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Jiang L, Zhang X, Ding SA, Tang M, Ding F, Mei J, Liu H. Simultaneous thoracoscopic surgery in patients with atrial fibrillation and early-stage lung cancer. Int J Cardiol 2024; 414:132422. [PMID: 39098610 DOI: 10.1016/j.ijcard.2024.132422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES Atrial fibrillation (AF) and early-stage lung cancer can both be treated under thoracoscopy. This study aims to evaluate the feasibility and safety of simultaneous thoracoscopic surgery for atrial fibrillation and early-stage lung cancer. METHODS This was a single-center, retrospective study of 865 patients with paroxysmal or non-paroxysmal AF who underwent surgical ablation between October 2014 and December 2021. Patients were divided into two groups according to whether they have undergone simultaneous thoracoscopic early-stage lung cancer surgery and resulting in 24 pairs of patients. RESULTS In total, 48 patients (24 matched pairs) were analyzed. The age was 63.71 ± 8.43 years. Procedure time and postoperative mechanical ventilation time were significantly lower in the group AF than group AFLC (Atrial fibrillation and lung cancer) (140.38 ± 27.53 vs. 230.79 ± 59.06 min, P<0.001; 5 vs 6.5 h, P = 0.002). There was no significant difference between the groups in terms of operative bleeding volume (90.00 ± 29.78 vs 85.83 ± 53.56 ml, P = 0.741), total postoperative drainage volume (1020.83 ± 516.5 vs 1406.25 ± 840.33 ml, P = 0.067), ICU (intensive care unit) length of stay (LOS) (43.5 vs 44 h, P = 0.33), hospitalization LOS (9.29 ± 1.92 vs 8.58 ± 1.98 days, P = 0.214) and incidence of freedom from AF or complications. CONCLUSIONS Simultaneous thoracoscopic surgical AF ablation and early-stage lung cancer is safe and feasible. It can be used as an alternative method for coexisting atrial fibrillation and lung cancer with acceptable operative risks.
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Affiliation(s)
- Lianyong Jiang
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Xuefeng Zhang
- Department of Radiology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Shi-Ao Ding
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Ming Tang
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Fangbao Ding
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Ju Mei
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Hao Liu
- Cardiothoracic Surgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China.
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Thomas PA, Seguin-Givelet A, Pages PB, Alifano M, Brouchet L, Falcoz PE, Baste JM, Glorion M, Belaroussi Y, Filaire M, Heyndrickx M, Loundou A, Fourdrain A, Dahan M, Boyer L. Real-world outcomes of lobectomy, segmentectomy and wedge resection for the treatment of stage c-IA lung carcinoma. Eur J Cardiothorac Surg 2024; 66:ezae251. [PMID: 38917411 DOI: 10.1093/ejcts/ezae251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/01/2024] [Accepted: 06/23/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVES To determine safety and survival outcomes associated with lobectomy, segmentectomy and wedge resection for early-stage lung cancer by quiring the French population-based registry EPIdemiology in THORacic surgery (EPITHOR). METHODS Retrospective analysis of 19 452 patients with stage c IA lung carcinoma who underwent lobectomy, segmentectomy or wedge resection between 2016 and 2022 with curative-intent. Main outcome measures were 90-day mortality and 5-year overall survival estimates. Proportional hazards regression and propensity score matching were used to adjust outcomes for key patient, tumour and practice environment factors. RESULTS The treatment distribution was 72.2% for lobectomy, 21.5% for segmentectomy and 6.3% for wedge. Unadjusted 90-day mortality rates were 1.6%, 1.2% and 1.1%, respectively (P = 0.10). Unadjusted 5-year overall survival estimates were 80%, 78% and 70%, with significant inter-group survival curves differences (P < 0.0001). Multivariable proportional hazards regression showed that wedge was associated with worse overall survival [adjusted hazard ratio (AHR), 1.23 (95% confidence interval 1.03-1.47); P = 0.021] compared with lobectomy, while no significant difference was disclosed when comparing segmentectomy to lobectomy (1.08 [0.97-1.20]; P = 0.162). The three-way propensity score analyses confirmed similar 90-day mortality rate for wedge resection and segmentectomy compared with lobectomy (hazard ratio: 0.43; 95% confidence interval 0.16-1.11; P = 0.081 and 0.99; 0.48-2.10; P = 0.998, respectively), but poorer overall survival (1.45; 1.13-1.86; P = 0.003 and 1.31; 1-1.71; P = 0.048, respectively). CONCLUSIONS Wedge resection was associated with comparable 90-day mortality but lower overall survival when compared to lobectomy. Overall, all types of sublobar resections may not offer equivalent oncologic effectiveness in real-world settings.
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Affiliation(s)
- Pascal Alexandre Thomas
- Department of Thoracic Surgery, Diseases of the Esophagus & Lung Transplantation, Hôpital Nord & CRCM, Inserm UMR 1068, CNRS, UMR 7258, Assistance Publique-Hôpitaux de Marseille & Aix-Marseille University, Marseille, France
| | - Agathe Seguin-Givelet
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Thorax Institute-Curie-Montsouris, Paris, France
| | - Pierre-Benoît Pages
- Department of Thoracic and Cardiovascular Surgery, Hôpital François Mitterrand, CHU Dijon Bourgogne, Dijon, France
| | - Marco Alifano
- Thoracic Surgery Department, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris & University of Paris Cité, Paris, France
| | - Laurent Brouchet
- Department of Thoracic Surgery, Hôpital Larrey, Toulouse University Hospitals, Toulouse, France
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg University Hospitals, Strasbourg, France
| | - Jean-Marc Baste
- Department of Thoracic and Cardiovascular Surgery, Hôpital Charles-Nicolle & U1096, Rouen University Hospitals, Rouen, France
| | - Matthieu Glorion
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch & Paris-Saclay University, Suresnes, France
| | - Yaniss Belaroussi
- Department of Thoracic Surgery, Hôpital Haut Lévêque, Bordeaux University Hospitals, Bordeaux, France
| | - Marc Filaire
- Department of Thoracic and Endocrine Surgery, Centre Jean Perrin Unicancer Clermont Auvergne Métropole, Clermont-Ferrand, France
| | - Maxime Heyndrickx
- Department of Thoracic Surgery, Hôpital Universitaire de la Côte de Nacre, University Hospitals of Caen Normandie, Caen, France
| | - Anderson Loundou
- Public Health Department Research, Unit EA3279, Aix-Marseille University, Marseille, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Diseases of the Esophagus & Lung Transplantation, Hôpital Nord & CRCM, Inserm UMR 1068, CNRS, UMR 7258, Assistance Publique-Hôpitaux de Marseille & Aix-Marseille University, Marseille, France
| | - Marcel Dahan
- Department of Thoracic Surgery, Hôpital Larrey, Toulouse University Hospitals, Toulouse, France
| | - Laurent Boyer
- Public Health Department Research, Unit EA3279, Aix-Marseille University, Marseille, France
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Zhao D, Ma A, Li S, Fan J, Li T, Wang G. Development and validation of a nomogram for predicting pulmonary complications after video-assisted thoracoscopic surgery in elderly patients with lung cancer. Front Oncol 2023; 13:1265204. [PMID: 37901337 PMCID: PMC10613030 DOI: 10.3389/fonc.2023.1265204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
Background Postoperative pulmonary complications (PPCs) significantly increase the morbidity and mortality in elderly patients with lung cancer. Considering the adverse effects of PPCs, we aimed to derive and validate a nomogram to predict pulmonary complications after video-assisted thoracoscopic surgery in elderly patients with lung cancer and to assist surgeons in optimizing patient-centered treatment plans. Methods The study enrolled 854 eligible elderly patients with lung cancer who underwent sub-lobectomy or lobectomy. A clinical prediction model for the probability of PPCs was developed using univariate and multivariate analyses. Furthermore, data from one center were used to derive the model, and data from another were used for external validation. The model's discriminatory capability, predictive accuracy, and clinical usefulness were assessed using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis, respectively. Results Among the eligible elderly patients with lung cancer, 214 (25.06%) developed pulmonary complications after video-assisted thoracoscopic surgery. Age, chronic obstructive pulmonary disease, surgical procedure, operative time, forced expiratory volume in one second, and the carbon monoxide diffusing capacity of the lung were independent predictors of PPCs and were included in the final model. The areas under the ROC curves (AUC) of the training and validation sets were 0.844 and 0.796, respectively. Ten-fold cross-validation was used to evaluate the generalizability of the predictive model, with an average AUC value of 0.839. The calibration curve showed good consistency between the observed and predicted probabilities. The proposed nomogram showed good net benefit with a relatively wide range of threshold probabilities. Conclusion A nomogram for elderly patients with lung cancer can be derived using preoperative and intraoperative variables. Our model can also be accessed using the online web server https://pulmonary-disease-predictor.shinyapps.io/dynnomapp/. Combining both may help surgeons as a clinically easy-to-use tool for minimizing the prevalence of pulmonary complications after lung resection in elderly patients.
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Affiliation(s)
- Di Zhao
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Anqun Ma
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shuang Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Jiaming Fan
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tianpei Li
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Gongchao Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Kawaguchi T, Yoshikawa D, Nakai T, Ohbayashi C, Sawabata N. Outcome of Resected Lung Cancers with Subcentimeter Solid Component on Computed Tomography. Thorac Cardiovasc Surg 2022; 71:214-221. [PMID: 36323327 DOI: 10.1055/s-0042-1758072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background Although the opportunity to treat subcentimeter lung cancers has increased, the optimal surgical methods remain unclear. We performed a retrospective study to examine the clinical outcome of subcentimeter lung cancers.
Patients and Methods In total, 118 patients who underwent curative resection for subcentimeter lung cancer from January 2005 to December 2013 were analyzed. Multivariate Cox proportional hazards models were used to calculate the hazard ratio to identify independent predictors of recurrence-free survival (RFS) and overall survival (OS).
Results Anatomical resections were performed for 64 patients (59 lobectomies and 5 segmentectomies) and wedge resections for 54 patients. Recurrence developed in six patients who had consolidation-predominant tumors (consolidation/tumor [C/T] ratio of >0.5) and underwent wedge resections. The first recurrence patterns were regional recurrences in three patients, both regional and distant in one, and distant in two. Seventeen patients died of other causes. The multivariate analysis revealed that the C/T ratio was the independent predictor of RFS (p = 0.008) and OS (p = 0.011).
Conclusion Patients with subcentimeter lung cancer rarely developed recurrence. The C/T ratio was the independent prognostic factor, and all relapsed patients received wedge resections. Even for subcentimeter lung cancers, we should select the extent of pulmonary resection after thoroughly considering whether wedge resection (less invasiveness) is a reasonable alternative to anatomical resection (superior oncologic efficacy) considering the C/T ratio of the lesion.
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Affiliation(s)
- Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
| | - Daiki Yoshikawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
| | - Tokiko Nakai
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
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Chao C, Di D, Wang M, Liu Y, Wang B, Qian Y. Identifying octogenarians with non-small cell lung cancer who could benefit from surgery: A population-based predictive model. Front Surg 2022; 9:972014. [PMID: 35965875 PMCID: PMC9366359 DOI: 10.3389/fsurg.2022.972014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background As the population ages, there will be an increasing number of octogenarian patients with non-small cell lung cancer (NSCLC). In carefully selected elderly patients, surgery can improve long-term survival. To identify candidates who would benefit from surgery, we performed this study and built a predictive model. Materials and methods Data from NSCLC patients over 80 years old were obtained from the Surveillance, Epidemiology and End Results database. A 1:1 propensity score matching was performed to balance the clinicopathological features between the surgery and non-surgery groups. Kaplan-Meier analyses and log-rank tests were used to assess the significance of surgery to outcome, and Cox proportional-hazards regression and competing risk model were conducted to determine the independent prognostic factors for these patients. A nomogram was built using multivariable logistic analyses to predict candidates for surgery based on preoperative factors. Results The final study population of 31,462 patients were divided into surgery and non-surgery groups. The median cancer-specific survival time respectively was 53 vs. 13 months. The patients’ age, sex, race, Tumor, Node, Metastasis score, stage, chemotherapy use, tumor histology and nuclear grade were independent prognostic factors. Apart from race and chemotherapy, other variates were included in the predictive model to distinguish the optimal surgical octogenarian candidates with NSCLC. Internal and external validation confirmed the efficacy of this model. Conclusion Surgery improved the survival time of octogenarian NSCLC patients. A novel nomogram was built to help clinicians make the decision to perform surgery on elderly patients with NSCLC.
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Affiliation(s)
| | | | | | | | - Bin Wang
- Correspondence: Bin Wang ; Yongxiang Qian
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Zhang W, Liu Y, Wu J, Wang W, Zhou J, Guo J, Wang Q, Zhang X, Xie J, Xing Y, Hu D. Surgical Treatment is Still Recommended for Patients Over 75 Years with IA NSCLC: A Predictive Model Based on Surveillance, Epidemiology and End Results Database. Cancer Control 2022; 29:10732748221142750. [DOI: 10.1177/10732748221142750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background To determine the populations who suitable for surgical treatment in elderly patients (age ≥ 75 y) with IA stage. Methods The clinical data of NSCLC patients diagnosed from 2010 to 2015 were collected from the SEER database and divided into surgery group (SG) and no-surgery groups (NSG). The confounders were balanced and differences in survival were compared between groups using PSM (Propensity score matching, PSM). Cox regression analysis was used to screen the independent factors that affect the Cancer-specific survival (CSS). The surgery group was defined as the patients who surgery-benefit and surgery-no benefit according to the median CSS of the no-surgery group, and then randomly divided into training and validation groups. A surgical benefit prediction model was constructed in the training and validation group. Finally, the model is evaluated using a variety of methods. Results A total of 7297 patients were included. Before PSM (SG: n = 3630; NSG: n = 3665) and after PSM (SG: n = 1725, NSG: n = 1725) confirmed that the CSS of the surgery group was longer than the no-surgery group (before PSM: 82 vs. 31 months, P < .0001; after PSM: 55 vs. 39 months, P < .0001). Independent prognostic factors included age, gender, race, marrital, tumor grade, histology, and surgery. In the surgery cohort after PSM, 1005 patients (58.27%) who survived for more than 39 months were defined as surgery beneficiaries, and the 720 patients (41.73%) were defined surgery-no beneficiaries. The surgery group was divided into training group 1207 (70%) and validation group 518 (30%). Independent prognostic factors were used to construct a prediction model. In training group (AUC = .678) and validation group (AUC = .622). Calibration curve and decision curve prove that the model has better performance. Conclusions This predictive model can well identify elderly patients with stage IA NSCLC who would benefit from surgery, thus providing a basis for clinical treatment decisions.
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Affiliation(s)
- Wenting Zhang
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Yafeng Liu
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Jing Wu
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
- Anhui Province Engineering Laboratory of Occupational Health and Safety, Anhui University of Science and Technology, Huainan, P.R. China
| | - Wenyang Wang
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Jiawei Zhou
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Jianqiang Guo
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Qingsen Wang
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Xin Zhang
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
| | - Jun Xie
- Cancer Hospital of Anhui University of Science and Technology, Huainan, P.R. China
| | - Yingru Xing
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
- Cancer Hospital of Anhui University of Science and Technology, Huainan, P.R. China
- Department of Clinical Laboratory, Anhui Zhongke Gengjiu Hospital, Hefei, P.R. China
| | - Dong Hu
- School of Medicine, Anhui University of Science and Technology, Huainan, P.R. China
- Anhui Province Engineering Laboratory of Occupational Health and Safety, Anhui University of Science and Technology, Huainan, P.R. China
- Department of Clinical Laboratory, Anhui Zhongke Gengjiu Hospital, Hefei, P.R. China
- Key Laboratory of Industrial Dust Prevention and Control & Occupational Safety and Health of the Ministry of Education, Anhui University of Science and Technology, Huainan, P.R. China
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