VATS or conversion to thoracotomy can avoid any impact on either short-term or long-term patient outcomes.
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Affiliation(s)
- Mark F Berry
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Chen HW, Du M. Video-assisted thoracoscopic pneumonectomy. J Thorac Dis 2015; 7:764-6. [PMID: 25973245 PMCID: PMC4419327 DOI: 10.3978/j.issn.2072-1439.2015.04.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 03/20/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Lung cancer often requires pneumonectomy. This procedure is challenging and usually performed by thoracotomy, which is traumatic and may involve complications. Video-assisted thoracoscopic surgery (VATS) lobectomy is a recognized procedure that has been accepted by surgeons. There is no standard procedure to perform a pneumonectomy using VATS. The aim of this paper is to share our experiences and to show our technique for performing a pneumonectomy using VATS. METHODS A 65-year-old man was admitted to the First Affiliated Hospital of Chongqing Medical University. A thoracic computed tomography (CT) scan revealed a 56 mm × 45 mm × 40 mm lesion in the left upper lung lobe. Lesions involving the left lower lung lobe were also identified and the subcarinal and hilar lymph nodes were enlarged. A VATS pneumonectomy was performed. RESULTS The total surgery time was approximately 90 min, the intraoperative blood loss was 100 mL, the number of resected lymph nodes was 15; and the postoperative hospital stay was 8 days. Follow-up revealed no recurrence or metastasis for 6 months. CONCLUSIONS Video-assisted thoracoscopic pneumonectomy is a safe and effective treatment procedure.
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Affiliation(s)
- Huan-Wen Chen
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ming Du
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Feng M, Shen Y, Wang H, Tan L, Mao X, Liu Y, Wang Q. Uniportal video assisted thoracoscopic lobectomy: primary experience from an Eastern center. J Thorac Dis 2015; 6:1751-6. [PMID: 25589969 DOI: 10.3978/j.issn.2072-1439.2014.11.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/04/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy is an emerging technique for the surgical resection of non-small cell lung cancer (NSCLC). Besides its wide debates on safety and efficacy throughout the world, there were few report on uniportal VATS from the Eastern countries. In this article, we summarized our primary experience on uniportal VATS lobectomy in an Eastern center. METHODS From October 2013 till February 2014, 54 consecutive uniportal VATS lobectomy were performed in the Department of Thoracic Surgery, Zhongshan Hospital of Fudan University. Patients' clinical features and operative details were recorded. Post-operatively, the morbidity and mortality were recorded to analyze the safety and efficacy of uniportal VATS lobectomy for NSCLCs. RESULTS Among the 54 planned uniportal VATS lobectomy, there was one conversion to mini-thoracotomy due to lymph node sticking. Extra ports were required in two patients. The uniportal VATS lobectomy was achieved in 51 out of 54 patients (94.4%). The average operation duration was 122.2±37.5 min (90-160 min). The average volume of estimated blood loss during the operation was 88.8±47.1 mL (50-200 mL). The mean chest tube duration and hospital stay were 3.2±1.9 days and 4.6±2.0 days, respectively. There was no postoperative mortality in this study. Two patients suffered from prolonged air leakage (5 and 7 days), and one atrial fibrillation was observed in this cohort. CONCLUSIONS Based on our primary experience, uniportal VATS lobectomy is a safe and effective procedure for the surgical resection of NSCLCs. The surgical refinements and instrumental improvements would facilitate the technique. Further studies based on larger population are required to determine its benefits towards patients with NSCLCs.
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Affiliation(s)
- Mingxiang Feng
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Yaxing Shen
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Hao Wang
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Lijie Tan
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Xuping Mao
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Yi Liu
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
| | - Qun Wang
- 1 Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Surgery, Danyang People's Hospital of Jiangsu Province, Danyang 212300, China
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Nishio W, Tane K, Uchino K, Yoshimura M. Total thoracoscopic posterior basal segmentectomy for primary lung cancer. Multimed Man Cardiothorac Surg 2014; 2014:mmu025. [PMID: 25500769 DOI: 10.1093/mmcts/mmu025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This report introduces a hilar side approach for posterior basal segmentectomies by the process of specific vision thoracoscopic surgery, which has been used extensively for peripheral small lung cancer by the author. Although it requires a deeper understanding of hilar anatomy and fine control, it is safer and less invasive to the thoracic wall and results in less postoperative pain than the thoracotomy counterpart and as a hilar side approach allows for less deformation. The necessary order of processes involves specific vision, inflation-deflation and blunt dissection from the hilum.
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Affiliation(s)
- Wataru Nishio
- Department of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Kenta Tane
- Department of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Kazuya Uchino
- Department of Chest Surgery, Hyogo Cancer Center, Akashi, Japan
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Demir A, Ayalp K, Ozkan B, Kaba E, Toker A. Robotic and video-assisted thoracic surgery lung segmentectomy for malignant and benign lesions†. Interact Cardiovasc Thorac Surg 2014; 20:304-9. [DOI: 10.1093/icvts/ivu399] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Litle VR. Esophagectomy first: a shift in the treatment algorithm for regionally advanced cancer? Only with brains and brawn. J Thorac Cardiovasc Surg 2014; 149:412-3. [PMID: 25467370 DOI: 10.1016/j.jtcvs.2014.10.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 12/01/2022]
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Comparative outcomes of elderly stage I lung cancer patients treated with segmentectomy via video-assisted thoracoscopic surgery versus open resection. J Thorac Oncol 2014; 9:383-9. [PMID: 24495998 DOI: 10.1097/jto.0000000000000083] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Video-assisted thorcacic surgery (VATS) is considered an alternative to open lobectomy for the treatment of non-small-cell lung cancer (NSCLC). Limited data are available, however, regarding the equivalence of open versus VATS segmental resections, particularly among elderly patients. METHODS From the Surveillance, Epidemiology, and End Results-Medicare database we identified 577 stage I NSCLC patients aged more than 65 years treated with VATS or open segmentectomy. We used propensity score methods to control for differences in the baseline characteristics of patients treated with VATS versus open segmentectomy. Outcomes included perioperative complications, need for intensive care unit, extended hospital stay, perioperative mortality, and survival. RESULTS Overall, 27% of patients underwent VATS. VATS-treated patients had lower rates of postoperative complications (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.37-0.83), intensive care unit admissions (OR: 0.18, 95% CI: 0.12-0.28), and decreased length of stay (OR: 0.41, 95% CI: 0.21-0.81) after adjusting for propensity scores. Postoperative outcomes were not significantly different across groups after adjusting for surgeon characteristics. Overall (hazard ratio: 0.80, 95% CI: 0.60-1.06) and lung cancer-specific (hazard ratio: 0.71, 95% CI: 0.45-1.12) survival was similar across groups. CONCLUSIONS VATS segmentectomy can be safely performed among elderly NSCLC patients and is associated with equivalent postoperative and oncologic outcomes.
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Kim D, Kim HK, Choi YS, Kim J, Shim YM, Kim K. Is video-assisted thoracic surgery lobectomy in benign disease practical and effective? J Thorac Dis 2014; 6:1225-9. [PMID: 25276364 DOI: 10.3978/j.issn.2072-1439.2014.08.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/24/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND The aim of this study was to analyze the surgical outcomes of video-assisted thoracic surgery (VATS) lobectomy for benign pulmonary disease and to propose surgical guidelines based on the retrospective cohort study. METHODS From January 2004 to December 2009, all lobectomies performed in a university-based tertiary care hospital were analyzed. The inclusion criteria were as follows: (I) VATS lobectomy for benign disease; (II) thoracotomy conversion cases initially approached by VATS lobectomy. All malignant cases were excluded. Electronic medical records were retrospectively analyzed and patients were divided into two groups: with infection and without infection. The primary outcomes were the thoracotomy conversion rate, length of hospital stay, period of thoracic drainage and complications. RESULTS VATS was performed in 163 (42%) of 385 patients who underwent lobectomy for benign disease. There were 68 in the infection group and 95 in the group without infection. VATS lobectomy was successful in 157 (96%) patients while 6 were converted into thoracotomy. The mean operation time and blood loss were 160 minutes and 326 mL. Comparing two groups, operation time and blood loss were not statistically different (P value =0.92, 0.63). Moreover conversion rate, length of hospital stay, period of thoracic drainage and complications (P value =0.67, 0.18, 0.25, and 0.50) were not different. CONCLUSIONS VATS lobectomy for benign disease is practical and effective in selected cases regardless of the presence of infection. However, because various technical obstacles may be encountered during the procedure, therefore, careful patient selection is needed.
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Affiliation(s)
- Dohun Kim
- 1 Department of Thoracic and Cardiovascular surgery, Chungbuk National University Hospital, Cheongju, South Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, South Korea
| | - Hong Kwan Kim
- 1 Department of Thoracic and Cardiovascular surgery, Chungbuk National University Hospital, Cheongju, South Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, South Korea
| | - Yong Soo Choi
- 1 Department of Thoracic and Cardiovascular surgery, Chungbuk National University Hospital, Cheongju, South Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, South Korea
| | - Jhingook Kim
- 1 Department of Thoracic and Cardiovascular surgery, Chungbuk National University Hospital, Cheongju, South Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, South Korea
| | - Young Mog Shim
- 1 Department of Thoracic and Cardiovascular surgery, Chungbuk National University Hospital, Cheongju, South Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, South Korea
| | - Kwhanmien Kim
- 1 Department of Thoracic and Cardiovascular surgery, Chungbuk National University Hospital, Cheongju, South Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang, South Korea
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Paul S, Isaacs AJ, Treasure T, Altorki NK, Sedrakyan A. Long term survival with thoracoscopic versus open lobectomy: propensity matched comparative analysis using SEER-Medicare database. BMJ 2014; 349:g5575. [PMID: 25277994 PMCID: PMC4183188 DOI: 10.1136/bmj.g5575] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare long term survival after minimally invasive lobectomy and thoracotomy lobectomy. DESIGN Propensity matched analysis. SETTING Surveillance, Epidemiology and End Results (SEER)-Medicare database. PARTICIPANTS All patients with lung cancer from 2007 to 2009 undergoing lobectomy. MAIN OUTCOME MEASURE Influence of less invasive thoracoscopic surgery on overall survival, disease-free survival, and cancer specific survival. RESULTS From 2007 to 2009, 6008 patients undergoing lobectomy were identified (n=4715 (78%) thoracotomy). The median age of the entire cohort was 74 (interquartile range 70-78) years. The median length of follow-up for entire group was 40 months. In a matched analysis of 1195 patients in each treatment category, no statistical differences in three year overall survival, disease-free survival, or cancer specific survival were found between the groups (overall survival: 70.6% v 68.1%, P=0.55; disease-free survival: 86.2% v 85.4%, P=0.46; cancer specific survival: 92% v 89.5%, P=0.05). CONCLUSION This propensity matched analysis showed that patients undergoing thoracoscopic lobectomy had similar overall, cancer specific, and disease-free survival compared with patients undergoing thoracotomy lobectomy. Thoracoscopic techniques do not seem to compromise these measures of outcome after lobectomy.
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Affiliation(s)
- Subroto Paul
- Department of Health Policy and Research, Patient Centered Comparative Effectiveness Program, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA
| | - Abby J Isaacs
- Department of Health Policy and Research, Patient Centered Comparative Effectiveness Program, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Nasser K Altorki
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA
| | - Art Sedrakyan
- Department of Health Policy and Research, Patient Centered Comparative Effectiveness Program, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA
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Licht PB, Schytte T, Jakobsen E. Adjuvant Chemotherapy Compliance Is Not Superior After Thoracoscopic Lobectomy. Ann Thorac Surg 2014; 98:411-5; discussion 415-6. [DOI: 10.1016/j.athoracsur.2014.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/17/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
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Luo Q. [Discussion and summary on operation treatment of small lung nodules]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:531-5. [PMID: 25034581 PMCID: PMC6000471 DOI: 10.3779/j.issn.1009-3419.2014.07.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Qingquan Luo
- Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China
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Hanna JM, Berry MF, D'Amico TA. Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open. J Thorac Dis 2014; 5 Suppl 3:S182-9. [PMID: 24040521 DOI: 10.3978/j.issn.2072-1439.2013.07.08] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/15/2013] [Indexed: 11/14/2022]
Abstract
Since the introduction of anatomic lung resection by video-assisted thoracoscopic surgery (VATS) was introduced 20 years ago, VATS has experienced major advances in both equipment and technique, introducing a technical challenge in the surgical treatment of both benign and malignant lung disease. The demonstrated safety, decreased morbidity, and equivalent efficacy of this minimally invasive technique has led to the acceptance of VATS as a standard surgical modality for early-stage lung cancer and increasing application to more advanced disease. However, only a minority of lobectomies are performed using the VATS technique, likely owing to concern for intraoperative complications. Optimal operative planning, including obtaining baseline pulmonary function tests with diffusion measurements, positron emission tomography and/or computed tomography scans, bronchoscopy, and endobronchial ultrasound or mediastinoscopy, can be used to anticipate and potentially prevent the occurrence of complications. With increasing focus on operative planning, as well as comfort and experience with the VATS technique, the indications for which this technique is used has grown. As such, the absolute contraindications have narrowed to inability to tolerate single lung ventilation, inability to achieve complete resection with lobectomy, T3 or T4 tumors, and N2 or N3 disease. However, as VATS lobectomy has been applied to more advanced stage disease, the rate of conversion to open thoracotomy has increased, particularly early in the surgeon's learning curve. Causes of conversion are generally classified into four categories: intraoperative complications, technical problems, anatomical problems, and oncological conditions. Though it is difficult to anticipate which patients may require conversion, it appears that these patients do not suffer from increased morbidity or mortality as a result of conversion to open thoracotomy. Therefore, with a focus on a safe and complete resection, conversion should be regarded as a means of completing resections in a traditional manner rather than as a surgical failure.
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Affiliation(s)
- Jennifer M Hanna
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Thoracoscopic approach to lobectomy for lung cancer does not compromise oncologic efficacy. Ann Thorac Surg 2014; 98:197-202. [PMID: 24820392 DOI: 10.1016/j.athoracsur.2014.03.018] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/12/2014] [Accepted: 03/20/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND We compared survival between video-assisted thoracoscopic surgery (VATS) and thoracotomy approaches to lobectomy for non-small cell lung cancer. METHODS Overall survival of patients who had lobectomy for any stage non-small cell lung cancer without previous chemotherapy or radiation from 1996 to 2008 was evaluated using the Kaplan-Meier method and multivariate Cox analysis. Propensity scoring was used to assess the impact of selection bias. RESULTS Overall, 1,087 patients met inclusion criteria (610 VATS, 477 thoracotomy). Median follow-up was not significantly different between VATS and thoracotomy patients overall (53.4 versus 45.4 months, respectively; p=0.06) but was longer for thoracotomy for surviving patients (102.4 versus 67.9 months, p<0.0001). Thoracotomy patients had larger tumors (3.9±2.3 versus 2.8±1.5 cm, p<0.0001), and more often had higher stage cancers (50% [n=237] versus 71% [n=435] stage I, p<0.0001) compared with VATS patients. In multivariate analysis of all patients, thoracotomy approach (hazard ratio [HR] 1.22, p=0.01), increasing age (HR 1.02 per year, p<0.0001), pathologic stage (HR 1.45 per stage, p<0.0001), and male sex (HR 1.35, p=0.0001) predicted worse survival. In a cohort of 560 patients (311 VATS, 249 thoracotomy) who were assembled using propensity scoring and were similar in age, stage, tumor size, and sex, the operative approach did not impact survival (p=0.5), whereas increasing age (HR 1.02 per year, p=0.01), pathologic stage (HR 1.44 per stage, p<0.0001), and male sex (HR 1.29, p=0.01) predicted worse survival. CONCLUSIONS The thoracoscopic approach to lobectomy for non-small cell lung cancer does not result in worse long-term survival compared with thoracotomy.
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Miyazaki T, Nagayasu T, Yamasaki N, Tsuchiya T, Matsumoto K, Tagawa T, Obatake M, Nanashima A, Hidaka S, Hayashi T. Video-assisted thoracoscopic lobectomy with the patient in the semi-prone position: initial experience and benefits of lymph node dissection. Gen Thorac Cardiovasc Surg 2014; 62:614-9. [DOI: 10.1007/s11748-014-0408-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 04/12/2014] [Indexed: 12/22/2022]
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Blackmon SH. Minimally Invasive Resections for Lung Cancer. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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